The North Carolina TBI Waiver application was submitted to the Centers for Medicare and Medicaid Services (CMS) on February 29, 2016. At this time, the TBI Waiver is pending approval by CMS.
Alliance hosted a TBI Waiver Provider Listening Session on December 15, 2017. Here are questions and answers from that session.
Alliance hosted a web-based Listening Session on February 28, 2018 to hear from service providers who provide support to individuals with a TBI.
Disclaimer: Information, questions and responses may change as the TBI waiver has not yet been approved by CMS. Completion of the survey by providers is not intended as an endorsement of the quality of the service or provider, nor is it to be interpreted as a guarantee of a future contract, referrals, or business.
If you have questions, please reach us at TBIInfo@AllianceBHC.org.
For information on becoming a Medicaid provider in NC, please go to www.nctracks.nc.gov.
The following Frequently Asked Questions have been developed to address questions that are likely present while approval is pending.
Frequently Asked Questions
What is a Medicaid waiver?
Medicaid waivers are developed to address the unique healthcare needs of specific populations in the state by providing services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community. Waiver programs can accommodate a limited number of enrollees based on available funding and eligibility requirements.
To learn more about Medicaid waivers, visit Medicaid.gov or for NC specifically www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/waivers_faceted.html.
For more information on current qualification requirements, individuals should call their State Medical Assistance (Medicaid) office or visit Medicaid.gov. Eligibility for Medicaid is income based, and eligibility requirements and benefits vary from state to state.
What is the Traumatic Brain Injury (TBI) Waiver?
The Waiver is designed to provide a variety of community-based rehabilitative services and supports as an alternative to nursing facility care or specialty rehabilitation hospital care. The Waiver supports recovery and promotes choice, independence and community involvement. This is a pilot program managed by Alliance Behavioral Healthcare (Alliance) in four North Carolina counties (Durham, Wake, Cumberland and Johnston).
What is a Traumatic Brain Injury (TBI) and how is it different from an Acquired Brain Injury (ABI)?
A Traumatic Brain Injury (TBI) is caused by an external force to the brain which can result in impairments to cognition (thinking), physical functioning, behavioral and emotional functioning. Causes include but are not limited to:
- Motor vehicle crashes
- Gunshot wounds
- Occupational/recreational injuries
- Physical abuse/assault
- Military action
Only Traumatic Brain Injuries are covered under the TBI waiver.
An Acquired Brain Injury (ABI) is a broader classification of injuries to the brain that includes but is not limited to:
- Blood clots
- Toxic exposure
- Metabolic disorders
- Anoxia (injuries that may cause lack of oxygen to get to the brain)
Who may be eligible to participate in the TBI Waiver?
Adults with cognitive, behavioral and or physical support needs, who’s TBI occurred after their 22nd birthday and who need specialty rehabilitation hospital care or skilled nursing care and who meet financial eligibility requirements may be eligible to participate in this Waiver.
What kinds of services/supports are proposed to be provided for in the TBI Waiver?
The TBI Waiver offers support services that includes but is not limited to:
- Staff supports to enable you to live independently or in a group-living situation
- Personal care services
- Life-skills training
- Cognitive rehabilitation
- Home and/or vehicle modification
- Technology supports
- Occupational, physical and speech therapy
- Activities to do during the day or help in finding a job
- Family/caregiver support
What is Alliance Behavioral Healthcare and what is its role in the TBI Waiver?
Alliance is one of seven local management entity/managed care organizations (LME/MCO) in NC that contracts with the Division of Medical Assistance to administer specialty medical plans to people with mental health, intellectual and/or developmental disabilities, TBI, and substance use disorders. Each survivor participating in the TBI Waiver will receive the support of a TBI Care Coordinator from Alliance. Alliance’s role is to manage payment from the state to fund services for providers and includes:
- Determining whether services are medically necessary
- Developing individual support and treatment/care plans
- Coordinating care for members
- Identifying community resources
- Monitoring the quality of services delivered
- Paying providers in their network for delivering services
- Coordinating patient’s health insurance benefits
Where can I go to find out more information about the TBI Waiver?
The draft TBI Waiver application is available for review on the NC Department of Health and Human Services website at https://dma.ncdhhs.gov/search?search_api_views_fulltext=TBI. Additional information about the TBI Waiver is also available through the NC Division of Medical Assistance (DMA) at https://dma.ncdhhs.gov/.