Medicaid Acquired Brain Injury Waiver Program – Connecticut CT – MFP ABI TBI – WHAT IS THE?

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 ca

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