What is a Brain Injury Waiver?

For individuals who have unfortunately suffered a traumatic brain injury, the brain injury (BI) waiver provides them with funding for housing and other community-based services. 

The BI waiver applies to and may be received by eligible adults and children with a documented acquired or traumatic brain injury.  It may be used in their current home, adoptive or foster family home, the home of a relative, any transitional lodging facility, or an assisted living home (if accepted by that community). 

Things covered under a BI waiver include 24-hour emergency assistance, caregiver living expenses, employment support, home-delivered meals, in-home family support, living skills therapies, night supervision, and more. See the full list here. 

Who is eligible for BI Waiver services?

After a traumatic brain injury, patients may be scrambling to get coverage for a multitude of things that affect their livelihood. Unfortunately, eligibility for a BI waiver is not as easy as 1, 2, 3. However, there are a few key things that can aid in the screening process for BI waiver eligibility, and it’s critical to know what they are as you start that process.

During the BI waiver screening process, you may be found eligible if you meet the following criteria:

  • Are certified as disabled by your state’s Medical Review Team or Social Security Administration
  • Are eligible for Medical Assistance
  • Are assessed to be at Level 4 or above on the Rancho Los Amigos Levels of Cognitive Functioning 10-Point Scale 
  • Are determined to need a high level of neurobehavioral care found in a nursing facility or hospital
  • Have a documented diagnosis of acquired or traumatic brain injury
  • Have a documented diagnosis of degenerative disease with cognitive impairment (provided the diagnosis is not congenital)
  • You are noted to experience severe behavioral and cognitive problems related to the documented brain injury or disease
  • Are under the age of 65 years when the waiver is submitted

Important Things to Note About Eligibility

Once you are determined eligible for BI Waiver services, a series of questions must be asked regarding services offered, including, but not limited to:

  • Are these services necessary to ensure the recipient’s overall health, welfare, and safety?
  • Does this option meet your needs and preferences after all options have been reviewed?
  • Is the cost of the service considered reasonable and falls in line with standard costs?
  • Is the service already covered by Medical Assistance, Medicare, private health care, education, or any other source of funding?
  • Must there be a review or renewal of the recipient’s waiver on an annual basis?
  • Are there any stipulations for receiving BI waiver care in a senior living community or nursing care facility?

You can contact us with questions regarding your brain injury waivers or other inquiries below. 

Contact Us

Sunflower Communities accepts the BI waiver as one of our waiver offerings and we welcome the opportunity to assist you with your housing needs. Our dedicated team of liaisons is available to answer any questions you might have or to assist you with connecting with your local county offices. Please connect with us here. Individuals can apply for a BI waiver with their local county. Full list here.