The Traumatic Brain Injury (TBI) Medicaid Waiver Program

The TBI waiver program is a Medicaid-funded program for income eligible adults between the ages of 18-64 who have a primary diagnosis of TBI or similar non-degenerative condition that results in deficits similar to a TBI such as stroke, or anoxia (oxygen supply loss), and who would require long term care in a facility without waiver services. Waiver participants may come from a nursing facility or other institution (transition) or choose to participate in the waiver to prevent facility placement (diversion).

The New York State Department of Health determines participant eligibility based on the following criteria:

• Individuals must be Medicaid eligible 
• Individuals must be diagnosed with a Traumatic or Acquired brain injury 
• Individuals must be between the ages of 18 to 64 years old 
• Individuals must be eligible for nursing facility level of care as determined by the initial assessment 
• Individuals must choose to live in the community rather than a nursing facility 
• Individuals can identify a safe living arrangement to meet their needs 
•  Individuals can be supported safely within the community with the funds and services available under the HCBS/TBI Waiver Program

Based on an Individualized Service Plan, the following services can be provided such as Service Coordination, Home and Community Support assistance, Independent Living Skills Training, respite care, vocational support, housing support, and other services that are necessary to keep the individual living in the community.

The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver Program

The NHTD waiver program is a Medicaid-funded program for income eligible adults between the ages of 18-64 who have a physical disability or those age 65 and older upon application to the waiver. The NHTD waiver program identifies and assesses, plans, and supports the transition of nursing home residents who are eager to and capable of returning to community living, back to integrated community living situations of their own choosing. In addition, the program assists in the diversion of individuals at risk of being placed in a nursing facility.

TBI and NHTD Waiver Program Services Provided by Unlimited Care, Inc.

Service Coordination - a Service Coordinator is chosen by the waiver participant and/or guardian to work on identifying and coordinating support and services in the waiver program, securing initial enrollment and maintaining ongoing annual enrollment, and ensuring participants continue to receive essential services. 

Independent Living Skills Training- provides individualized support to improve or maintain the ability of the waiver participant to live as independently as possible in the community. Support focuses on increasing independence in practical skills such as cooking, shopping, money management and maintaining a household, as well as self-care, medication management and pre-vocational and vocational skills, as needed. 

Home and Community Support Services- provides assistance with personal care tasks as well as oversight and supervision to enable the waiver participant to reside safely within the home and community environments. Unlimited Care Inc. has been a leader in providing services for the NYS Medicaid Waiver TBI program since 1996 and the NHTD program since 2010. 

Unlimited Care is approved by the Department of Health to provide services in the following Regional Resource Development Center (RRDC) regions: New York City, Lower Hudson Valley, Long Island, Capital, Adirondack and Rochester. Our specially trained professionals and paraprofessionals offer compassionate service and peace of mind to our TBI and NHTD participants and their families by providing a comprehensive network of services and support.

NYS NHTD and TBI Waiver Program Process

• Contact your local RRDC: (Insert link here for RRDC addresses and contact information) -- Nursing Home Transition and Diversion (NHTD) Waiver
• RRDC screens and determines eligibility of the participant
• Once approved, the RRDC provides the participant with a list of Service Coordination agencies
• Participant interviews providers and notifies RRDC of choice Service Coordination agency
• Service Coordinator meets with participant and initiates writing an Initial Service Plan, including scheduling interviews with waiver service providers
• Once the RRDC approves the Initial Service Plan, waiver services will commence