In the state of Kentucky, the Acquired Brain Injury Branch operates two 1915(c) HCBS Medicaid Waivers. Through these Acquired Brain Injury (ABI) waivers, adults with brain injuries receive the supports they need to live as independently as possible. The first, the Acquired Brain Injury (ABI) waiver, is for adults who require intensive rehabilitation after acquiring a brain injury to rehabilitate them back into the community. The second is the Acquired Brain Injury Long Term Care (ABI LTC) waiver, which is for individuals who require long term care to maintain their safety while living in the community.
Throughout this guide, we will walk you through the Acquired Brain Injury waivers, what they are and what services they cover, and how to apply for the waivers.
Applied Behavioral Advancements, LLC is one of the largest suppliers of Behavioral Support in the Commonwealth of Kentucky. Our clients come from all walks of life, with many needing financial assistance through Medicaid waivers. The Acquired Brain Injury (ABI) waiver is a fantastic way for individuals with acquired or traumatic brain injuries to access ABA Therapy and other services.
Please Note: There is currently a waitlist for the Acquired Brain Injury (ABI) waiver in the State of Kentucky. Because of this, ABA, LLC does not personally make any promises that any individual who applies will receive the Acquired Brain Injury (ABI) waiver will receive it.
What is the ABI waiver?
The Acquired Brain Injury (ABI) waiver is for adults who have acquired a brain injury who require intensive rehabilitation. The ABI waiver empowers these individuals to receive care that better prepares them to re-enter the community. Some of the services provided focus on external factors, such as providing funding for a person to modify their environment to be safer. Other services provided will focus on building skills for navigating life with a brain injury, like Adult Day Training, Companion or CLS support, and counseling. The ABI waiver is not meant for life long care, and participants who find that they need extended support may need to apply for services under the ABI TLC Waiver.
https://www.chfs.ky.gov/agencies/dms/dca/waivers/abibrochureenglish.pdf
What is the ABI TLC Waiver?
In light of varying recovery needs, the Acquired Brain Injury Long Term Care (ABI TLC) Waiver is for adults with an acquired brain injury who have plateaued in rehabilitation, and will require long term care to live in the community. The ABI TLC waiver exists as an alternative to institutionalization, where adults have an option to receive the care they need while living within their community.
https://www.chfs.ky.gov/agencies/dms/dca/waivers/abiltcbrochureenglish.pdf
What is an Acquired Brain Injury?
An Acquired Brain Injury defines any damage that occurs to the brain after birth, that is not related to a genetic, congenial, or hereditary cause. Essentially, it is defined as any kind of brain injury that occurs after birth. The cause of the injury might be traumatic, such as a fall or motor accident. However, it might be from a non-traumatic cause such as stroke, tumor, aneurysm, near-drowning, or inhaling of toxic chemicals.
Traditional Versus Patient-Directed Services
Participants in the Acquired Brain Injury (ABI) waiver services can choose to receive their non-medical, non-residential services through one of three different delivery styles:
Traditional services are provided through a provider agency. The agency will send an employee to deliver services.
Person Directed Services (PDS) enable the participant to hire their own employees to fulfill certain services. This puts the participant in the position of manager, and they must interview and select each of the employees they wish to hire. Some assistance is available in navigating the business decisions involved with this style of service delivery.
A participant may also choose to take a Blended approach, where they can receive services from both employees of a provider agency and employees that they personally have hired.
Eligibility
According to Kentucky.gov, you may qualify for medicaid waiver services if you…
- Have an acquired brain injury. There are exclusions. Read section seven of the ABI regulation or ABI LTC regulation for the list.
- Are age 18 or older
- Meet the requirements for residence in a nursing facility. These are defined in Kentucky Administrative Regulation 907 KAR 1:022
- Are expected to benefit from waiver services
- Meet the financial qualifications for Medicaid. There are special financial qualifications applied to the ABI and ABI LTC waiver programs. Read the Medicaid Waiver Services Fact Sheet for details.
Services and Supports Under the Acquired Brain Injury Waiver
Adult Day Training
Adult Day Training (ADT) is a type of service that enables clients to spend their days engaged in meaningful activities with a community of disabled individuals. Supported by a service team, individuals receive dynamic care with a focus on learning vocational, educational, and social skills. These programs often run during the day Monday through Friday.
Behavior Programming
For those with the Acquired Brain Injury (ABI) waiver, Behavior Programming utilizes the theories of Applied Behavioral Analysis to those who have a brain injury. A BCBA will create a behavior plan to help rebuild social skills and the ability to perform daily tasks through the use of interventions.
Companion
Companion services can provide compensation for an individual to have a non-medical in-home aide who helps with daily tasks. The companion does not perform tasks for the individual, but rather provides the necessary support for the individual to live as independently as possible.
Individual and Group Counseling
Delivered either one-on-one or in a group setting, ABI waiver recipients have the option to pursue traditional counseling. This will give participants the chance to address their concerns and work through their emotional health.
Environmental Modifications
Gives participants the ability to make modifications to their living environment to increase their safety and comfort. This could include enhancing accessibility and mobility with things like handrails, or the addition of a ramp.
