Traumatic Brain Injury (TBI) Waiver

Eligibility Criteria

  • Overview is also available in Portable Document Format (PDF)

An individual applying to participate in the TBI waiver must meet all of the following criteria:

  1. Be a recipient of Medicaid coverage that supports community–based long–term care services;
  2. Have a diagnosis of traumatic brain injury (TBI);

    Note: Because eligibility is restricted to individuals with physical disabilities, additional information may be needed to verify the existence of such a disability.
  3. Be between the ages of 18 and 64 upon application to the waiver;
  4. Be assessed to need a nursing home level of care as a direct result of the traumatic brain injury. Nursing home eligibility is determined by the Hospital and Community Patient Review Instrument and SCREEN (PRI/SCREEN). The form must be dated within 90 calendar days of the individual´s application packet to the waiver and be completed by an individual certified to use the tool;
  5. Choose to participate in the waiver rather than reside in a nursing facility by signing the Freedom of Choice form. Application for Participation form and Service Coordination Selection form;
  6. Identify the residence in which the waiver participant will be living when receiving waiver services;
  7. Complete an Initial Service Plan and Application Packet in cooperation with a Service Coordinator and be approved by the Regional Resource Development Specialist (RRDS). This Plan must describe why the individual is at risk for nursing home placement without the services of the waiver and indicate how the available supports and requested waiver services identified in the Plan will support the health and welfare of the potential participant; and
  8. Have a completed Plan for Protective Oversight (PPO).

Participant Enrollment Information

NHTD Waiver Enrollment by Region as of August 2015

Region Active Participants
Adirondack 204
Binghamton 271
Buffalo 331
Capital 371
Long Island 336
Lower Hudson Valley 267
New York City 457
Rochester 463
Syracuse 383
TOTAL 3083

TBI Active Participant Demographics

As of 08/14/2015