Eligibility

Eligibility A. In order to qualify as a beneficiary of the Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver Program, individuals must meet the following criteria: 1. Persons must be diagnosed with one (1) of the following disease(s) or condition(s): a) Traumatic brain injury which the Division of Medicaid defines as an insult to the skull, brain, or its covering resulting from external trauma, which produces an altered state of consciousness or anatomic, motor, sensory, or cognitive/behavioral deficits. b) Spinal cord injury which the Division of Medicaid defines as a traumatic injury to the spinal cord or cauda equina with evidence of motor deficit, sensory deficit, and/or bowel and bladder dysfunction. The lesions must have significant involvement with two (2) of the above three (3) deficits. 2. The extent of injury must be certified by the physician. 3. Brain or spinal cord injury that is due to a degenerative or congenital condition, or that result, intentionally or unintentionally, from medical intervention is excluded. 4. Must require nursing facility level of care as determined by a comprehensive long-term service and supports (LTSS) assessment. 5. Must be certified as medically stable by a physician or nurse practitioner. The Division of Medicaid defines medically stable as the absence of all of the following: a) An active, life-threatening condition requiring systematic therapeutic measures. b) Intravenous drip to control or support blood pressure. c) Intracranial pressure or arterial monitoring. 6. Must meet the criteria in one (1) of the following Categories of Eligibility (COE): a) Supplemental Security Income (SSI), b) Parents and Other Caretaker Relatives Program, c) Katie Beckett, d) Children under age nineteen (19) who meet the applicable income requirements, e) Disabled Adult Child, f) Protected Foster Care Adolescents, g) Child Welfare Services (CWS) Foster Children and Adoption Assistance Children, h) IV-E Foster Children and Adoption Assistance Children, or i) An aged, blind, or disabled individual who meets all factors of institutional eligibility. If income exceeds the current institutional limit, the individual must pay the Division of Medicaid the portion of their income that is due under the terms of an Income Trust in order to qualify, or j) Working Disabled B. Beneficiaries enrolled in the TBI/SCI Waiver cannot reside in a nursing facility or licensed or unlicensed personal care home. C. In the event of imminent danger to the beneficiary, caregiver, or service provider, the beneficiary may be discharged from the waiver immediately.