WV Traumatic Brain Injury Waiver Explained

The Traumatic Brain Injury Waiver (TBIW) program is a cornerstone in West Virginia's healthcare landscape, offering crucial support to individuals aged three and above who have endured traumatic brain injuries. 

Overview of the Traumatic Brain Injury Waiver (TBIW)

West Virginia's Traumatic Brain Injury Waiver (TBIW) is a pivotal program designed to cater to the needs of individuals three years and older who have suffered traumatic brain injuries. This initiative operates under the auspices of the state's Home and Community-Based Waiver Services, extending a lifeline to those who fulfill medical and financial prerequisites.

The TBIW program is a beacon of support that waives traditional regulations, enabling West Virginians to receive the care they require while residing within the familiarity of their homes. By embracing the principles of choice, independence, respect, and community involvement, the program seeks to empower individuals and families alike.

At its core, the TBIW program aims to alleviate the challenges of traumatic brain injuries by providing comprehensive care that fosters physical, emotional, and cognitive well-being. By bridging the gap between institutional care and home-based support, the program endeavors to enhance the quality of life for its beneficiaries. 

Eligibility Requirements for the Traumatic Brain Injury Waiver 

To qualify for the Traumatic Brain Injury Waiver (TBIW) in West Virginia, individuals must fulfill a set of specific criteria outlined below:

• Age and Condition: The applicant must be at least three years old and possess documented evidence of a traumatic brain injury. This injury should result from physical force leading to either total or partial disability, including challenges in social participation. Alternatively, the damage could stem from oxygen deprivation due to near-drowning. Additionally, the applicant must meet the medical prerequisites to warrant a level of care equivalent to that provided in a nursing home.
• Residency: Applicants must be permanent residents of West Virginia and be readily available to receive the services mandated by the program.
• Financial Qualification: Prospective participants must meet the financial criteria established by the West Virginia Department of Health and Human Resources (DHHR) county office for Medicaid waiver programs.
• Cognitive Functioning: Applicants aged 18 and above should exhibit a Rancho Los Amigos Levels of Cognitive Functioning Scale score of Level VII or below. Individuals aged three to 17 years must meet a minimum of Level II on the Rancho Los Amigos Pediatric Level of Consciousness Scale is necessary.
• Current Setting: Applicants should either be inpatients at licensed nursing facilities, hospitals, or rehabilitation centers specifically catering to traumatic brain injuries or reside within a community setting at the time of application.
• Voluntary Participation: Individuals applying for the TBIW program must prefer participating in this initiative over seeking care at a nursing facility.
• Safe Environment: Applicants must be capable of offering a secure workspace for the TBIW program and agency staff.
• Non-Dual Enrollment: Those enrolled in the TBIW program cannot simultaneously serve as paid caregivers in other waiver programs or West Virginia's Medicaid Personal Care Services program.

Both medical and financial eligibility must undergo evaluation and determination on an annual basis.

Services and Supports Offered by the Traumatic Brain Injury Waiver (TBIW)

The Traumatic Brain Injury Waiver (TBIW) offers an array of services and supports designed to cater to the unique needs of its participants. Upon acceptance into the program, beneficiaries can choose between two distinct service models: the Traditional (Agency) Model and the Self-Directed Model, also known as Personal Options.

Under the Traditional Model, participants receive services from employees of a certified provider agency. Conversely, the Personal Options model empowers members to take charge of their care by hiring, supervising, and dismissing their employees.

Critical services provided by the TBIW program include:

• Case Management Services: Enlist the expertise of professionals who coordinate services, conduct evaluations, identify individual needs, devise person-centered service plans, and facilitate connections with community resources.
• Personal Attendant Services: Engaging personal attendants who provide essential assistance with activities of daily living, such as eating, bathing, dressing, grooming, mobility, and toileting, both at home and within the community.
• Environmental Accessibility Adaptations (EAA) for Home and Vehicle: Offering physical adaptations to homes and vehicles that enhance accessibility, thereby promoting greater independence and functionality.
• TBIW Non-Medical Transportation: Facilitating transportation for essential errands and community activities as outlined in the individual's Person-Centered Service Plan, with the aid of a personal attendant.
• Personal Emergency Response System (PERS): Equipping participants with a device that enables them to summon assistance from a monitoring center in times of emergency.

These services align with the member's personalized Person-Centered Service Plan, ensuring that support is tailored to individual needs. By embracing both traditional and self-directed service models, the TBIW program underscores its commitment to promoting autonomy, dignity, and improved quality of life for individuals navigating the challenges of traumatic brain injuries.

Compensation for Caregivers under the Traumatic Brain Injury Waiver (TBIW)

The Traumatic Brain Injury Waiver (TBIW) in West Virginia has a self-direction option called Personal Options. This option gives you more control and choice over the types of services you receive, who provides them, and how they are delivered. 

You can use a monthly budget to pay for personal assistance services, goods, supports, or supplies that increase your independence or substitute for human help. You can also hire and manage your employees, such as family members, friends, or professionals, to provide personal assistance services to you1.

Some of the benefits of choosing Personal Options are:

• You can design your service plan and budget based on your needs and preferences.
• You can select the best qualified and most suitable employees for your situation.
• You can set your employees' wages and schedules within your budget's limits.
• You can train and supervise your employees according to your standards and expectations.
• You can change your service plan and budget as your needs and preferences change.

Some of the responsibilities of choosing Personal Options are:

• You must follow the rules and regulations of the TBIW program and Medicaid.
• You must manage your budget and payroll with a financial management service (FMS).
• You must keep accurate records and receipts of your expenses and services.
• You must report problems or issues with your employees or services to your service coordinator.
• You must participate in regular reviews and evaluations of your service plan and budget.

Learn more about Medicaid self-directed care >>

A Note from Givers

In the realm of healthcare, caregivers are the unsung heroes. The Traumatic Brain Injury Waiver recognizes their worth and offers a pathway to compensation. Discover your eligibility by filling out this form and championing the cause of caregivers.