Home and Community-Based Services for People with Brain Injury

What is “brain injury?”

There are several legal and medical definitions for “brain injury” (BI) or “traumatic brain injury” (TBI). For most social service programs in Minnesota, TBI includes any “sudden insult or damage to the brain or its coverings” as long as it happens after birth.

BI is a broader term that includes “acquired” brain injuries, like those caused by seizures, infectious diseases, or strokes. BI can also include degenerative diseases that cause cognitive damage like multiple sclerosis (MS). Recently, Minnesota has begun to use BI to describe the services available for persons with any brain injury sustained after birth.

What services can I get from Medical Assistance (MA)?

There are many programs that provide home and community-based services and supports for eligible people with BI disabilities. People with BI who qualify for Medical Assistance, may be able to get:

cognitive rehabilitation therapy
adult rehabilitative mental health services
home health aide and nursing services
various home health therapies
personal care assistant services
medical supplies and equipment, and
medical transportation services

Are there other support services available?

Minnesota has a “Family Support Grant” (FSG) program that provides state funds in the form of vouchers or direct payments to a vendor of up to $3,113.99 per year to families of children with certified disabilities. The goal of the FSG program is to prevent or delay out-of-home placement of children with disabilities and promote family health and social well-being by providing access to family-centered services and supports.

Note: you can’t get FSG and BI Waiver (see next section) at the same time.

There is more information about the FSG program at www.mn.gov/dhs. Apply at your local county agency.

Counties offer some home and community-based services through their “Vulnerable Children and Adults Act” programs. Check with your local county to see if it has programs or services specific to BI.
The Minnesota Department of Employment and Economic Development, Rehabilitation Services branch, also offers vocational services and supports.
You might also be able to get services through the “Essential Community Supports” program if you need help to live in the community. You have to meet certain eligibility rules. It is designed for people who don’t need the level of care provided in a nursing home. You may qualify for up to $452 a month for services and supports.

What is the BI Waiver?

The BI Waiver is the main program providing home- and community-based services for persons with BI. The BI Waiver is part of the Medical Assistance program. The Disability Services Division of the Minnesota Department of Human Services administers the waiver with help from county social service agencies.

The Waiver gives services and support, so people can live in the community and be more independent instead of in hospitals or nursing facilities.

The Waiver covers services and support that you might not be able to get under regular Medical Assistance. Both children and adults can use the waiver.

With the Waiver you can live in your own home or:

in a biological or adoptive family’s home
in a relative’s home
in a family foster care home
in a corporate foster care home
in a board and lodging facility
in an assisted living facility.

If you are married, you can get BI Waiver services while living at home with your spouse.

What services can I get with a BI Waiver?

It depends on your abilities and needs. The following are some services and supports available with a BI Waiver:

24-hour emergency assistance
Adult companion
Adult day service/Adult day service bath
Caregiver living expenses
Case management and case management aide 
Chores 
Community Residential Services
Consumer-directed community supports
Crisis respite
Customized living 
Day Support Services
Employment development
Employment exploration
Employment support
Environmental accessibility adaptations
Extended home care nursing
Extended Home Health Care Services
Extended personal care assistance
Family residential services
Family training and counseling
Foster care 
Home-delivered meals 
Homemaker 
Housing access coordination
Independent living skills therapies 
Independent living skills training
Individualized home support
In-home family support
Integrated community supports
Night supervision 
Personal support services
Positive support services
Prevocational services 
Respite 
Specialist services
Specialized equipment and supplies
Structured day program
Supported employment services
Transitional services
Transportation

These services can change often. Find a complete list and details on www.dhs.state.mn.us.

Who is eligible for the BI Waiver?

Eligibility depends on a screening process. To be eligible for the BI waiver, you must meet all these criteria:

Be on Medical Assistance (MA) or be eligible for MA
Have a documented diagnosis of:
- traumatic or acquired brain injury, or
- an acquired or degenerative disease where cognitive damage is present. But it cannot be “congenital” (present at birth)
Have significant/severe behavioral and cognitive problems because of the injury
Be under the age of 65 when you apply
Be certified as disabled by the State Medical Review Team or by the Social Security Administration
Need the kind of care you get in a nursing facility (NF) or neuro-behavioral (NB) hospital
Choose services in the community instead of services in a nursing facility or neuro-behavioral hospital
Be assessed at Level IV or above on the Rancho Los Amigos Levels of Cognitive Functioning Scale (this measures how a person functions after experiencing a BI).
The rehabilitation services could really help your situation. This is figured out through screening.
Need a higher level of service than you could get through other waivers because of cognitive and behavior impairments.

How do I apply for the BI Waiver?

Do I automatically get BI Waiver services if I am found eligible for the Waiver?

Usually, yes. The county will ask the following questions to be sure that you need waiver services:

Are the services necessary to ensure your health, welfare and safety?
Have all options been reviewed and does this option meet your needs and preferences?
Is the cost of the service considered reasonable and customary?
Is the service covered by any other funding source, like Medical Assistance state plan services, private health care coverage, Medicare, education or Vocational Rehabilitation Service funding?

What can I do if the county decides I am not eligible for the BI Waiver?

If your county refuses to assess you for the BI Waiver or says you are not eligible, and you disagree with them, you can ask for an administrative appeal with the Department of Human Services (DHS).

Ask for your appeal from the county or from the Appeals and Regulations Division of the Department of Human Services. You have to ask in writing and you have to ask within 30 days of getting the notice from the county that you were denied. You have 90 days if you have a good reason why.

How do I appeal?

There are different ways you can get your appeal in.

Online: You can fill out a form and submit your appeal online at https://mn.gov/dhs/.

There are instructions and the form. Read everything carefully, fill the form out completely and click "Submit" on the bottom right. It is a good idea to print a copy for yourself.

By mail or fax:
You can print out a blank form from the website or you can get one from the county. If you don’t want to use a form it is okay to just write a letter and mail or fax it. Say you want to appeal a decision and why. If you want to keep getting your benefits during the appeal, there is a time limit. See “How soon do I have to appeal?” below.

Make sure you put your case number and the date on your letter. Keep a copy for yourself. You can give the appeal letter to your county worker. You can also mail or fax your appeal to:

Minnesota Department of Human Services Appeals Office
PO Box 64941
St. Paul, MN 55164-0941

Fax (651) 431-7523