Book Appointment Now
TBI Waiver Services in New York
The Traumatic Brain Injury (TBI) Medicaid Waiver is a Home and Community-Based Services (HCBS) program, administered by the New York State Department of Health (DOH), helping people recovering from a brain injury get the right support to live safely at home.
What Is the TBI Waiver?
The Traumatic Brain Injury (TBI) waiver is a Medicaid program administered by the New York State Department of Health (DOH). It is designed for people who have experienced a traumatic brain injury and need a nursing home level of care, but want to receive that care at home or in their community instead.
TBI waiver services are built around your specific recovery needs, from rebuilding daily living skills to emotional support during a major life transition. The goal is to help you regain as much independence as possible while staying connected to your home and community.
What's Included
Service Coordination (SC)
Your service coordinator builds a personalized plan, connects you with the right providers, and helps you access the services you need to remain in, or return to, community living.
Independent Living Skills Training (ILST)
One-on-one support to rebuild the daily living skills that may have been affected by a brain injury, from managing a household to daily routines.
Community Integration Counseling (CIC)
One-on-one counseling for TBI waiver participants adjusting to life changes, including a transition from a hospital or nursing facility. Counselors help you cope emotionally and coordinate with your other providers.
Home and Community Support Services (HCSS)
Available under the TBI waiver: support with daily activities and supervision at home, coordinated as part of your service plan.
Structured Day Program
Available under the TBI waiver: structured, supportive daytime programming that helps build skills and community connection.
Assistive Technology & Environmental Modifications
Available under the TBI waiver: equipment and home modifications that make it safer to live independently, coordinated as part of your service plan.
Ready to Talk Through Your Options?
How the TBI Waiver Process Works
Getting started with TBI waiver services involves a few clear steps. Here is what the process generally looks like:
1. Reach Out for a Free Consultation
We will talk through your situation and help you understand if the TBI waiver may be a fit.
2. Confirm Medicaid & Waiver Eligibility
Eligibility is generally based on a diagnosed traumatic brain injury, Medicaid enrollment, and level of care needs.
3. Get Matched With a Service Coordinator
Your coordinator gets to know your needs and builds an Individualized Service Plan (ISP) with you.
4. Services Are Authorized & Begin
Once your plan is approved, services start, and your team checks in regularly to make sure your plan still fits your life.
TBI Waiver vs. NHTD vs. PCA — Which Program Fits?
The TBI Waiver, NHTD, and Personal Care Assistance (PCA) are often confused because they all support people living at home instead of in a facility. Here’s a plain-language side-by-side to help you get oriented.
| Program | Generally Serves | Typical Focus |
|---|---|---|
| TBI Waiver | Individuals with a traumatic brain injury who need specialized, coordinated support to live in the community | Rehabilitative and community-support services tailored to brain-injury recovery and daily functioning |
| NHTD Waiver | Adults with disabilities and seniors who meet a nursing-home level of care but want to live in the community instead of a facility | Community-based services built around an individualized service plan |
| PCA / Personal Care Assistance | People who need hands-on help with everyday activities but not full nursing-home-level care | Direct, hands-on personal care in the home |
PCHS provides services under the TBI Waiver, NHTD, and PCA. If you’re not sure which pathway fits your situation, our team can help you sort that out.
Common Situations Where the TBI Waiver May Help
Every recovery after a brain injury looks different, and this list isn’t a checklist for determining eligibility — it’s meant to help you recognize when it might be worth a conversation.
You might consider starting a conversation about the TBI Waiver if you’re noticing:
- A traumatic brain injury that continues to affect memory, communication, or day-to-day functioning
- Difficulty with behavior regulation, planning, or safety awareness since the injury
- A need for coordinated rehabilitative and support services — such as service coordination or structured community-based support — to live safely at home
- A hospital or rehab discharge plan that mentions community-based waiver services as a next step
- A situation where family or informal caregiver support alone isn’t enough to meet day-to-day needs safely
This list is for informational purposes only and is not medical advice, and it is not a medical diagnosis or an official eligibility determination. TBI Waiver eligibility is determined by New York State based on a documented brain injury and a formal assessment process. If this sounds like your situation, the next step is a conversation — with a physician, a Medicaid service coordinator, or our team — to find out for sure.
Getting Ready to Apply: What Families Typically Have on Hand
Every TBI Waiver application moves through New York State’s process, and your care team will confirm exactly what’s needed for your specific situation. As a general starting point, it helps to have the following ready:
- Proof of current NY Medicaid enrollment (or documentation that an application is underway)
- Basic identification — photo ID and proof of date of birth
- Medical and hospital/rehab records documenting the brain injury and its ongoing effects
- Contact information for your current doctor(s), rehab team, or hospital discharge planner
- A general sense of daily support needs — what kind of help, how often, and from whom
- Any existing service or discharge plan that references community-based waiver services
Not sure what applies to your specific situation? Our team is happy to walk through it with you before anything gets submitted.
Not Sure Which Program Fits? Start Here
TBI, NHTD, and PCA all support people who want to stay in their own home or community — but they’re built for different situations. As a quick starting point:
- If you or a loved one has a traumatic brain injury and needs specialized rehabilitative and coordinated support to live in the community, the TBI Waiver is generally the more direct starting point.
- If nursing-home-level care needs exist without a brain injury being the primary driver, NHTD may be the better starting point — see our NHTD page for more detail.
- If the main need is everyday hands-on help — bathing, dressing, meal prep, mobility — without nursing-home-level needs, Personal Care Assistance (PCA) might be the simpler fit.
This is just a starting point, not an official determination of which program you qualify for — the fastest way to know for sure is to talk with our team. You can also try our free NHTD/TBI eligibility checklist first, on your own time.
Frequently Asked Questions
What is the TBI waiver?
The TBI (Traumatic Brain Injury) waiver is a New York State Medicaid program, administered by the Department of Health, that helps people recovering from a brain injury receive care and support at home instead of in a nursing home.
Who can benefit from TBI waiver services?
People who have experienced a traumatic brain injury and need ongoing support with daily living, rehabilitation coordination, or community integration may benefit from TBI waiver services.
How do I access TBI services with Priority Cares HS?
Call us at (718) 400-6166 or use our online contact form. We will help you understand eligibility and walk you through next steps.