Home- and Community-Based Services: A Comparison of Brain Injury Waivers Across the United States.

Objective: Adults and children who experience brain injury may need services and support when they return to the community. Home- and community-based services waivers are one way to access those supports. Brain injury waivers do not exist in every state, and variations exist in current waivers. This article describes existing brain injury waivers and how they vary by state.

Design: States were included if their most recent waiver application was approved by the Centers for Medicare and Medicaid Services. States were excluded if waivers were terminated or expired. Data were collected by analyzing each state's waiver across the areas of diagnosis definition, ages served, self-direction, service setting, persons served, services offered, budget, and assistive technology. Statistical analysis included frequency and descriptive statistics due to the limited number of participants.

Results: Each state designs its own waivers. Differences exist in eligibility criteria, services provided, settings, and the rights of participants.

Conclusions: Analysis of the waivers showcased differences in all areas. These factors determine which brain injury survivors can receive services from specialized waivers, what services are available to them, where they can receive services, and what rights they can exercise.