MN Brain Injury Waiver Explained

Brain injuries can have devastating effects on the lives of individuals and their families. They can impair cognitive, physical, emotional, and behavioral functions and require long-term care and support. However, many people with brain injuries prefer to remain in their homes and communities rather than be institutionalized. That’s where the Brain Injury (BI) Waiver comes in.

The BI Waiver is a Medicaid program that provides home and community-based services to individuals with traumatic or acquired brain injuries who meet the level of care criteria for a nursing facility or a neurobehavioral hospital. The program aims to promote independence, choice, and community integration for people with brain injuries while reducing the costs of institutional care.

In this article, we cover the BI Waiver in detail, including its eligibility requirements, services and supports, and caregiver compensation. 

Overview of the BI Waiver

The BI Waiver is one of the five Medicaid waivers in Minnesota that offer home and community-based services to individuals with disabilities or chronic conditions. The program was established in 1992 and is administered by the Minnesota Department of Human Services (DHS) in collaboration with county agencies.

The BI Waiver serves individuals who:

• Have a diagnosis of traumatic or acquired brain injury
• Are between 18 and 64 years old
• Are eligible for Medical Assistance (MA), Minnesota’s Medicaid program
• Meet the level of care criteria for a nursing facility or a neurobehavioral hospital
• Have an assessed need for at least one BI Waiver service
• Choose to receive assistance in their home or community instead of an institution
• Have a person-centered service plan that meets their needs and preferences
• Have a case manager who coordinates their services and supports

The BI Waiver provides services and supports tailored to the individual’s needs and goals. These include:

• Case management
• Independent living skills training
• Behavioral support services
• Crisis respite
• Extended home healthcare
• Residential supports
• Structured day program
• Transitional services
• Transportation
• Assistive technology
• Environmental modifications
• Specialized supplies and equipment

The BI Waiver also offers a self-direction option called Consumer Directed Community Support (CDCS), which allows individuals to choose, hire, and pay their service providers, including family caregivers.

Eligibility Requirements

To be eligible for the BI Waiver, individuals must meet the following requirements:

• Have a diagnosis of traumatic or acquired brain injury that occurred after age 22 and before age 65. Traumatic brain injury is caused by an external force, such as a fall, car accident, or gunshot wound. Acquired brain injury is caused by an internal event, such as a stroke, tumor, infection, or lack of oxygen.
• Be between 18 and 64 years old at the time of application. Individuals enrolled in the BI Waiver before age 65 can continue to receive services after age 65 as long as they remain eligible.
• Be eligible for Medical Assistance (MA), Minnesota’s Medicaid program. MA eligibility is based on income, assets, household size, disability status, and other factors. 
• Meet the level of care criteria for a nursing facility or a neurobehavioral hospital. The level of care is determined by a comprehensive assessment of the individual’s functional abilities, medical needs, behavioral needs, and risk factors. The evaluation is done by a certified assessor from the county or tribal agency or a contracted agency.
• Have an assessed need for at least one BI Waiver service. The assessed need is based on the individual’s strengths, preferences, goals, and challenges. The individual works with a case manager to develop a person-centered service plan that identifies the services and supports to help them achieve their desired outcomes.
• Choose to receive services in their home or community instead of an institution. The individual must live in a setting that meets the federal Home and Community-Based Services (HCBS) settings rule, which ensures that individuals have privacy, autonomy, access to community resources, and freedom from coercion and restraint.
• Have a case manager who coordinates their services and support. The case manager is assigned by the county or tribal agency or chosen by the individual from a list of qualified providers. The case manager helps the individual apply for the BI Waiver, develop their service plan, arrange their services, monitor their progress, and advocate for their rights.

Services and Supports

The BI Waiver provides various services and supports designed to help individuals with brain injuries live independently, participate in their communities, and achieve their goals. The services and supports are based on the individual’s person-centered service plan, which reflects their needs, preferences, and choices.

