Frequently Asked Questions

WHat is the TBI Waiver?

The Traumatic Brain Injury (or TBI) Waiver is a program offered by the New York State Department of Health that provides services to those people who have been diagnosed with an acquired brain injury and who are eligible for a nursing facility level of care. The goal of the program is to support those individuals to live in community-based settings and achieve maximum independence. For more information on the TBI Waiver, click here.

What is the nhtd waiver?

The Nursing Home Transition & Diversion (or NHTD) Waiver is a program offered by the New York State Department of Health that provides services to those people who are elderly or physically disabled and who are eligible for a nursing facility level of care. The goal of the program is to support those individuals to live in community-based settings and achieve maximum independence. For more information on the NHTD Waiver, click here.

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Which program is right for me?

If you are between the ages of 18 and 64, have a diagnosis of an acquired brain injury and have been assessed to need a nursing facility level of care as a direct result of your brain injury, then you may be eligible for the TBI Waiver Program. If you are between the ages of 18-64 with a diagnosed physical disability and have been assessed to need a nursing facility level of care as a direct result of that disability OR you are age 65 or older and have been assessed to need a nursing facility level of care, then you may be eligible for the NHTD Waiver program.

who pays for these services?

Traditionally New York State Medicaid pays for all TBI & NHTD Waiver services. In order to receive these services through the New York State Department of Health, the recipient needs to have and maintain active New York State Medicaid coverage. Some agencies, including FLXCC, will enter into agreements with a Worker’s Compensation insurance company to pay for an individual’s services. Some agencies, including FLXCC, will also accept private payment for services. For more information on these options, please contact us.

what if i make too much to be eligible for medicaid?

If your monthly income is over the Medicaid level, you may still be able to get Medicaid coverage to pay for your waiver services. The amount your income is over the Medicaid level is called “excess income.” It is like a deductible. If you are eligible for Medicaid except for having excess income and you can show that you have medical bills equal to your excess income in a particular month, Medicaid will pay your additional medical bills beyond that for the rest of that month. This includes outpatient care, doctor and dental visits, lab tests, prescription drugs, and long-term care in the community such as the waiver programs, home care and assisted living. For more information on the Medicaid Excess Income Program, click here.

What is the process to get enrolled in one of the waiver programs?

The first step is the contact the Department of Health’s Regional Resource Development Center (RRDC) for the county you will be living in when you’re enrolled in your waiver program. For those individuals who will be living in Broome, Chemung, Schuyler, Steuben, Tompkins or Tioga counties, you will contact the Southern Tier Independence Center (STIC) at 607-724-2111 and ask to speak with a representative from the TBI or NHTD Waiver Program. A representative from the waiver program will come out and meet with you and your family and supports to talk more about the program, the services available and supply you with a list of Service Coordination providers for you to interview and choose to help you complete the waiver enrollment process. For more information on STIC, please click here.

what can my service coordinator do for me?

Initially, your Service Coordinator will be the person with whom you and your family work to complete the waiver enrollment paperwork for approval by the RRDC. You should talk to you Service Coordinator openly and honestly about your needs and the services and supports you will need in order to be safe in your own home. Your Service Coordinator will then refer you to other waiver providers and local agencies to meet your needs and to ensure your safety at home. Once you’re approved for the waiver program, your Service Coordinator will meet with you at least once a month face-to-face to talk about your health, your services and your satisfaction with your providers. As your needs change, you Service Coordinator will be the one to recommend and refer you to new services or work with you, your providers and the RRDC to amend your currently approved services. Your Service Coordinator is an advocate for you, your health and safety, your satisfaction, your wishes and your overall well-being.

What is my service coordinator not able to to?

Your Service Coordinator is there to help you navigate the service delivery systems in your area and through the waiver. Their primary role is to link and refer you to those services and supports required to keep you healthy and safe. They are not able to provide direct services to you such as personal care, formal counseling or transportation.

why doesn’t flxcc just provide all the services i need so i can do a “one-stop-shop?”

FLXCC is the first local agency to offer Conflict-Free Service Coordination through the TBI and NHTD Waivers. “Conflict-free” means that the only service we provide through the waivers is Service Coordination. This allows us to assess your needs and coordinate services for you that are separate from our own agency. This eliminates any biases and ultimately promotes your choice and independence.

what do i do if i’m not satisfied with a provider?

Both the TBI & NHTD Waiver Programs are centered around independence, choice and personal satisfaction with service providers. If you are not feeling completely satisfied with any of your providers, talk to you Service Coordinator right away. They will help you by contacting the provider, if you do not feel comfortable doing so, and mediating a solution.

what do i do if i’m not satisfied with my service coordinator?

Your Service Coordinator is a key component of your care team. You need to feel confident in them and their ability to meet your needs in a timely and professional manner. If for any reason you are dissatisfied with your Service Coordinator’s performance, we encourage you to talk to their supervisor about the situation. Each waiver participant is given a Service Provider Contact List with each provider’s supervisor’s name and contact information. If you are not comfortable with addressing your concerns with your Service Coordination provider agency, then we encourage you to contact a waiver representative at the RRDC to help resolve the situation.