A traumatic brain injury (TBI) is a severe condition resulting from a blow, bump, or jolt to the head that interrupts the brain's normal function. According to the Centers for Disease Control and Prevention (CDC), an estimated 2.8 million people sustain a TBI yearly in the United States, and about 288,000 are hospitalized. A TBI can cause physical, cognitive, emotional, and behavioral impairments that can affect a person's ability to live independently and participate in everyday activities.
Many adults with TBI in Missouri prefer to receive care in their homes or communities instead of nursing homes or other institutional settings. However, the cost of home and community-based services (HCBS) can be prohibitive for many low-income individuals. Fortunately, there is a Medicaid program that can help: the Missouri Brain Injury Waiver (BIW).
The BIW is a Medicaid program that waives some of the rules of regular Medicaid to provide HCBS to eligible individuals with a TBI diagnosis and who would otherwise require intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care. The BIW aims to prevent or delay institutionalization, promote independence, and improve the quality of life of its participants.
This article covers the BIW, who can qualify for it, what services it covers, and whether it pays family caregivers.
The BIW is one of several Medicaid waivers in Missouri that offer HCBS as an alternative to institutional care. The BIW serves individuals who:
To be eligible for the BIW, individuals must also meet the financial criteria for MO HealthNet (Missouri Medicaid). As of 2023, the monthly income limit for a single applicant is $903, and the asset limit is $5,000. For married applicants, the income limit is $1,215, and the asset limit is $10,000. Some income and assets may be excluded or disregarded when determining eligibility.
The BIW provides a range of services and supports tailored to each participant's individual needs and preferences. These services are intended to help participants with their personal care, health care, cognitive rehabilitation, behavioral support, and social needs. The BIW also provides case management to coordinate and monitor the delivery of services.
One of the benefits of the BIW is that it allows participants more choice and control over their care. Participants can choose their providers from a list of approved agencies or opt for a self-directed option that lets them hire their own workers, including family members.
To qualify for the BIW, individuals must meet the following requirements:
A TBI diagnosis must be confirmed by a licensed physician or neuropsychologist based on medical records or an evaluation. The TBI must have occurred after age 21 and resulted in significant functional impairments.
The level of care criteria for ICF/IID placement is based on assessing the applicant's functional abilities, medical needs, cognitive status, and behavioral issues. The assessment is conducted by a nurse from the Department of Health and Senior Services (DHSS) or a contracted agency. The applicant must score at least 21 points on a scale of 0 to 60 to be eligible for the BIW.
The BIW offers various services and supports designed to help participants remain safely and comfortably in their homes or communities. These services include:
The BIW also provides case management services to help participants plan, arrange, and monitor their care. The DHSS or a contracted agency assigns case managers. They conduct assessments, develop service plans, authorize services, coordinate providers, and conduct periodic reviews.
One of the most frequently asked questions about the BIW is whether it pays family caregivers. The answer is yes, but only under certain conditions.
The BIW has two options for service delivery: agency-directed and self-directed. Under the agency-directed option, participants choose their providers from a list of approved agencies that employ qualified workers. Under the self-directed option, participants hire their workers, who can be friends, neighbors, or relatives (except spouses or legal guardians).
The self-directed option gives participants more flexibility and control over their care but also involves more responsibilities. Participants must act as employers and handle recruiting, hiring, training, supervising, paying, and firing their workers. They must also comply with state and federal taxes, insurance, and labor laws.
To participate in the self-directed option, individuals must meet the following requirements:
If participants choose the self-directed option and hire family members as their workers, they can potentially receive compensation for their caregiving. However, the amount of payment depends on several factors, such as:
As of 2023, the hourly rate of pay for self-directed workers in Missouri is $12.50 for regular hours and $18.75 for overtime hours. However, this rate may change depending on the state's minimum wage and budget adjustments.
If you are interested in applying for the BIW or finding out if you are eligible for other programs that pay family caregivers, we invite you to fill out this form and get in touch with us. We are Givers, a free service that helps caregiving families find and access programs to compensate them for their work. We are here to support you and make your caregiving journey easier.
