OPA: Acquired Brain Injury (ABI) Waiver Program

A Guide to the Department of Social Services Administered Acquired Brain Injury (ABI)

Waiver Program

 

What is the Acquired Brain Injury (ABI) waiver?

The ABI waiver is a program administered by Connecticut’s Department of Social Services, (DSS) and funded under a Medicaid Home and Community based services waiver.  The ABI waiver program provides a range of non-medical, home and community based services, to eligible individuals with an acquired brain injury, who would otherwise require placement in an institutional setting.

Who is eligible for the ABI waiver?

Ø Individuals with an acquired brain injury not associated with a developmental or degenerative disorder;

Ø Individuals between the ages of 18-64;

Ø Individuals who meet the DSS “Level of Care” requirement which states that without waiver services the individual would require care in either:

§  a nursing facility

§  an ABI nursing facility

§  a chronic disease hospital

§  an immediate care facility for persons with intellectual disability;

Ø Individuals, both with and without a conservator, who can actively participate in the program;

Ø Individuals who meet all the requirements of the DSS administered Medicaid program, including:

§ a gross income not to exceed $2202.00/month

§ countable assets not to exceed $1600 for a single adult, although certain protections and exceptions may apply.

If an individual’s gross income exceeds 200% of the federal poverty level, they will be required to contribute to the cost of services rendered under the waiver.

 

What are the limits of the ABI waiver?

The ABI waiver program is not an entitlement program, does not provide housing, and services may be limited based on available funding and program quotas.  The program also has “aggregate” and “individual” caps on service expenditures.         

Ø The individual cap ensures that the total cost of an individual’s service plan cannot exceed 200%of the state’s expenditure if the individual was placed, or remained in, institutional care.

Ø The aggregate cap ensures that at any given time, the total cost of services for all participants cannot exceed 75% of the state’s projected expenditures if all individuals had received institutional care.

 

What services are available under the ABI waiver?

There are 19 services available under the ABI waiver.  Some services may not be accessed in conjunction with other services.

Ø Case management- assistance to the individual in implementing and coordinating all sources of support and services to the waiver participant.

Ø Chore Services- services needed to maintain the participant’s home in a sanitary and safe condition.

Ø Cognitive/Behavioral Programs- individualized programs to decrease severe maladaptive behaviors that would jeopardize the participant’s ability to remain in the community.

Ø Community Living Support Services- supervised living in a community residential setting which provides up to 24 hour support services.  Services may include medication management, self care, interpersonal skills, etc.

Ø Companion Services- non-medical care, supervision, and socialization services that have a therapeutic goal as noted in the participant’s services plan.

Ø Environmental Accessibility Adaptations- physical adaptations to the participant’s home to ensure the participant’s health and safety, and to promote independence.  Services may include ramp installation, bathroom modifications, doorway widening, etc.

Ø Family Training- training and counseling for individuals who live with or provide care to the waiver participant.

Ø Habilitation- services provided outside the participant’s home, to assist the participant with obtaining or enhancing adaptive, socialization, and self-help skills to live successfully in the community.

Ø Pre-Vocational Services- services designed to prepare the participant for employment when the participant is not expected to be able to work, or participate in a transitional work program, within 1 year.

Ø Supported Employment Services- Paid employment with intensive supports provided in a variety of settings, for participants unlikely to secure competitive employment.

Ø Homemaker Services- General household activities including meal preparation, vacuuming, etc.

Ø Home Delivered Meals- Meals delivered to the participant when the person responsible is unable to do so.

Ø Independent Living Skills Training- Services designed and delivered on an independent or a group basis to improve the participant’s ability to live independently in the community.  Services may include training in self care, medication management, mobility, etc.

Ø Personal Care Assistance- Assistance with activities of daily living.  These services may be provided by a family member of the participant if they meet the training requirements established by DSS.

Ø Personal Emergency Response Systems- Electronic Devices that enables individuals at a high risk for institutionalization to obtain help in an emergency.

Ø Respite Care- To provide short-term assistance to the participant if a caretaker is absent or in need of relief.

Ø Specialized Medical Equipment and Supplies- As specified in the participant’s service plan that will enable the individual to perform activities of daily living.

Ø Substance Abuse Programs-Interventions to reduce or eliminate the use of alcohol or drugs by the participant.

Ø Transitional Living Services -Individualized, short-term, residential services providing up to 24 hour support provided only once in the participant’s lifetime.

Ø Transportation-Mobility services offered after exhaustion of all other resources.

Ø Vehicle Modification Services- Alterations made to the vehicle that is the participant’s primary mode of transportation to avoid institutionalization.

 

How are services coordinated under the ABI waiver?

If a person is deemed eligible for the ABI waiver, a DSS social worker will work with the individual with the brain injury, and the individual’s interdisciplinary Person-Centered team to develop a Service Plan.  The team consists of the individual with the brain injury, who is the essential person in developing his/her service plan, the individual’s conservator as applicable, a neuropsychologist familiar with the individual, other necessary clinical staff, and any other person(s) chosen by the participant.  The Service Plan will contain an individualized selection from the above services, which will enable the participant to live in the community.  The participant’s level of care and Service Plan are reviewed at least once per year, and may be revised as necessary.  The participant in the ABI waiver program is given free choice of all qualified providers of each service specified in the Service Plan.  Providers of ABI services must meet DSS qualification standards, and be listed in the DSS ABI Provider Registry maintained by Allied Community Resources, Inc.

 

What Can I do if I am Denied the ABI Waiver?

Although the ABI waiver is not an entitlement program there is a formal Fair Hearing Process.  An individual may request a formal hearing if:

  • DSS did not offer an individual with a acquired brain injury the choice of home and community based services as an alternative to their present living situation of residing in either a nursing facility, an ABI nursing facility, a chronic disease hospital, or an immediate care facility for persons with intellectual disability;
  • DSS does not determine financial eligibility within “the standard of promptness” of 45 days;
  • DSS denies the application for any reason other than limitations on the number of participants who can be served, or funding limitations;
  • DSS disapproves the participant’s Service Plan;
  • DSS denies or terminates a service the individual has chosen;
  • DSS denies or terminates payment to the qualified provider of the participant’s choice;
  • DSS discharges the participant from the waiver program;

 

Where Can You Obtain Additional Information and Assistance?

The Connecticut Office of Protection and Advocacy for Persons with Disabilities operates the PATBI (Protection and Advocacy for Persons with Traumatic Brain Injury) program in Connecticut through a federal grant from the United States Department of Health and Human Services.  The PATBI program provides FREE individualized advocacy assistance to individuals with TBI.  You can connect with the PATBI program in one of the following ways:

 

  • Call the Office of Protection and Advocacy for Persons with Disabilities at (860) 297-4300 (Voice), (860)297-4380 (TTY), or toll free at 1-800-842-7303 (V/TTY) CT only.
  • Fax the Office of Protection and Advocacy for Persons with Disabilities at (860) 566-8714.
  • E-mail the Office of Protection and Advocacy for Persons with Disabilities at OPA-Information@CT.gov

For additional information on OPA programs, services, and publications please visit the OPA website at: www.ct.gov/opapd

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Created 1/18/07



Content Last Modified on 2/27/2014 1:01:12 PM