Financial Management Services
Participants are provided with assistance in creating and implementing a financial budget, organizing mail, setting up automatic bill paying, and generally protecting finances.
Goods and Services
Provides compensation for equipment, services, or supplies that enhance independence and safety.
Occupational Therapy
Occupational therapy focuses on improving health and wellness through everyday tasks (occupations). This type of therapy will help Acquired Brain Injury (ABI) Waiver participants to overcome challenges posed by everyday living.
Personal Care
Many individuals require assistance performing daily personal care tasks such as bathing, dressing, grooming, daily chores, laundry, and meal planning and preparation. Under the Acquired Brain Injury (ABI) Waiver, individuals are connected to assistance with these tasks.
Respite
Under the Acquired Brain Injury (ABI) Waiver, Respite provides a temporary break for an individual’s primary caregiver. This care can happen either as a planned break, or in the case of an emergency.
Residential Services
Residential Services are often essential in recovery from a Brain Injury. This term can cover a range of services, ranging from inpatient rehabilitation to independent living programs. In general, these services provide structure in a residential environment to help ABI waiver participants adapt.
Specialized Medical Equipment
If outlined in the person’s plan of care, the cost of a device, control, or appliance that ensures a person’s health and welfare is covered by waiver services. This could include an assessment, partial nutrition supplements, special clothing, customizing a device, or training needed for learning new skills or operating new devices.
Speech Therapy
Speech Therapy can help restore a person’s ability to communicate, speak, and even swallow following a brain injury.
Supported Employment
Supported Employment gives individuals with a brain injury the opportunity to pursue employment in an integrated work environment. It guarantees they receive competitive wages and benefits for their contribution.
Adult Day Health Care (LTC)
Adult Day Health Care covers the implementation of specialized nursing services. Nursing services might include meals, supervision, scheduled daily activities, and routine.
Family Training (ABI LTC)
Family Training provides the relatives of Acquired Brain Injury Long Term Care (ABI TLC) waiver participants with counseling and training. It encourages family members to be informed on their relative’s condition, and even prepared to participate in their care.
Nursing Supports (ABI LTC)
Nursing Supports gives Acquired Brain Injury Long Term Care (ABI TLC) waiver participants with help from a nurse. The nurse may provide services like monitoring, managing medication administration, and training.
Physical Therapy (ABI LTC)
Physical Therapy is a treatment performed by a therapist that focuses on improving the body’s performance. This kind of therapy can help participants regain physical functions.
A Note on Applying for Medicaid
It is important to note that to be eligible for either of the Acquired Brain Injury waivers in Kentucky, you must first be approved for Kentucky Medicaid. These are two separate applications that you should plan to complete separately. We suggest that you apply for Medicaid before applying for the Acquired Brain Injury waiver, because you need to guarantee that you are eligible for the type of Medicaid that pays for Waiver Services. You can apply for yourself or someone else.
You may find it helpful to go over this checklist before applying for Medicaid:
Medicaid Enrollment Checklist.pdf
You can learn about applying for Medicaid at https://kynect.ky.gov/benefits/s/medicaid-kchip-program?language=en_US
How to Apply for the Acquired Brain Injury (ABI) Waivers
To apply for the Acquired Brain Injury (ABI) waivers, you need to apply for waiver-supported Medicaid.
Once you have finished your Medicaid Application and received either an approved or pending status, you should begin your application for waiver services. At this time applications by mail are not accepted. However, you are able to apply online or in person. You can apply for yourself or for someone else. After your application is submitted, you will receive a letter detailing whether or not the applicant qualifies and what steps to take next.
Before you begin your application, you may find it helpful to have the following documents handy:
- Identification
- Social Security number
- Income information
- Resource information
- Health insurance card and premiums
- Medical bills
- Proof of citizenship (if applicable)
- For the ABI waiver, you will need a MAP-10 document filled out by your family physician, with hospital discharge summary from the brain injury occurrence with CT or MRI results
- For the ABI LTC waiver, you will need a MAP-10 document filled out by your family physician along with medical records detailing a brain injury diagnosis.
Online:
Applying online is easy with the recently updated Kynect website. You will need to have a KOG (Kentucky Online Gateway) account to apply. However, if you do not have this already set up, do not worry, you will be able to sign up on the Kynect website.
Go to kynect.ky.gov on your computer, phone, or tablet. To get started, look for the purple Benefits icon towards the bottom of the page and choose Apply for All Programs. The application will guide you through the process of applying for waiver services.
In Person:
You can apply for the Acquired Brain Injury (ABI) Waiver and Acquired Brain Injury Long Term Care (ABI LTC) Waiver in person at a Aging and Disability Resource Center (ADRC) or a Community Mental Health Center.
Find an ADRC at https://chfs.ky.gov/agencies/dail/Pages/adrc.aspx or call (877) 925-0037.
Find a CMHC near you at https://dbhdid.ky.gov/cmhc.
For questions about Applying to the Acquired Brain Injury (ABI) waiver, please contact:
Department for Medicaid Services
(844) 784-5614
1915cWaiverHelpDesk@ky.gov
https://www.chfs.ky.gov/agencies/dms/dca/Documents/HowToApplyforWaiver.pdf