The BI Waiver services and supports include:

• Case management: A service that helps individuals access and coordinate their BI Waiver services and other resources. The case manager assists the individual with applying for the BI Waiver, developing their service plan, arranging their services, monitoring their progress, and advocating for their rights.
• Independent living skills training: A service that helps individuals build or maintain the skills they need to live independently in their home or community. The skills may include personal care, household management, communication, socialization, transportation, money management, medication management, and crisis prevention.
• Behavioral support services: A service that helps individuals manage or reduce challenging behaviors that interfere with their daily functioning or pose a risk to themselves or others. The service may include assessment, consultation, intervention, training, and supervision by a qualified professional or paraprofessional.
• Crisis respite: A service that provides temporary relief to the individual or their primary caregiver during a crisis or emergency. The service may be provided by a qualified provider in the individual’s home or another licensed setting.
• Extended home health care: A service that offers skilled nursing, home health aide, or personal care assistant services to individuals who need more than the MA state plan limit of 180 hours per year. A licensed home health agency or a qualified individual provider provides the service.
• Residential supports: A service that includes supervision, assistance, and training for individuals living in a licensed residential setting with up to four other BI Waiver recipients. The service may include room and board, personal care, household services, social and recreational activities, transportation, and medication management.
• Structured day program: A service that provides structured activities to individuals who need supervision and support during the day. The activities may include skill development, community integration, leisure, recreation, wellness, and socialization. A licensed or certified provider in a facility or community setting provides the service.
• Transitional services: A service that helps individuals move from an institutional setting to a community setting. The service may include expenses for security deposits, utility deposits, household items, furniture, moving costs, environmental modifications, and other one-time costs.
• Transportation: A service that provides access to non-emergency medical transportation (NEMT) or non-medical transportation (NMT) for individuals who need assistance to access their BI Waiver services or other community resources. The service is provided by a qualified provider or reimbursed to the individual or their representative.
• Assistive technology: A service that provides devices or equipment that enhance the individual’s ability to perform daily activities, communicate, control their environment, or access information. The service may include assessment, installation, training, maintenance, and repairing the devices or equipment.
• Environmental modifications: A service that provides physical changes to the individual’s home or vehicle that improve their accessibility, safety, or independence. The service may include assessment, design, installation, maintenance, and repair of the modifications.
• Specialized supplies and equipment: A service that provides items necessary for the individual’s health, welfare, or functioning. The items may include medical supplies, personal care items, adaptive clothing, incontinence products, and nutritional supplements.

Compensation for Caregivers

One of the benefits of the BI Waiver is that it allows individuals to self-direct their services and supports, which means that they can choose, hire, and pay their service providers. This option is called Consumer Directed Community Supports (CDCS).

CDCS gives individuals more flexibility and control over their BI Waiver services and budget. Individuals can decide what services they need, how they are delivered, who provides them, and how much they are paid. Individuals can also use their CDCS budget to purchase goods and services not covered by the BI Waiver or MA state plan.

One of the advantages of CDCS is that it enables individuals to hire and pay family members as caregivers. Family caregivers can provide personal care assistance, home health aide, or extended home health care services to their loved ones under CDCS. Family caregivers can include spouses, parents, children, siblings, grandparents, grandchildren, aunts, uncles, cousins, nieces, nephews, or other relatives.

The amount of compensation for family caregivers depends on several factors, such as the type and amount of services provided, the individual’s CDCS budget, and the prevailing wage rates in the area. Family caregivers must comply with the CDCS policies and procedures, such as completing a background check, signing a service agreement, submitting timesheets and invoices, and paying taxes.

Family caregivers can also receive training and support from CDCS staff or consultants to help them perform their duties effectively and safely. Family caregivers can also access respite services to take a break from their caregiving responsibilities.

A Note from Givers

If you want to apply for the BI Waiver or learn more about its benefits, please fill out this form to contact one of our experts. We will help you navigate the eligibility process and find the best services and support for your situation.