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ME Home and Community-Based Services for Members with Brain Injury Waiver

Published on
August 23, 2023
Last updated
April 19, 2024
Written by
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Katie Wilkinson
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The Section 18 Waiver is a Medicaid program that provides HCBS for adults with acquired brain injury (ABI) or other related conditions (ORC) who meet the nursing facility level of care to prevent or delay institutionalization and promote community integration.
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Brain injury is a severe condition that can affect a person’s physical, cognitive, emotional, and behavioral functioning. According to the Brain Injury Association of America, an estimated 2.8 million Americans sustain a traumatic brain injury (TBI) each year, and more than 5.3 million live with a disability caused by TBI.

Living at home and in the community is preferable to institutional care for many people with brain injury. However, they may need various services and supports to maintain their health, safety, and quality of life. In addition, their family members or friends may provide unpaid care for them, which can be challenging and stressful.

Fortunately, a Medicaid waiver program in Maine can help people with brain injury and their caregivers access home and community-based services (HCBS). This program is called the Home and Community-Based Services for Members with Brain Injury Waiver, or Section 18 Waiver for short.

In this article, we will explain the Section 18 Waiver, who is eligible for it, what services and supports it offers, and how it compensates caregivers. We will also provide some resources for further information and assistance.

Overview of Section 18 Waiver

The Section 18 Waiver is a Medicaid program that provides HCBS for adults with acquired brain injury (ABI) or other related conditions (ORC) who meet the nursing facility level of care. The waiver aims to prevent or delay institutionalization and promote community integration for people with brain injury.

The waiver serves up to 200 participants at any given time. The target population includes adults aged 18 to 64 with ABI or ORC, as defined by the Maine Department of Health and Human Services (DHHS) 2. ABI is an injury to the brain after birth and is unrelated to a congenital disorder, degenerative disease, or aging process. ORC means a condition closely related to ABI regarding the required treatment or services.

The waiver operates under the authority of Section 1915c of the Social Security Act, which allows states to waive certain Medicaid rules and offer HCBS to specific groups of people who would otherwise need institutional care. The waiver is administered by the Maine DHHS Office of Aging and Disability Services (OADS).

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Eligibility Requirements

To be eligible for the Section 18 Waiver, a person must meet the following criteria:

  • Be a Maine resident
  • Be aged 18 to 64
  • Have MaineCare (Medicaid) or be eligible for MaineCare
  • Have an ABI or ORC as determined by DHHS
  • Meet the nursing facility level of care as determined by DHHS
  • Require at least one waiver service
  • Have a person-centered plan that identifies the goals, preferences, strengths, and conditions of the person
  • Agree to participate in the waiver
  • Live in a home or community setting that meets the HCBS settings requirements
  • Not be enrolled in another HCBS waiver program

The income limit for the waiver is 300% of the Supplemental Security Income (SSI) federal benefit rate, which, in 2023, is $914 per month for an individual and $1,371 per month for a couple. The asset limit is $10,000 for an individual and $15,000 for a couple. There are some exceptions and deductions that may apply to these limits.

Services and Supports

The Section 18 Waiver offers various services and supports designed to help people with brain injury live independently and participate in their communities. These services include :

  • Assistive technology: Devices or equipment that help a person perform daily activities or communicate
  • Career planning: Services that help a person explore employment options and develop a career plan
  • Community integration: Services that help a person access community resources and activities
  • Community support: Services that help a person develop skills for independent living
  • Environmental modifications: Changes or adaptations to a person’s home or vehicle that improve accessibility or safety
  • Home health aide: Services that provide personal care or health-related tasks
  • Homemaker: Services that provide household assistance or chores
  • Non-medical transportation: Transportation services that enable a person to access waiver or other community services
  • Personal emergency response system: A device or system that allows a person to call for help in an emergency
  • Respite: Services that provide temporary relief for caregivers
  • Shared living: A living arrangement where a person lives with a paid caregiver who provides support and supervision
  • Supportive home care: Services that provide personal care, health-related tasks, or household assistance in a person’s home
  • Supported employment: Services that help a person find and keep a job in the community
  • Transitional services: Services that help a person move from an institutional setting to a community setting

The amount and frequency of services are determined by the person’s needs and preferences and the availability of funds. The services are provided by qualified providers contracted or enrolled with DHHS. The person can choose their providers from a list of available options.

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Compensation for Caregivers

One of the benefits of the Section 18 Waiver is that it allows people with brain injury to self-direct some of their services, which means they can have more control and flexibility over how, when, where, and by whom their services are delivered. Self-direction also enables people to hire and pay their family members or friends as caregivers for certain services, such as community support, homemaker, respite, shared living, or supportive home care.

To self-direct their services, people need to work with a support broker, who is a person who helps them plan, manage, and monitor their services. The support broker also assists them with hiring, training, supervising, and paying their caregivers. The caregivers are paid through a financial management service (FMS), which is an entity that handles the payroll and tax responsibilities for the self-directed services.

The amount of compensation for caregivers depends on several factors, such as the type and duration of service, the qualifications and experience of the caregiver, and the rates set by DHHS. According to the MaineCare Benefits Manual Chapter II Section 18 Appendix C-1, the hourly rates for self-directed services range from $12.50 to $20.00 as of July 1, 2020. The annual limits for self-directed services range from $2,500 to $75,000 per person.

A Note from Givers

You may be eligible for this program if you or someone you know has a brain injury and needs home and community-based services. To learn more, contact the OADS Brain Injury Services Coordinator at (207) 287-9200 or visit the OADS website.

If you are a family member or friend who provides unpaid care for someone with a brain injury, you may also be eligible for compensation through this program. To determine if you qualify, please fill out this form, and we will get back to you as soon as possible.

At Givers, we are passionate about supporting caregivers and advocating for their rights. We believe that caregivers are part of the healthcare system, and they deserve to be paid for the work that they do. 

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