Page posted: 10/1/03
Page reviewed: 4/16/13
Page updated: 11/18/16
Effective with the waiver renewal April 1, 2011, the name of this waiver changed from Traumatic Brain Injury to Brain Injury to accurately reflect the people eligible for this program. Please note you may continue to see references to the TBI Waiver in various forms, documents and CBSM pages as we work on implementing the name change. Thank you for your patience as we continue with these updates.
Brain Injury (BI) Waiver: Home and community-based services necessary as an alternative to institutionalization that promote the optimal health, independence, safety and integration of a person and who would otherwise require the level of care provided in a specialized nursing facility or neurobehavioral hospital.
To be eligible for the BI Waiver, a person must choose the BI Waiver and meet all of the following criteria:
1. Eligible for Medical Assistance
2. Certified disabled by Social Security or the State Medical Review Team (SMRT)
3. Under age 65 at the time of opening to the waiver
4. Determined by the case manager/service coordinator to meet one of the following level of care criteria :
5. Have a completed BI Waiver Assessment and Eligibility Determination (DHS-3471) (PDF)
6. Diagnosed with one of the following documented diagnoses of brain injury or related neurological condition that resulted in significant cognitive and behavioral impairment:
7. Have the potential to benefit from rehabilitative services as determined by a Ranchos Los Amigos score of IV or above
8. Has an assessed need for supports and services over and above those available through the MA State plan
9. Has an assessed need for one or more of the following:
The following services are covered under the BI Waiver. For a service-specific policy page, select a service from the list:
Local waiver program administration
Local county or tribal administration acting as agents for the state Medicaid agency and DHS have many responsibilities. See the state and county/tribal responsibilities for waiver management section on CBSM – Waiver programs overview.
For a comparison grid of forms applicable across and/or specific to waiver programs, see CBSM – Required waiver forms .
Process and procedure
Brain Injury (BI) Waiver Program brochure, DHS-3442 (PDF)