Medicaid Managed Care Transitions’ Impact On Brain Injury Waiver Populations

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As of June 2015, 24 states utilize a traumatic or acquired brain injury waiver,1 as provided under section 1915(c) of the Social Security Act, which are designed to help individuals with traumatic brain injury (TBI) live in the community setting of their choice. The waiver services are intended to help an individual achieve maximum independence in the community, thus improving overall quality of life.

For the past decade, individual states have pursued unique and oftentimes novel approaches to managing their Medicaid population. However, as more states look to transition their Medicaid populations into managed care as a potential way to save money, several serious consequences have arisen, impacting the quality of care and the level of collaboration between providers and state officials. Through state-specific research, we found that as states look to incorporate waivers into their managed care models, rapid transitions have caused unnecessary disruptions for those with traumatic brain injury and negatively impacted the delivery of care. As a result, states that are interested in pursuing a managed care model should learn from the experience and lessons learned in other states. These lessons include easing vulnerable populations, such as TBI waiver populations, into managed care models in addition to conducting robust stakeholder outreach, which includes beneficiary, insurer, and provider education.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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