Brain Injury

This Brain Injury (BI) Waiver is for people with traumatic or acquired brain injuries who need the level of care provided in a nursing facility that provides specialized services for persons with a BI or a neurobehavioral hospital.

To be eligible for the BI Waiver, a person must choose the BI Waiver and meet all of the following criteria:

• Be eligible for Medical Assistance (MA)
• Be certified disabled by Social Security or through the State Medical Review Team (SMRT) process
• Be under the age of 65 at the time of opening to the waiver
• Be diagnosed with one of the following documented primary or secondary diagnoses of brain injury or a related neurological condition that resulted in significant cognitive and significant behavioral impairment:
  • Acquired brain injury including traumatic brain injury that is not congenital
  • Degenerative or genetic disease where cognitive impairment is present, becomes symptomatic on or after the person’s 18th birthday, and is not congenital
  • Documented brain impairment from an event, disease, or condition that is not congenital
• Be able to function at a level that allows participation in rehabilitation
• Be in need of a service that is only available through the TBI Waiver or requires a higher level of service than is available through the other waivers due to cognitive and behavior impairments
• Meet one of the following:
  • Nursing Facility Level of Care criteria for  Brain Injury-Nursing Facility (BI-NF) or
  • Neurobehavioral Hospital Level of Care criteria for Brain Injury-Neurobehavioral (BI-NB)
• Have completed a BI Waiver Assessment and Eligibility Determination (DHS-3471)