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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