Catching up – Day 24 – Medicaid at 50: Traumatic Brain Injury

Medicaid 1915(c) waivers are designed to enable people who would otherwise be institutionalized to receive home- and community-based services (HCBS) that would not typically be covered under the basic Medicaid package. One population for whom many states have developed waivers is people with traumatic brain injury. This is not a common condition, but it is very serious and care-intensive. Between 10-15,000 people are covered by Medicaid TBI waivers, though there are thousands of people on the wait list. A slightly older analysis found that TBI waivers saved $30,000 per person per year compared with institutionalization. For patients and families, the richness of services available through the waiver program can offer vital practical, medical, and financial support.

States have discretion to determine the eligibility guidelines for the waivers, as well as the services offered, so there is a good amount of variation among states. Eligibility can be as high as 300% FPL. Waivers can include such comprehensive services as: home care, durable medical equipment, family and caregiver training, assistance with financial literacy, transportation, home modification, counseling and cognitive therapy, and even employment support.


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