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Posted on: 09/22/2006

[This is not a new program, but I just found out about it from Marilyn C.  It was very useful for her and she wants me to spread word of it! - Thanks Marilyn!   Note it is for New York State residents only - check to see if your state has one!]

Traumatic Brain Injury Waiver

• For individuals with Traumatic Brain Injury (HCBS/TBI)
• One component of a comprehensive strategy developed by the NYS Department of Health to prevent unnecessary entrances into nursing homes and to help individuals leave nursing homes to live in the community
• Provides 11 Medicaid-funded services needed to assist participants to live in community-based settings and achieve maximum independence; services are used in combination with existing Medicaid services
• Participants may be eligible for rent subsidies and housing supports and limited one-time payment for furniture and household supplies.
• Each recipient must be given the choice of living in the community or in a nursing facility, and – if choosing the community – a living arrangement that can meet his or her needs.

Who is eligible?

An individual who is:

• diagnosed with TBI or a related condition,
• eligible for nursing facility level of care,
• enrolled in the Medicaid program, and
• between 18 and 64 years of age, and injured after the age of 18.

A Regional Resource Development Specialist (RRDS) educates the individual about the waiver program, helps the applicant select a service coordinator, and approves all service plans. A service coordinator compiles all documentation needed to establish eligibility, and in conjunction with the individual develops a Service Plan which describes his/her interests, strengths, and goals.

Providers of TBI Waiver services must demonstrate to the RRDS that they meet program qualifications, which include assessments of character, competence, and ability to deliver services according to the Waiver's standards. Each waiver participant has an individualized service plan which the RRDS reviews every six months to ensure the health and welfare of the participant and to ensure that all necessary services are provided. The NYS Department of Health oversees the program.

For details: http://www.nyhealth.gov/health_care/medicaid/program/longterm/tbi.htm

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