Traumatic Brain Injury (TBI) Waiver Programs
The Home and Community-Based Services Medicaid Waiver for Individuals with Traumatic Brain Injury (HCBS/TBI) is one component of a comprehensive strategy developed by the New York State Department of Health to assure that New Yorkers with a traumatic brain injury could receive services within New York in the least restrictive setting.
Philosophy
The HCBS/TBI waiver was developed based on the philosophy that:
- An individual with a TBI has the same right to be in control of his or her life as anyone else in our society.
- An individual with a TBI must be able to choose where he or she wants to live, with whom he or she will live and who will provide any needed services.
- An individual with a TBI has the right to learn as a member of society, by encountering and managing risks and, through experience, learn from related failures.
Why did New York State Develop the HCBS/TBI Medicaid Waiver?
- In the 1970's and 80's New York was sending individuals with TBI to out-of-state nursing homes. By the late 1980's, 500 people were in those facilities at a cost to Medicaid of $56 million.
- The HCBS/TBI waiver provides a cost-effective community-based alternative to nursing facility care.
- Individuals with TBI and their families advocated for community-based services and supports.
- Institutional care prevents an individual with a TBI from becoming reintegrated into his/her home community.
Expected Outcomes from the HCBS/TBI Waiver
- Individuals with TBI will be able to choose where and with whom they live.
- Individuals with TBI will be able to live self-satisfying lives.
- With a decrease in reliance on expensive nursing facility care, the State Medicaid program will realize significant savings.
To be Eligible for the HCBS/TBI Waiver an Individual Must:
- Have a diagnosis of TBI or a related diagnosis
- Be eligible for nursing facility level of care as determined by a Patient Review Instrument (PRI) and SCREEN
- Be a Medicaid recipient
- Be 18-64 years old
- Choose to live in the community rather than a nursing facility
- Have or find a living arrangement which meets the individual's needs
- Be able to be served with the funds and services available under the HCBS/TBI waiver and New York State Medicaid State Plan
Regional Resource Development Centers (RRDC)
The HCBS/TBI waiver is administered through a network of RRDCs, each covering specific counties throughout the State. The contact person at the RRDC is the Regional Resource Development Specialist (RRDS).
The RRDS is responsible for:
- Interviewing potential waiver participants
- Assisting participants to access approved providers
- Approving Service Plans
- Reviewing Incident Reports
- Maintaining regional budgets for waiver services
Source of Supports and Services for Waiver Participants
Informal Supports:
- Family
- Friends
- Community
Other State and Federally Funded Services
- VESID
- HEAP
- Housing subsidies/subsidized housing
- Education benefits
- Mental health
- Substance abuse services
- Other