Traumatic Brain Injury Fund
by: Thomas D. Begley, Jr.
The Traumatic Brain Injury Trust Fund is different from the Traumatic Brain Injury Medicaid Waiver Program. The Fund is administered by the New Jersey Department of Human Services, Division of Disability Services. The Fund pays, as a last resort, for the cost of post-acute care, services, and supports to New Jersey residents who have survived neurotrauma with a traumatic brain injury. There is a TBI Fund Review Committee that reviews requests for services and supports.
Expenditure Caps and Limitations
Services provided to an individual will not exceed a lifetime total of $100,000 nor an annual total of $15,000 for any 12-month funding year. The applicant may apply to the Fund for a waiver of those expenditure limits, if there is extraordinary hardship. Extraordinary hardship means loss of income, extreme medical need, or potential functional decline of the applicant.
Financial Requirements
To be eligible, the applicant must demonstrate:
- An inability to pay for the requested services. The applicant or his/her immediate family’s liquid assets shall not exceed $100,000, and those assets are otherwise committed or not available to fund the requested services. (Liquid assets include checking accounts, savings accounts, certificates of deposit, stocks, and bonds. Your home is not considered a liquid asset nor is your IRA or 401(k), unless you are of retirement age.)
- That there are no trust funds, settlements, gifts or donations for which the applicant is eligible and which are unavailable on a timely basis, to meet the applicant’s needs.
- That there are no other funds, insurance coverage, or public or private programs for which the applicant is eligible, to provide the requested care, services, or supports for the applicant in a timely manner.
Payment for services or supports rendered prior to the receipt of the formal committee approval shall be ineligible for reimbursement. The Fund shall have a lien on future monies received by the person, including a personal injury settlement or payment made in connection with the traumatic brain injury.
Residential Requirements
The applicant must be a resident of New Jersey for at least 90 consecutive days and a permanent resident of the United States.
Support Services
The following support services are available:
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Eligible Services
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| • Service coordination• Nursing services• Neuropsychiatric/Neuropsychological
evaluation • Medication management • Prescription medication • Behavior management • Substance abuse evaluation/treatment • Counseling services • Cognitive rehabilitation therapy • Physical therapy • Home modification
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• Occupational therapy• Speech therapy• Alternative therapy• Structured day program
• Life skills training • Vocational services • Educational service • Respite care • Medical care • Vision care • Dental care • Post-acute in-patient treatment • Protective legal services • Assistive technology |
• Personal care• Companion care• Housekeeping• Parental support
• Household management • Money management • Beneficiary/family education • Transportation/vehicle modification • Environmental modifications • Durable medical equipment and assistive technology • Housing support |
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Ineligible Services
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| • Acute medical care/emergency medicaltreatment• Motor vehicle
• Recreational drugs, alcohol or illegal substances • Vacations or entertainment • Services unrelated to the diagnosis or treatment of brain injury • Entertainment equipment • Food and meals • Services furnished by relatives |
• Medical Servicesexcept those itemized inthe list of eligible services• Services by unlicensed
providers • Furniture • Child care services • Legal services, except those under eligible legal services • Services provided by other government programs • Gifts
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• Payment for normalexpenses related to theoperation of a vehicle• Cable TV
• Internet services • Services needed by beneficiary’s family • Insurance coverage other than medical or pharmaceutical • Veterinary care • Consumable supplies associated with use of a computer |