Individuals receiving HCBS/TBI wavier services must meet all of the following requirements:

1. Be atleast 16 years of age but less thatn 65* years of age.
   * However, if a person is receiving waiver services at age 65 and is still showing progression in their rehabilitation, special consideration may be given by the TBI Program Manager for them to remain on the waiver until a time when they no longer significantly benefit from Transitional Living Skills and Rehabilitation Therapies.
2. Be financially eligible for Medicaid as determined by SRS eligibility workers.
3. Have a Traumatic brain injury (TBI). TBI is an insult to the brain caused by an external physical force resulting in total or partial functional disability and/or psychosocial impairment. TBI may arise from blunt or penetrating trauma or from acceleration-deceleration forces and is often marked by partial or complete loss of consciousness. TBI does not apply to brain injuries that are congenital or degenerative, or to those induced by birth trauma. The TCM should seek proof of the TBI by means of medical records, Social Security information, or, as a last recourse, establish confirmation from a reliable source such as a spouse or parent.
4. Meet the Medicaid Long Term Care (LTC) threshold score for Traumatic Brain Injury based on an assessment completed with use of the TBI Uniform Assessment Instrument (TBI-UAI) and the accompanying TBI Assessment Addendum. The assessment tools must be completed by a certified TBI Targeted Case Manager.
   
   The scores must be: 1) 24 or above on the TBI Assessment Addendum, Parts 2 and 3; 2) OR 26 or above on the TBI UAI-LTC threshold;3) OR have a combined score of 25 from the TBI Assessment Addendum (parts 2 & 3)
   and the UAI-LTC threshold, AND answer “YES” to all questions in part I of the TBI Assessment Addendum.
5. Show the capacity for receiving rehabilitation in the form of Transitional Living Skills.
6. If 20 years of age or younger, must receive a KAN-Be-Healthy screening on a yearly basis.
7. If a traumatic brain injury is obtained prior to the age of 21, the individual may be considered developmentally disabled. Community Developmental Disability Organizations (CDDOs) are required to assess all persons with developmental disabilities for the MR/DD waiver.
8. For any consumer to be eligible for HCBS, they must be eligible for Medicaid. If a consumer fails to provide the necessary information to determine and verify Medicaid eligibility, and subsequently their Medicaid case is denied or closed, they are not eligible for HCBS services. In this instance, 10 days notice is not required for the closure of an HCBS case, as Medicaid will no longer pay for services. Services will not be reimbursed if the consumer does not have Medicaid eligibility.
9. If an individual with ongoing services fails to submit their annual financial eligibility paperwork to SRS by the due date, the eligibility worker will notify the individual and the TCM of the potential termination of Medicaid. Services will be suspended until eligibility is reinstated. The eligibility worker has the authority to reinstate services if all necessary paperwork is received within the month of closure or the following month. Should eligibility be reinstated during this time, the individual will have continued eligibility and will not be placed on the TBI waiver waiting list. If the required paperwork is not returned in the time allotted, they will no longer be eligible to receive services.

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