Abstract
Traumatic brain injury (TBI) is a significant injury resulting in devastating effects that can last a lifetime. It is reported that over 250,000 California residents had a non-fatal emergency department visit related to TBI in 2014 (CDPH, 2016). Individuals with TBI are a significantly underserved population in California and for those with Medicaid as their primary health insurance, there are very few options for long-term services and supports (LTSS) (DMH, 2010). Those in need of LTSS are left to navigate a fractured system of service providers attempting to piece together an effective treatment plan (Cusick et al., 2003). Current law directs the California Department of Health Care Services (DHCS) to implement a Medicaid program designed to serve individuals with TBIs (Feuer, 2007; Monning, 2009), but this program has yet to be implemented. The purpose of this project was to determine what is needed for California to comply with the law and implement a Medicaid TBI program. Through extensive research and interviews with California Department of Rehabilitation (DOR) staff it was determined that there is a lack of funding to implement and sustain a Medicaid TBI program. Regardless of the current lack of funding, California still has an opportunity to make TBI a priority and advocate for the legislature to appropriate the necessary funding. This project provides a concept paper (Attachment C) in a format that is usable by advocates to demonstrate the need of a Medicaid home and community-based services (HCBS) waiver for individuals with TBI to state legislators. The concept paper also recommends an overall program structure that would establish a continuum of care and provide the services necessary to significantly improve the overall health and quality of life for individuals with TBI.