NYS TBI Wavier Program

NYS TBI Wavier Program

The New York State Department of Health (DOH) Traumatic Brain Injury (TBI) waiver program provides rehabilitative services to persons with a TBI. The purpose of the program is to help persons with a TBI live in the community setting of their choice. Medicaid funds the program. The waiver is a program of choice. The philosophy of the waiver supports the participant’s right to choose where to live, who to live and socialize with, and what goals and activities to pursue. Waiver services are provided based on the participant’s unique strengths, needs, choices and goals. The individual is the primary decision-maker and works in cooperation with providers to develop a plan for services. This process leads to personal empowerment, increased independence, greater community inclusion, self-reliance and meaningful and productive activities.

The HCBS/TBI Medicaid waiver program was developed based on the philosophy that individuals with traumatic brain injury may be successfully served and included in their surrounding communities. The individual is the primary decision maker and works in cooperation with care providers to develop a plan of services that promotes personal independence, greater community inclusion, self-reliance and participation in meaningful activities and services.

The HCBS/TBI waiver is administered centrally by the New York State Department of Health (DOH) and implemented through Regional Resource Development Centers (RRDC) and Specialists (RRDS) who serve to assure access to services in communities throughout the State.

The waiver uses Medicaid funding to provide supports and services to assist individuals with a traumatic brain injury (TBI) toward successful inclusion in the community. Waiver participants may choose to move into the community from a nursing facility. Others may choose to participate in the waiver to prevent unnecessary institutionalization.

HCBS/TBI waiver services are available to supplement informal supports; the broad array of local, State and federally funded services, as well as Medicaid State Plan services to assure the health and welfare of the individual in the community.

Eligibility Criteria

An individual applying to participate in the waiver must meet all of the following criteria:

Be a recipient of Medicaid coverage that supports community based long-term care services.
Have a diagnosis of traumatic brain injury (TBI). NOTE: Individuals who experience deficits similar to a traumatic brain injury as a result of anoxia, toxic poisoning, stroke or other neurological conditions may also be eligible. Individuals with gestational or birth related difficulties such as cerebral palsy or autism or who have a progressive degenerative disease, are not eligible for the waiver.
Be between the ages of 18 and 64 upon application to the waiver.
Be assessed to need a nursing home level of care as a direct result of the traumatic brain injury.
Choose to participate in the waiver rather than reside in a nursing facility by signing the Freedom of Choice form, Application for Participation form and Service Coordination Selection form.
Identify the residence in which the waiver participant will be living when receiving waiver services.
Complete an Initial Service Plan and Application Packet (Appendix C-1) in cooperation with a Service Coordinator and be approved by the RRDS. This Plan must describe why the individual is at risk for nursing home placement without the services of the waiver and indicate how the available supports and requested waiver services identified in the Plan will support the health and welfare of the potential participant.
Have a completed Plan for Protective Oversight (PPO).NYSDOH, Office of Health Insurance Programs (OHIP), Division of Long Term Care (DLTC) is responsible for the implementation and oversight of the TBI waiver. NYSDOH is designated as the single State agency responsible for the administration of the Medicaid program. This waiver is an important element of NYS' effort to restructure its long term care system.