Traumatic brain injury (TBI) seriously affects a person's cognitive, behavioral, emotional, and physical functioning. According to the Centers for Disease Control and Prevention (CDC), an estimated 2.8 million people sustain a TBI yearly in the United States. TBI can result from various causes, such as falls, motor vehicle crashes, assaults, or sports injuries.
Living independently at home or in the community can be challenging for many individuals with TBI. They may require assistance with daily activities, such as bathing, dressing, eating, or managing medications. They may also need specialized services like rehabilitation, behavior management, or supported employment. Without adequate support, some individuals with TBI may end up in institutional settings, such as nursing or intermediate care facilities for individuals with intellectual disabilities/developmental disabilities (ICF/IID).
Fortunately, there is a program that can help individuals with TBI remain in their home or community of choice: the Traumatic Brain Injury Waiver in Indiana. This program provides home- and community-based services (HCBS) to individuals who would otherwise require institutional care without such assistance. This article explores the Traumatic Brain Injury Waiver in Indiana, who is eligible for it, what services and supports it offers, and how it can compensate family caregivers who provide care to their loved ones with TBI.
The Traumatic Brain Injury Waiver in Indiana is a Medicaid waiver program approved by the Health Care Financing Administration (HCFA) in 2000. A Medicaid waiver is a special provision allowing states to waive certain federal rules and regulations to provide HCBS to specific populations eligible for Medicaid. HCBS are services delivered in the individual's home or community rather than in an institutional setting.
The purpose of the Traumatic Brain Injury Waiver in Indiana is to increase the availability and access to cost-effective TBI services for people who have suffered a traumatic brain injury. The program aims to enhance individuals' quality of life and independence with TBI by providing individualized and person-centered services that meet their needs and preferences.
To be eligible for the Traumatic Brain Injury Waiver in Indiana, individuals must meet both HCBS waiver eligibility and Medicaid eligibility guidelines. The HCBS waiver eligibility criteria are:
The Medicaid eligibility criteria are:
To apply for the Traumatic Brain Injury Waiver in Indiana, individuals must contact their local Area Agency on Aging (AAA) or Aging and Disability Resource Center (ADRC). The AAA or ADRC will assess the individual's level of care and service needs. If the individual meets the eligibility criteria and there is an available slot on the waiver, the AAA or ADRC will refer the individual to a case management agency. The case management agency will assign a case manager who will assist the individual with developing a person-centered service plan and accessing the waiver services.
The Traumatic Brain Injury Waiver in Indiana offers services and supports designed to help individuals with TBI live as independently as possible in their home or community. The services and supports available under the waiver include:
The Traumatic Brain Injury Waiver in Indiana has an annual cost limit of $50,000 per individual. This means that the total cost of all waiver services provided to an individual in a year can be, at most, $50,000. The cost limit does not include case management services or Medicaid state plan services.
One of the benefits of the Traumatic Brain Injury Waiver in Indiana is that it allows individuals to choose their providers for some of the waiver services. Care recipients can hire their family members or friends as paid caregivers for services such as attendant care, homemaker, respite, or supported employment. This option is called self-direction or participant direction.
Self-direction gives individuals more control and flexibility over their services and supports. It also enables family caregivers to receive compensation for caring for their loved ones with TBI. Family caregivers are often underpaid or unpaid for their work. According to AARP, about 41 million family caregivers in the U.S. provided an estimated 34 billion hours of care in 2017. The economic value of this unpaid care was about $470 billion.
To participate in self-direction, individuals must meet specific requirements and follow procedures. They must:
Self-direction can be rewarding for individuals who want more choice and control over their services and support. It can also benefit family caregivers who want to be recognized and compensated for their work.
