As we discussed last time, once the acute care period is over and the patient is stabilized, the resources available to the patient can substantially impact treatment and recovery. In a perfect world, every patient would have unlimited access to the best resources available to meet their needs. Ours unfortunately is not a perfect world.

The consequences of a traumatic brain injury are far reaching. Not only are there treatment costs associated with the recovery from the acute injuries, but there are the costs of long term care and supervision, the lost support to the family unit that the injured party previously contributed, the increased physical demands placed upon the caregivers and family of the survivor to meet the needs of their injured loved ones, and the family having to step into the breach of the role that the injured person previously contributed to the family.

This analysis will focus on governmental sources of funding for treatment and assistance to the traumatically brain injured.

B. Medicaid Medicaid is health insurance that helps people who cannot afford medical care pay for some or all of their medical bills. Medicaid is available based on income, and applies only to low income individuals and families who fit into the eligibility group recognized by Federal and State law. Medicaid is administered on a state-by-state basis. Medicaid pays money directly to the health care providers.

1. Medicaid Liens. Like private health professionals, Medicaid may assert a lien on any recovery for the monies which it has paid. However, to the extent that there are not enough monies in the recovery to pay every provider in full, Medicaid must share "pro-rata" with any unpaid medical providers pursuant to the requirements of N.C.G.S. 108A-57.

2. Medicaid waiver North Carolina has instituted certain waiver services allowed by statute. These are commonly known as Medicaid Waivers. The Waivers tend to be aimed at different target populations. a) NC-Community Alternatives Programs. This provides case management, respite, adult day health, in home aids, delivered meals, waiver supplies and home mobility aids to AIDs diagnoses for persons thirteen and older, HIV seroposivity and CDC classification of category A, B, or C for children aged 2 to 12 and HIV seropositivity for children up to age 2. b) NC-CAP Choice. This waiver provides adult day health, respite, personal assistant, telephone alert, home delivered meals, in-home health aids, home mobility aids, waiver supplies, consumer designated goods and services, care advice, and financial management services to individuals elderly and disabled. c) NC-Managed Behavioral Health Care Waiver This Medicaid waiver provides managed behavioral health care to the piedmont region. d) NC Community Alternatives Program for Children The program provides case management, personal care services, respite care, nursing services, home mobility aids and waiver supplies for disabled children aged 18 years or younger. e) NC-Community Alternatives Program for Disabled Adults. Provides case management, respite (in home and institutional), adult day care, day health care, home modifications, PERS, attendant care, waiver supplies and home delivered meals. f) NCMR/DD This Medicaid waiver provides case management, personal care, respite habilitation (day and in-patient), environmental modifications, transportation, specialized medical equipment and supplies, PERS, family training, in home aid, vehicle adaptations, crisis stabilization, developmental day care, therapeutic case consultation, supported living, augmentative communication, live-in caregiver and interpreter services to individuals with MR/DD.

Page 1 of 2 :: First | Last :: Prev | 1 2 | Next