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Traumatic Brain Injury Waiver

What is a Traumatic Brain Injury (TBI)?

A Traumatic brain injury (TBI) is a disruption in the normal function of the brain  caused when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue.

A TBI may produce a diminished or altered state of consciousness, and results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment.

Our staff are specially trained to care for individuals suffering from a TBI and can offer the support and assistance they need to live independent, successful lives in the community. 

What is the Traumatic Brain Injury Waiver?

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

Philosophy of the TBI Waiver:

The dignity of risk and right to fail are integral parts of the waiver’s philosophy. 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.


To be eligible for the TBI Waiver an individual must:

  • Have a TBI diagnosis

  • Be eligible for nursing home level of care

  • Be an active Medicaid recipient or be eligible for Medicaid

  • Be 18-64 years old

Access To Home Care Services provides the following TBI Waiver Services:

Service Coordination

When you become a TBI Waiver participant, you are the primary decision-maker in the development of your goals. Together with your Service Coordinator (SC) and other individuals you choose, you select your service providers and other supports. The key to individual choice and satisfaction is person-centered Service Coordination.


The Service Coordinator:

  • Assists eligible persons to become TBI Waiver participants

  • Coordinates and oversees the provision of all services in the Service Plan, including TBI Waiver services and Medicaid State Plan services, as well as other local, state and federally funded educational, vocational, social and medical services

  • Is responsive to the individual and helps the TBI Waiver participant identify his or her unique needs and goals

  • Promotes activities which will increase the individual’s independence and life satisfaction, while maintaining the health and welfare of the individual

  • Assists in the integration of the individual in the community of his or her choice

  • Helps in increasing the individual’s productivity and participation in meaningful activities in the home and community

  • Assists in arranging for daily living supports and services to meet the individual’s needs, such as the scheduling of Personal Care Aides (PCA’s) in the home, scheduling medical appointments, and recertifying the participant for Medicaid and food stamps


Home and Community Support Services (HCSS)

Home and Community Support Services (HCSS) are provided when the TBI Wavier participant needs oversight and supervision as a discreet service to maintain his or her health and welfare to live in the community.  Oversight and supervision may be necessary to protect the TBI Waiver participant from adverse outcomes related to his or her activities, for example, wandering or leaving the stove unattended.  Oversight and supervision includes cueing, prompting, directing and instructing. 


In addition to oversight and supervision, some TBI Waiver participants may also be assessed to need assistance with Activities of Daily Living (ADL) and/or Instrumental Activities of Daily Living (IADL). ADL’s include dressing, bathing, hygiene/grooming, toileting, ambulation/mobility, transferring and eating.  IADL’s include housekeeping, shopping, meal preparation and laundry.

Independent Living Skills Training (ILST)

Independent Living Skills Training helps to improve and maintain the participant’s community living skills so that the individual can live as independently as possible. ILST services assist in recovering skills that have decreased as a result of the onset of the TBI.


The ILST provider will conduct a comprehensive functional assessment of the TBI Waiver participant, identifying the participant’s strengths and weaknesses in performing Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) related to his or her established goals. Based on that assessment, the ILST provider will develop an ILST Detailed Plan, identifying goals to be met by the participant and setting forth the best manner in which to attain the identified goals.


ILST is done primarily in one-on-one training and focuses on the development of practical needs such as self-care, medication management, task completion, communication skills, interpersonal skills, socialization, sensory/motor skills, problem solving skills, shopping, cooking, money management, organization and use of public transportation, and other skills required to maintain a household. ILST is provided in the participant’s residence and in the community.

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