To be eligible for the ABI Waiver II, individuals must be:
- Eligible for Medicaid
- Between ages 18 and 64 with an acquired brain injury
- Meet the DSS “Level of Care Requirement” which means that without the waiver services the individual would otherwise receive services in an institutional setting
- Able to participate in the development of a service plan in partnership with a DSS social worker or have a conservator to do so.
An ABI is an injury to the brain that has occurred after birth which results in improper brain function. The condition cannot be congenital, developmental, or degenerative to be considered for the ABI Waiver II.
Med-Connect applicants may also meet the financial eligibility rules for the program through the Medicaid for Employed Disabled coverage group. Under the program, working individuals can have income up to $75,000 per year, $10,000 in assets and receive Medicaid subject to payment of a monthly premium.
Individuals who cannot afford the cost of care, but are over Medicaid’s limits may still qualify. The state has a spend down program that evaluates an individual’s care costs and their income. If it is calculated that an individual cannot meet their care costs, they can qualify for Medicaid by spending-down their income over the limit on their medically-necessary care costs.
