What is a waiver program?
Medicaid Waivers are developed by States to help provide services to people who would otherwise be in a nursing home or hospital to receive long-term care in the community. Although there are waivers for many conditions, our focus is towards waivers for people with traumatic brain injuries and those transitioning out of nursing homes into the community.
The 1915(c) waiver, the "Home and Community-Based Services Waiver" (HCBS) enables States to tailor services to meet the needs of a particular target group. Eligible individuals must demonstrate the need for a Level of Care that would meet the State's eligibility requirements for services in an institutional setting.
Gallub Services for TBI
TBI & NHTD Waiver Programs
Gallub Services for TBI offers services under the TBI & NHTD Waiver Programs assisting individuals with regaining cognitive skills, coping with emotional issues related to their brain injury, illness or deficits, increasing appropriate social behavior, and improving their overall quality of life.
What is covered?
States can offer a variety of unlimited services under an HCBS Waiver program. Programs can provide a combination of standard medical services and non-medical services. Standard services include but are not limited to: case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care. States can also propose "other" types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.
Nursing Home Transition and Diversion Medicaid Waiver Program
The New York State Department of Health (DOH) Nursing Home Transition and Diversion (NHTD) waiver program is funded by Medicaid and provides supports and services to assist individuals with disabilities and seniors toward successful inclusion in the community. Waiver participants may come from a nursing facility or other institution (transition), or choose to participate in the waiver to prevent institutionalization (diversion). NHTD Waiver services can only be provided to eligible individuals whose application has been approved. An individual applying to participate in the waiver must meet all of the following criteria in order to be approved for the NHTD waiver:
- Be a recipient of Medicaid coverage that supports community-based long-term care services.
- Be between age 18 and 64 with a physical disability, or age 65 and older upon application to the waiver. NOTE: Because eligibility is restricted to individuals with physical disabilities, additional information may be needed to verify the existence of such a disability.
- Be assessed to need nursing home level of care.
- Have an approved plan of available services that reflects the services you need in order for you to live safely in the community.
- Be able to identify the actual location and living arrangements in which the waiver participant will be living when participating in the waiver.
For more information about eligibility criteria or becoming a waiver participant got to www.health.ny.gov
Traumatic Brain Injury Medicaid Waiver Program
The New York State Department of Health (DOH) Traumatic Brain Injury (TBI) waiver program is funded by Medicaid and provides services to persons with a TBI. The purpose of the program is to help individuals with a TBI live in the community setting of their choice. An individual applying to participate in the waiver must contact the Regional Resource Development Specialist (RRDS) in the region he/she chooses to reside. An individual applying to participate in the waiver must meet all the following criteria:
- Be a recipient of Medicaid coverage that supports community based long term care services.
- Have a diagnosis of TBI. NOTE: Individuals who experience deficits similar to TBI as a result of anoxia, toxic poisoning, stroke, or other neurological conditions may also be eligible. Individuals with gestational or birth related difficulties such as cerebral palsy or autism or who have a progressive degenerative disease are not eligible for the waiver.
- Be between the ages of 18 and 64 upon application to waiver.
- Be assessed to need nursing home level care.
- Have an approved plan of available servces that reflects the services you need in order for you to live safely in the community.
For more information about eligibility criteria or becoming a waiver participant go to www.health.ny.gov