NH Acquired Brain Disorder Waiver

Published on
July 10, 2023
Last updated
April 19, 2024
Written by
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Katie Wilkinson
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Learn about the Acquired Brain Disorder Waiver, how it aids people with brain injuries, and how family caregivers can receive financial compensation for their support.
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For countless Americans with acquired brain disorders, staying in familiar environments can significantly enhance their quality of life and recovery. This is where Medicaid's Acquired Brain Disorder (ABD) Waiver comes into play. As a crucial cog in our healthcare system, this waiver provides in-home support services, helping individuals remain in their preferred settings while receiving necessary care.

This blog post delves into the Acquired Brain Disorder Waiver, a program designed to offer services that help people with acquired brain injuries to stay in their homes or community-based settings. Living independently with supportive services becomes a reality for many with this waiver. Notably, it also compensates family caregivers for their invaluable contributions. 

Although the waiver varies in terms of its specifics from state to state, this article gives a general overview and guide on how caregivers can use this waiver to receive the caregiver pay they rightly deserve. 

Overview of the Acquired Brain Disorder Waiver

The Acquired Brain Disorder (ABD) Waiver is a Medicaid program that aims to provide a wide range of services to individuals who have suffered an acquired brain injury. The purpose of the waiver is twofold: to help these individuals maintain their independence by staying in their homes or community-based settings and to offer some financial relief to family caregivers who are integral to their care.

The primary target population for the ABD Waiver includes adults who have suffered a brain injury, causing impairments that interfere with their ability to lead a normal life independently. These impairments may be physical, cognitive, behavioral, or a combination.

While specific eligibility requirements vary from state to state, a common requirement is the need for a level of care that would otherwise be provided in an institutional setting such as a hospital or nursing home.

The overarching goals of the ABD Waiver include:

  • Promoting independence.
  • Reducing the burden on institutional care.
  • Improving the quality of life for affected individuals.

Additionally, it aims to acknowledge and support family caregivers' roles by compensating for their essential services. This recognition alleviates some financial stress for families and validates caregivers' critical role in the healthcare system. 

By allowing individuals to stay in comfortable, familiar environments while receiving the care they need and empowering family caregivers with deserved compensation, the ABD Waiver acts as a bridge towards more inclusive and equitable care for those with acquired brain injuries.

Alternate names for the Acquired Brain Disorder (ABD) Waiver

The Acquired Brain Disorder (ABD) Waiver is primarily known by that name, but it's worth noting that the specific names or titles of waiver programs can vary by state. Depending on the state, the ABD Waiver may also be referred to by alternative names such as:

  1. Traumatic Brain Injury (TBI) Waiver
  2. Brain Injury Waiver
  3. Neurological Rehabilitation Waiver
  4. Cognitive Disability Waiver
  5. Brain Injury and Spinal Cord Injury (BI/SCI) Waiver

These alternative names reflect the focus of the waiver program on individuals with acquired brain injuries or disorders, which can include traumatic brain injuries, strokes, brain tumors, anoxia, and other conditions that result in acquired brain damage.


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Eligibility Requirements

Several criteria must be met to qualify for the Acquired Brain Disorder Waiver, although the specifics may vary from state to state. These criteria often include the following:

1. Age Requirement: Most programs serve adults 18 and older. However, some states may consist of services for younger individuals.

2. Disability Criteria: The individual must have an acquired brain injury that significantly impacts their ability to perform daily living activities independently, which includes traumatic brain injuries, strokes, tumors, and other non-degenerative brain injuries.

3. Level of Care Requirement: The individual must require a level of care consistent with what would be provided in an institutional setting such as a hospital or nursing home.

4. Financial Eligibility: The individual must meet specific financial criteria, typically involving an income limit, usually set at a percentage of the Federal Poverty Level. Asset limits may also apply.

5. Residential Eligibility: The person must live at home or in a community setting, not in a hospital or nursing home. The waiver aims to help individuals avoid institutionalization.

The application process generally involves completing an application form and providing supporting documents. In many states, this includes medical documentation of the brain injury and assessing the individual's care needs. Some states also conduct an in-person assessment.

We recommended consulting with a local Medicaid office or a healthcare professional knowledgeable about the waiver to determine eligibility. Some states also provide online resources for self-screening. It's crucial to remember that even if an individual meets all these criteria, enrollment may be subject to the availability and resources of the state's program.

