What is Minnesota’s TBI Waiver? Simply put, it is a program that provides long-term care to people with traumatic brain injuries. The waiver was created and funded by the state of Minnesota. This article goes over everything you need to know about the waiver. We will cover how it started, who qualifies for coverage, and its benefits and limitations.
What is Considered a Traumatic Brain Injury?
The CDC defines a traumatic brain injury as an injury that affects how the brain works. Brain injuries can be caused by a bump, blow, or jolt to the head and penetrating injuries like gunshot wounds or other accidents where an object penetrates the skull.
Depending on the type and severity of the injury, there can be certain levels of TBI ranging from a mild concussion to moderate or severe brain injury. Unfortunately, TBI also causes many deaths, with nearly 60,000 per year—with suicide and motor vehicle crashes being the leading cause.
Symptoms of a Traumatic Brain Injury
People who survive traumatic brain injuries are often left with a wide range of symptoms that severely disrupt their daily lives and often require immense therapy, treatment, and care.
Symptoms of a Mild Brain Injury
- Nausea or vomiting
- Trouble speaking
- Blurred vision
- Ears ringing
- Inability to smell
- Sensitivity to light or sound
- Loss of consciousness (seconds to minutes)
- No loss of consciousness, but feeling dazed or disoriented
- Trouble concentrating
- Changes in Mood
- Feeling depressed or anxious
- Sleeping changes (difficulty falling asleep or staying asleep)
Symptoms of a Moderate-Severe Brain Injury
- Loss of consciousness (several minutes to hours)
- Persistent headache or worsening headache
- Persistent nausea or vomiting
- Dilated pupil(s)
- Clear fluids draining from the nose or ears
- Slurred speech
- Convulsions or seizures
- Can’t wake up from sleep
- Numb or weak extremities
- Changes to coordination
- Severe confusion
- Become agitated or combative
As you can see, the difference between a mild head or brain injury and a severe one is pretty drastic. Some people may recover from the symptoms mentioned above, but many have to make a complete lifestyle change to treat them. Some individuals even require complete, round-the-clock treatment to live their lives—which brings us to BI waivers and eligibility.
Minnesota’s Traumatic Brain Injury (TBI) Waiver, Defined
Like we stated, a Traumatic Brain Injury (TBI) waiver helps to provide necessary long-term care and other services to people who have experienced traumatic brain injuries. This program is funded by the state of Minnesota and requires specific eligibility before it can provide funding for both home and community-based services for children and adults who have an acquired brain injury. In addition, waivers offer financial assistance to services that may not otherwise be covered by insurance or would have to be paid for out of pocket—thus are incredibly valuable to people whose lives have been flipped upside down due to a traumatic brain injury.
Who is Eligible for a Brain Injury Waiver?
The BI waiver helps people with disabilities due to brain injuries live independent lives—while also providing them access to funding for home, community, socialization, or work support services as well as therapy or other medical costs associated with their head trauma treatment.
There is a screening process that officially determines eligibility for the BI waiver, but to start, patients would be assessed using the Rancho Los Amigos scale, which measures cognitive function and rates how well people with brain injuries are recovering. There are ten levels of function that would determine how severe someone’s brain injury is and how well they are or will recover. They are as follows:
Level I – No Response: Total Assistance
Level II – Generalized Response: Total Assistance
Level III – Localized Response: Total Assistance
Level IV – Confused/Agitated: Maximal Assistance
Level V – Confused, Inappropriate Non-Agitated: Maximal Assistance
Level VI – Confused, Appropriate: Moderate Assistance
Level VII – Automatic, Appropriate: Minimal Assistance for Daily Living Skills
Level VIII – Purposeful, Appropriate: Stand-By Assistance
Level IX – Purposeful, Appropriate: Stand-By Assistance on Request
Level X – Purposeful, Appropriate: Modified Independent
Anyone who measures at a level IV or higher on the Rancho Los Amigos scale may be eligible for BI waivers. Someone at a level IV shows a heightened state of activity, may attempt to remove constraints or IVs, can be aggressive and scream or thrash with or without provocation, and may exhibit little to no short-term memory. These patients begin to not comply with staff and require more strict attention and care.
Other eligibility requirements in the state of Minnesota include:
- Being certified as disabled by the State Medical Review Team or the Social Security Administration
- Using or are eligible for Medical Assistance
- Being under the age of 65 when the waiver is opened
- Requiring the level of care available in nursing homes or other neurobehavioral facilities
- Requiring community service outside of a nursing facility (such as transportation or companion services)
- Having a documented diagnosis of traumatic brain injury or a non-congenital degenerative disease diagnosis causing cognitive impairment
- Experiencing significant behavioral and cognitive problems related to the brain injury or disease
What Services are Covered Under a BI Waiver?
Several services can be covered under Minnesota’s TBI waiver. These include:
- Outpatient therapy (cognitive, physical, or speech)
- Other medically necessary treatments like prescriptions and hospital stays for other conditions not related to the traumatic brain injury (such as pneumonia or an infection)
- Community-based behavioral health treatment including day programming, case management services, and supported living
- Home health care (including nursing or personal care)
- Transportation to medical appointments or day programs
- Family counseling for caregivers if the patient is under 21 years of age—and legal guardianship coordination.
- And more
At Sunflower Communities, we accept CADI, Elderly, and BI waivers as long as patients are medically appropriate, meet all requirements and fill out the proper forms. In addition, we may work with their social worker or case manager to sort out the specific details and coverage.
If you or a loved one is looking for a senior community that will support and protect them as they recover and manage a traumatic brain injury—reach out to Sunflower Communities today.