Alliance was selected by the NC Department of Health and Human Services to operate a pilot Waiver for Traumatic Brain Injury (TBI) in its four-county service region. The NC Department of Health and Human Services (DHHS) submitted the North Carolina TBI Waiver application the Centers for Medicare and Medicaid Services (CMS) on February 29, 2016.
The TBI waiver application has been approved by CMS for implementation in late summer, 2018. Access the NC Division of Medical Assistance press release for more information.
What is the TBI Waiver Program?
If you or someone you care about has a traumatic brain injury (TBI), the TBI Waiver Program is designed to provide community-based rehabilitative services and support to help with your recovery. This is a pilot program managed by Alliance Health in four North Carolina counties (Durham, Wake, Cumberland and Johnston). The services are provided in your own home and community, or in a group living setting – giving you choices and promoting your independence. Under this three-year pilot, 49 individuals will have the opportunity to participate in the TBI waiver the first year, 99 in the second and 107 in the third year.
Who may be eligible to participate in the TBI Waiver Program?
A TBI is defined as an injury to the brain caused by an external force that can result in impairments to cognition (thinking) and physical, behavioral and emotional functioning. Such an injury may have been caused by a motor vehicle accident, fall, gunshot wound, occupational/recreational injury, abuse or military action.
If you have cognitive, behavioral and physical support needs, your TBI occurred on or after your 22nd birthday, you need specialty hospital care or skilled nursing care, and you meet certain financial eligibility, you may be eligible to participate in this program.
If you have questions about eligibility call Alliance’s 24-hour Access and Information line at (800) 510-9132 and request information about the TBI Waiver. Callers should expect to experience a brief crisis screening initially.
What services are available through the TBI Waiver Program?
Support for survivors may include (but are not limited to):
- Staff supports to enable you to live independently or in a group-living situation
- Personal care services
- Life-skills training
- Cognitive rehabilitation
- Home and/or vehicle modification
- Technology supports
- Occupational, physical and speech therapy
- Activities to do during the day or help in finding a job
- Family/caregiver support
What is Alliance Health and what is its role in this program?
Alliance Health is a North Carolina organization that contracts with the Division of Medical Assistance (DMA) to administer specialty medical plans for TBI survivors in Wake, Durham, Johnston and Cumberland counties. Alliance manages a group of healthcare providers to provide services, and coordinates the care of survivors participating in the TBI Waiver Program. This includes identifying appropriate community resources, developing support plans, and coordinating benefits.
What do I do if I’m interested in learning more about the TBI Waiver Program and applying for it?
Simply call Alliance’s 24-hour Access and Information line at (800) 510-9132. Please specifically ask for information on the TBI Waiver. Callers should expect to experience a brief crisis screening initially. You may find other helpful information through the Brain Injury Association of North Carolina by calling 1 (800) 377-1464.
Alliance is in the process of determining and evaluating the provider network capacity for the services outlined in the waiver needed to meet the needs of individuals that will be participating in this TBI waiver.
If you are a provider interested in our current TBI service needs, please visit our Current Service Needs page.
Access our printable TBI Waiver flyer.
Access questions and answers from previous TBI Waiver Provider Listening Sessions. Also, we’d appreciate your feedback as we are preparing to procure services for the individuals that will be enrolled in the TBI Waiver. This feedback will be used in our evaluation of the network capacity.
The presentation provided at the Listening Sessions can be found below.
Disclaimer: Information, questions and responses may change as the TBI waiver has not yet been approved by CMS. Completion of the survey by providers is not intended as an endorsement of the quality of the service or provider, nor is it to be interpreted as a guarantee of a future contract, referrals, or business.
If you have questions, please reach us at [email protected]
For information on becoming a Medicaid provider in NC, please go to www.nctracks.nc.gov.