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Brain Injury HCBS Waiver - Iowa

The brain injury (BI) waiver pays for services for people with a specific brain injury diagnosis to allow them to return to the community from a medical institution. To be eligible for the brain injury waiver the person must meet all of the following requirements:

·           Have a diagnosis of brain injury. The Iowa Foundation for Medical Care (IFMC) will verify the brain injury diagnosis. (See: Qualifying Brain Injury Diagnosis)

·           Be eligible for Medicaid in one of the following coverage groups:

·                        SSI-related

·                        FIP-related

·                        Eligible under the special income level (300 percent) coverage group consistent with a level of care in a medical institution.

·           Be between the ages of one month to 64 years.

·           Be a resident of a medical institution at the time of application and live in the institution for 30 consecutive days before the initial waiver application.

·           Be determined by IFMC as in need of Intermediate care facility for the mentally retarded (ICFMR), Skilled nursing facility or Nursing facility level of care.

·           Be assessed by IFMC as able to live in a home- or community-based setting where all medically necessary service needs can be met within the scope of this waiver.

·           At a minimum, receive case management services each quarter, and use at least one unit of respite or supported community living services each quarter under this program.

·           Choose HCBS Brain Injury Waiver over institutional care.

·           Have an individual comprehensive plan completed annually. Individual comprehensive plan (ICP) means a written consumer-centered outcome-based plan of services developed using an interdisciplinary process that addresses all relevant services and supports being provided or proposed to be provided. The ICP is also known as a case permanency plan or individualized program plan.

The total monthly cost of brain injury waiver program services the person needs (as determined by the case manager, client, and interdisciplinary team) cannot exceed $2,650.

Number of Brain Injury waiver slots:

The number of people served under the brain injury waiver is subject to a limit based on the number of payment slots. The county of legal settlement and the state designate the number of people to be served under each waiver. The payment slots are on a county basis for adults at the Intermediate care facility for the mentally retarded level of care with legal settlement, and on a statewide level for all other adults and children. These slots are specific to the Brain Injury waiver.

When a slot is not available, the application for BI waiver will be denied. The applicant’s name will be maintained on the waiting list. As slots become available, people are selected from the waiting list based on their order on the list. The applicant must resubmit an application when a slot becomes available.

See Also:

·           HCBS Waivers Overview

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employee Manual

Title 8 Medicaid

·                        Chapter N, pages 25 & 29-31

Regulation citations: 441 IAC, Chapter 83, Division IV, 83.82(3) and 83.82(4)"a" and "b"

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