If you are caring for a loved one with a traumatic brain injury, you may be wondering if there is any financial assistance available to help you with the costs and challenges of caregiving. Ahead, we explore one of the Medicaid waivers that may offer some relief: the Traumatic Brain Injury (TBI) Waiver in Massachusetts. This waiver supports adults with a traumatic brain injury who need facility-based care or are living in the community. It also allows participants to design and direct their services, including hiring and managing support workers, such as family members.
The TBI waiver is a Medicaid program to help adults with traumatic brain injury remain in their homes and communities rather than being institutionalized in nursing facilities or other long-term care settings. A traumatic brain injury is defined as a brain injury that occurred after birth and that was caused by an external force, such as a fall, a car accident, a gunshot wound, or a blast injury. The waiver covers people between 18 and 64 years old, who have been determined to be clinically eligible for nursing facility level of care, and who meet the financial eligibility criteria for MassHealth Standard. MassHealth is the name of the Medicaid program in Massachusetts.
The TBI waiver offers a variety of services and supports that are tailored to the individual needs and preferences of each participant. The services are delivered through a person-centered planning process involving the participant, their family, and a case manager. The participant can choose between two service delivery models: agency with choice or participant-directed program.
To qualify for the TBI waiver, a person must meet the following criteria:
The TBI waiver provides various services and supports designed to help participants live independently and safely in their homes and communities. Some of the services and supports include:
One of the benefits of the TBI waiver is that it allows participants to design and direct their services in partnership with a qualified provider agency or to hire and manage their support workers. This means that participants can choose who provides their services, including family members, friends, or neighbors. The waiver pays for the wages and benefits of these support workers through either the agency with choice model or the participant-directed program model.
In the agency with choice model, the participant selects a provider agency that acts as the employer of record for their support workers. The agency handles the payroll, taxes, insurance, training, and supervision of the workers. The participant can hire, fire, schedule, and direct their workers in collaboration with the agency.
In the participant-directed program model, the participant acts as the employer of their support workers. The participant is responsible for recruiting, hiring, training, scheduling, supervising, and firing their workers. The participant must also comply with the labor laws and regulations that apply to employers. The waiver provides a fiscal intermediary service that helps the participant with the payroll, taxes, insurance, and reporting of their workers.
Both models allow participants to pay their support workers at a competitive rate determined by the waiver. The rate varies depending on the type and level of service provided. For example, as of 2021, the hourly rate for a personal care attendant was $15.75. The waiver also covers the costs of worker’s compensation, unemployment insurance, and health insurance for support workers.
If you think you or your loved one may be eligible for this waiver, or if you want to learn more about other Medicaid waivers that may compensate family caregivers, please fill out this form, and we will get back to you as soon as possible. We are here to help you navigate the complex world of caregiving and find the best solutions for your situation.
