Adults with Brain Injury

Overview

MaineCare (Maine's Medicaid Program) has services available to qualifying individuals 18 years and older, who have sustained an acquired brain injury.

MaineCare defines a qualifying acquired brain injury as an insult to the brain resulting directly or indirectly from trauma, infection, anoxia, or vascular lesions, and not of a degenerative or congenital nature, but which may produce a diminished or altered state of consciousness resulting in impairment of cognitive abilities and/or physical functioning. It can also result in the disturbance of behavioral or emotional functioning.

These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment. This does not include brain injuries that are induced by birth.

Services

The State of Maine offers the following services: The Brain Injury Waiver, Outpatient Neurorehabilitation Services, and Nursing Facility Acquired Brain Injury Services. Each service has an assessment to determine an individual’s functional and financial eligibility.

Family Trainings

How to Apply: Brain Injury Waiver Services

Step 1. If you are not already receiving MaineCare Benefits, please apply for MaineCare Services. You must complete a Long Term Care Application.

Step 2. As part of the application process you will need to submit documentation from a qualified neuropsychologist and/or a licensed physician who is Board certified or Board eligible in Physical Medicine and Rehabilitation stating that the waiver services are medically necessary. The documentation for medical necessity must confirm the following:

Step 3. Applications can be mailed or faxed. Fax your application to (207) 287-9229. Mail your application to:

DHHS- OADS
Attn: Brain Injury Case Coordinator
41 Anthony Avenue, SHS #11
Augusta, Maine 04333-0011

Please call (207) 287-9200 and ask to speak to a Brain Injury Case Coordinator to ensure your application has been received.

Step 4. Once a completed application has been received, a referral is made on the individual's behalf to Maine's Assessing Services Agency. There is no charge and the assessment is private. If the Assessing Services Agency determines that a face-to-face assessment is needed, you will be contacted by an assessor to schedule the assessment.

Step 5. Once the assessment is completed, you will receive a medically eligible determination. Medical eligibility does not ensure you have funding under the waiver program. You will be contacted by letter and or telephone if you have a funded offer under the Brain Injury Waiver. A funded offer does not guarantee that services will start. Services are dependent on a service provider being able to provide the necessary services and accepting the applicant into their program.

How to Apply: Outpatient Neurorehabilitation Services

Services Offered: Assessments, physical therapy, occupational therapy, speech and language therapy, recreation therapy, and community re-integration.

Step 1.  Set up an appointment for a Clinical Assessment at a qualified clinic.  MaineCare will reimburse for the Clinical Assessment to confirm the diagnosis of brain injury, even if the member is not found eligible for MaineCare Outpatient Neurorehabilitation Services.

Step 2.  If you are found eligible, the clinic will set up an outpatient rehabilitation program for you.

How to Apply: Acquired Brain Injury Nursing Facility Services

Step 1. Apply for acceptance to a nursing facility that is qualified to provide acquired brain injury services. The two facilities in Maine that provide Acquired Brain Injury Nursing Facility services are Brewer Center for Rehabilitation and RiverRidge.

Step 2. If you have not already had a functional assessment by Maine's Assessing Services Agency, please contact 1-833-525-5784 (phone) or 1-844-356-7500 (fax). You will be asked questions regarding the level of support needed and the financial circumstances of the person being assessed. The Assessing Services Agency then decides if a face-to-face assessment will be needed. There is no charge, and the assessment is private. If the Assessing Services Agency determines that a face-to-face assessment is needed, you will be contacted by an assessor to schedule the assessment.

A face-to face assessment may be performed by a Registered Nurse in your home, in the hospital, or in a nursing facility. The nurse uses a laptop computer to collect the information to complete the assessment. The nurse will ask about the tasks you can do by yourself, what medications you take, what support you need, whether you have friends and family members or neighbors who can help you, what your income is, and other questions. You may request that a family member or other person be present during the assessment.

Step 3.  You will need to submit documentation from a qualified neuropsychologist and/or a licensed physician who is Board certified or Board eligible in Physical Medicine and Rehabilitation. The documentation must confirm that the nursing services are medically necessary and include the following:

  • Positively indicate that the individual is not in a persistent vegetative state;
  • Demonstrate that the individual has potential for physical and/or behavioral and/or cognitive rehabilitation;
  • Show evidence that the individual has moderate to severe behavioral and/or cognitive and/or functional disabilities; and
  • Result in specific rehabilitation goals, based on the findings of the assessment, describing types and frequencies of therapies and expected outcomes and timeframes.