Who is financially eligible?
Persons who are Medicaid eligible and those whose income
does not exceed 300 percent of the SSI standard may be eligible.
Medicaid resource limits and spousal impoverishment rules are
the same as those for nursing facility residents.
What services are covered?
Case Management: includes ongoing monitoring of service
provision and referral to other services providers as necessary. The
case management provider shall be responsible for ensuring the
overall health, welfare and safety of participants.
Personal Care Services: provides assistance with eating, bathing,
dressing, personal hygiene, activities of daily living and includes the
retraining of the individual in the performance of these activities.
Respite Care: services provided on a short-term basis to address the
absence or need of relief of those persons normally providing the
care. This shall not exceed 168 hours in a 6-month period.
Environmental Modifications: the physical adaptations to the home,
which are necessary to ensure the health, welfare and safety of the
individual, or which will enable the individual to function with
greater independence in the home.
Companion Services: non-medical care, supervision and
socialization provided to a functionally impaired adult.
Behavior Programming: individually designed strategies to decrease
severe maladaptive behaviors which have interfered with the ability
to remain in the community.
Counseling and Training: services to help the individual resolve
personal issues or interpersonal issues or interpersonal problems
resulting from the acquired brain injury.
Structured Day Program: services directed at the development and
maintenance of community living skills in a non-residential setting
separate from the home in which the recipient lives with a goal of
community reintegration.
Specialized Medical Equipment and Supplies: devices, controls
or appliances which are specified in the plan of care and enable
recipients to increase their abilities to perform activities of
daily living or to perceive, control, or communicate with the
environment in which the individual lives.
Prevocational Services: services are aimed at preparing an
individual for paid or unpaid employment, but are not job or task
oriented and include teaching such concepts such as compliance,
attending, task completion, problem solving and safety on a one-toone
basis. This is for persons not expected to join the general work
force within one year.
Supported Employment: services which consist of paid employment
for persons for whom competitive employment at or above the
minimum wage is unlikely, and who, because of their disabilities,
need intensive, ongoing support to perform in a work setting.
Community Residential Services: services which consist of
up to 24-hour supervision and oversight, supportive services,
individualized home care aide tasks and individualized
management tasks.
Occupational therapy, speech, hearing and language services:
rehabilitation designed to help the individual in activities of daily
living and effective communication.
Modified Services
Fortunately, in addition to the services just mentioned, the ABI
Medicaid Waiver program has some new, expanded options to
help individuals and families cope with some of the on-going
needs of an Acquired Brain Injury.
Consumer Directed Option: Method of Waiver Service
Administration
Consumer Directed Option (CDO) allows the Medicaid Waiver
recipient, the consumer, to make choices on how the non-medical
waiver services are provided. CDO lets consumers choose who
provides the services, how the services are provided and when
they will be provided. For people with brain injury under the ABI
Medicaid Rehab Waiver, CDO will cover companion care, respite
and personal care. CDO will cover community living and adult
day as well as respite under the Supports for Community Living
(SCL) Waiver and homemaking, respite and personal/attendant
care under the Home and Community Based (HCB) Waiver.
The first step in CDO is to develop a plan of care that identifies
the need for the service and how many hours of service are
necessary. The consumer, with assistance from family or others
will work with a Support Broker to develop the plan of care.
Support Brokers are staff from the local Area Agency on Aging
(AAA) or your local regional Community Mental Health Center.
When a recipient chooses CDO, the Support Broker takes the
place of their existing Waiver Case Manager. The plan of care will
also identify the dollar amount needed to provide the designated
services.
The consumer or his/her representative is able to recruit, hire and
supervise workers of their choosing to provide the services in
the plan of care. Family members, friends, neighbors, provider
agencies or others can be recruited to be the employee. The new
employees will need to receive training from the AAA, have a
criminal background check and undergo drug testing.
2020-2022 BIAK Resource Journal 27
Federal/State Resources