The Acquired Brain Disorder (ABD) Waiver is available in the following states:

  1. Arizona
  2. Delaware
  3. Iowa
  4. Kansas
  5. Kentucky
  6. Louisiana
  7. Maryland
  8. Mississippi
  9. New Hampshire
  10. New Mexico
  11. North Carolina
  12. North Dakota
  13. Ohio
  14. Oklahoma
  15. Pennsylvania
  16. Rhode Island
  17. South Dakota
  18. Tennessee
  19. Texas
  20. Utah
  21. Vermont
  22. Virginia
  23. West Virginia
  24. Wisconsin
  25. Wyoming

There may be changes or updates to the ABD waiver program in these states, so it's advisable to consult with your local Medicaid office or relevant state agencies to get the most current and accurate information about the availability and eligibility criteria.


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Services and Supports

The Acquired Brain Disorder (ABD) Waiver offers comprehensive services and supports to individuals with acquired brain injuries. While the specific services may vary by state, the following list provides an overview of standard services and supports available under the waiver:

1. Case Management: Assistance in coordinating and managing an individual's care plan, including assessing needs, developing a care plan, and monitoring services.

2. Personal Care Services: Help with activities of daily living (ADLs) such as bathing, dressing, grooming, meal preparation, and medication management.

3. Skilled Nursing Services: Nursing support and care for individuals with complex medical needs, including wound care, medication administration, and monitoring vital signs.

4. Therapy Services: Physical therapy, occupational therapy, and speech therapy to aid in rehabilitation, mobility, and communication skills.

5. Behavioral Health Services: Mental health counseling, behavioral interventions, and support for managing emotional and psychological challenges resulting from brain injury.

6. Respite Care: Temporary relief for family caregivers by providing short-term care for the individual, allowing caregivers to take a break and tend to their needs.

7. Assistive Technologies: Provision of assistive devices and technologies to enhance independence, such as mobility aids, communication devices, and adaptive equipment.

8. Home Modifications: Adaptations to the home environgment to improve accessibility and safety, including wheelchair ramps, grab bars, and modified bathrooms.

9. Transportation Assistance: Transportation to medical appointments, therapy sessions, and community activities when the individual cannot use public or private transportation independently.

10. Community Integration Services: Support for participation in community-based activities, socialization, and engagement in recreational and educational opportunities.

11. Supported Employment: Assistance in finding and maintaining employment opportunities, vocational training, and job placement services.

12. Cognitive Rehabilitation: Programs and services aimed at improving cognitive functions, memory, attention, and problem-solving skills.

13. Specialized Healthcare Services: Access to specialized medical care, including neurologists, neuropsychologists, and other healthcare professionals with expertise in acquired brain injuries.

Services and supports available may vary by state and the individual's assessed needs. Each state's waiver program may have its own set of guidelines and limitations regarding service eligibility and duration. 

Compensation for Caregivers

Under the Acquired Brain Disorder (ABD) Waiver, some states do provide compensation for unpaid family caregivers. This compensation recognizes family members' invaluable support and care and helps alleviate the financial burden associated with caregiving responsibilities. However, the availability and specific details of caregiver compensation can vary from state to state. Here is a general overview of the process and requirements:

1. Eligibility: Caregivers typically need to meet specific criteria set by the state, including being a family member of the individual receiving services under the ABD Waiver.

2. Caregiver Agreement: Caregivers may need to enter into a formal agreement with the state or a designated agency outlining the services they will provide and the compensation they are eligible for.

3. Documentation and Reporting: Caregivers may be required to keep records of their care, such as daily logs or timesheets, to demonstrate the hours and nature of their caregiving activities. This documentation is essential for reimbursement purposes.

4. Training and Certification: Some states may require caregivers to complete training programs or obtain certifications related to caregiving to be eligible for compensation.

5. Reimbursement Process: Caregivers are typically reimbursed based on an hourly rate or a predetermined payment structure. Reimbursement may be processed through payroll systems or specific reimbursement forms provided by the state.

Limitations and Challenges

While the Acquired Brain Disorder (ABD) Waiver provides essential services and support, there are limitations and challenges associated with the program. Some common challenges include funding constraints, resulting in limited resources and services, which may lead to waiting lists or gaps in coverage. Additionally, the eligibility criteria and requirements for the waiver can vary by state, leading to inconsistent access and availability of services. Individuals and caregivers should be aware of these limitations and seek up-to-date information from their state's Medicaid office or official government resources to understand the challenges and potential barriers they may encounter.

A note from Givers

This waiver acknowledges the pivotal role of caregivers in the healthcare system and aims to improve their well-being. Please take a moment to complete our survey to determine your eligibility for compensation.

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