The Importance of Medicaid and Medicare for People With Traumatic Brain Injuries

Steve Bazin
Aug 8
6 min read

Over my 25-year career leading programs for people with developmental and intellectual disabilities, I have had numerous opportunities to work with and understand the specific and special needs of people who live with Traumatic Brain Injury (TBI). Just as no two disabilities, medical or mental health conditions are the same, no two people with TBI are exactly alike either. There may be specific characteristics and challenges that are associated with TBI, but no two people are identical in how their brain injury affects them. I began writing this article in April, a month dedicated to Brain Injury Awareness — a cause that became deeply personal when my dad suffered his own traumatic brain injury that same month.

On April 28, 2011, my dad celebrated his 73rd birthday. He had cake and ice cream with my wife and I and our two children, and we went home at about 9 pm. In the middle of the night, my dad was coming up from the basement, and he lost his balance and fell backward about half-way down the stairs resulting in a spiral fracture of his right arm, six broken ribs, two fractured cervical vertebrae and a closed head injury. His bones all healed just fine, and physically my dad was as strong as ever. But here is the thing about brain injuries, regardless of a full physical recovery, more than 50% of moderate to severe head injuries still result in chronic disability and life changing issues. My dad’s severe head injury was no different.

The CDC reports that there are approximately two million Traumatic Brain Injuries (TBI) each year in the United States. Currently there are over 5.3 million people who have had a TBI and a related long-term disability or disabilities. The CDC also reports that at least 100,000 people die each year from the injuries and complications resulting from TBIs. Falls are the most common cause of TBI in people over the age of sixty-five while motor vehicle accidents, including automobiles, motorcycles, snow mobiles and all-terrain vehicles, are the leading cause of TBI in people younger than sixty-five. In addition, the Brain Injury Association of America reports that sports-related injuries account for 300,000 brain injuries each year worldwide. While many people associate brain injuries with trauma or impact, TBIs can also be attributed to neurological conditions, such as stroke or aneurysm, due to loss of oxygen flow to the brain.

Just as the cause of TBI can be physical or neurological, the outcome of a TBI also varies. The most common outcomes of TBI, according to The Brain Injury Association, include physical disabilities such as mobility issues, loss of hand/eye coordination and other motor coordination. The loss of motor coordination can result in a complete inability to ambulate and/or not being able to speak and communicate, requiring physical therapy to retrain a person how to walk or speech therapy to re-learn how to talk and communicate again. Other TBI outcomes may result in cognitive or behavioral/emotional issues, also requiring counseling or therapy, and chronic neurological conditions such as seizures or repeated brain bleeds that could be life-long disorders. These disabilities, even with therapy and treatment, can range from temporary to permanent or anywhere in between.

According to a National Institutes of Health Study published in 2016, 490,258 people are treated for Traumatic Brain Injury through Medicaid each year leading to Medicaid Expenditures of more than $8 billion dollars for TBI cases alone (see table below). The cost of treatment for TBI is one of the greatest consequences, and my father’s case is no different. After he was taken to the hospital, my father spent ten days there, and that was only his initial contact. He then spent 45 days in the hospital’s rehabilitation facility where he received intensive physical, speech and occupational therapy. He was released from rehab in the middle of June 2011, just under two months from his initial admission to the hospital, but his medical, mental health and other treatments did not stop upon his release. At home, his needs included physical, speech and occupational, and balance therapy. He also continued treatment with a neurologist every three months for more than a year. This does not include the three or four times he fell that first year and bumping his head due to his new loss of balance resulting in emergency room visits for CT scans.

	Low- AIS severity 1 and 2	Middle- AIS severity 3	High- AIS severity 4, 5, and 6	Severity not Assigned	Head Injury Unspecified
Medicaid Cases	87,427	22,204	4,269	41,501	334,857
Medicaid Costs	$612,886,875	$288,538,316	$121,541,290	$1,806,243,043	$5,163,615,489

Number of Traumatic Brain Injuries Covered by Medicaid in 2016 And Total Estimated Annual Healthcare Cost Attributable to TBI (n*Per Patient Cost)

Now imagine going through all this treatment and therapy without any kind of insurance coverage. This is why I am thankful for government programs such as Medicaid. A person with a debilitating TBI qualifies as disabled and as such is eligible for Medicaid programs like Indiana’s Hoosier Care Connect (HCC), Colorado’s Brain Injury Waiver through their Long-Term Services and Supports, and Illinois’ Home Services Program. In Indiana, Hoosier Care Connect covers any qualifying disability, including TBI, because of the long term and chronic conditions associated with a moderate to severe brain injury. Some Medicaid recipients, who have had a TBI and have severe medical conditions due to the brain injury, qualify for the Traumatic Brain Injury Waiver through Medicaid Home and Community Based Waiver Programs. The TBI waiver is a Home and Community Based Program that allows an individual who meets a Nursing Home Level of Care requirement to receive support that would allow them to live in their community as independently as possible. If a person with a brain injury does not need the type of services or care that one would traditionally receive in a nursing home, they would not qualify for the TBI waiver but may still be eligible for Medicaid coverage under HCC.

In addition to coverage for cost of treatment, many states offer special programs that allow people to work and make a better living without the Medicaid limitations on earnings. For example, in Indiana, Hoosier Care Connect offers MEDWorks. This is especially beneficial since one of the prominent downfalls of a TBI is that it often leads to cognitive dysfunction, especially in the recovery period, that can be long lasting. People with TBI often suffer from short-term memory impairments that can make it difficult to find and maintain a job. If a person with a TBI is able to hold a job, they also run the risk of making too much money and losing their Medicaid insurance and benefits. MEDWorks provides the long-term stability of health care benefits for those who can and desire to go back to work.

States’ Medicaid programs are there for people with TBI to help with their immediate and future healthcare needs. These are invaluable long-term health and wellbeing programs that help those who can and want to go back to work after a TBI get back on their feet financially while protecting their Medicaid benefits.

I am thankful that my father had Medicare, another government program, to take care of his needs, this was especially important to him. During the eight years after my dad’s accident and injury, we found many situations that would worsen his brain injury symptoms. The worst was anxiety and worry. When he would worry about even the smallest of things, his brain would shut down and he would have to go off by himself to de-stress and relax. Not having to worry about how he would pay for his continuing health care needs from the time of his injury until 2018 when he passed was a blessing. I am grateful that there are government healthcare programs for those with TBI who, like my father, suffer from long-term symptoms and setbacks due to their brain injuries but will have the support they need.

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Steve Bazin has spent 37 years working with special populations and 26 years working specifically with the developmental disabilities and aging populations, including those with traumatic brain injuries. He has a Bachelor’s Degree in Psychology from Valparaiso University and a Master’s Degree in Public Administration from Indiana University with a concentration in Healthcare Administration. Steve brings this knowledge and experience to help ensure that special populations receive the care and services they require and deserve. Outside of his passion for special populations, Steve enjoys time with his family and friends, being outdoors, photography and fishing.

Summit Managed Solutions is a management consulting and professional services firm that partners with healthcare organizations across the private, public, and social sectors to create value. By providing comprehensive solution management and inclusive business operation services, Summit helps deliver specific, transformative outcomes. With consulting and managed service offerings, Summit helps partners overcome the critical challenges associated with people, process, and technology, while providing partners with flexibility, reliability, and innovation that will propel growth.