Minnesota Brain Injury Waiver Policy - Research Paper Example

Minnesota Brain Injury Waiver Policy Individuals who have acquired traumatic brain injury often find it hard to raise the funds required to address the medical care bills that accrue courtesy of the care they receive. The Brain Injury Waiver was therefore established to provide funding for home and community-based services for individuals (regardless of age and gender) who had in one way or the other acquired traumatic brain injury. The Brain Injury Waiver Services are not limited to a given location as the affected persons can receive them in their homes, adoptive family homes, corporate foster care home or anywhere else as long as there is an established forum to register them. Those individuals who are deemed eligible for the services must meet a certain criteria. Their cognitive functioning scale is assessed at any Level IV or above facility, they must be certified as disabled by the two bodies responsible for the task i.e. the State Medical Review Team (SMRT) and the Social Security Administration (SSA), they should be eligible for medical assistance, the Brain Injury Waiver should be opened before they are sixty five years of age, the assessment done should establish that they need the level of care available in an established neurobehavioral hospital, the diagnosis that has been made for traumatic or acquired brain injury that is linked with cognitive impairment should not be congenital, and must be experiencing significant behavioral and/or cognitive problems which are linked to the brain injury. According to William (2015), traumatic brain injury was not understood well until the 1980s making it being known as the ‘silent epidemic’. The National Head Injury Foundation has played a major role in establish public awareness to the problem. New York was the first to develop public policies based upon diversity of input. Though the progress in the states’ in response to the TBI cases is significant, none has managed to develop a comprehensive system that addresses the needs of the TBI victims as well as their families. The policy making process has been influenced by various factors such as the rising cost of health care as well as the drop in public funding for such services. The changes made in delivering services to people with TBI has come to address the traditional problem where the model used was strictly medical and just aimed at fixing the patient. As earlier indicated, New York was the first to make significant progress to address the problem with the programs developed before 1990. Minnesota was authorized by the Federal Department of Health and Human Services (DHHS) to provide home and community based services to individuals with developmental disabilities (DD) in 1984. Punelli (2013), explains that since this inception, the HCB waiver programs have provided the primary means in supporting Minnesota’s shift from institutional to HCBs. This is economical and therefore preferred by the majority. Minnesota administers five home and community based waiver programs at the moment which include Developmental Disabilities (DD) Waiver for people with developmental disabilities who need the level of care provided at an ICF/DD, Community Alternative Care (CAC) Waiver for people who have chronic illness and who need the level of care provided by a hospital, Community Alternatives for Disabled Individuals (CADI) waiver which was developed for those with disability and require the level of care provided in a nursing home, Brain Injury (BI) Waiver for those with traumatic or acquired brain injury who need the level of care provided either in a nursing home or a neurobehavioral hospital, and Elderly Waiver for individuals above the age of sixty five. Social Problem Chambers & Wedel (2005), dissects the issue of social work and the factors to consider in developing policies to uphold the waiver. He says that like family, community, psychological, and work factors, social policies and programs are a critical feature of the clients’ surroundings and therefore they demand a great deal of professionalism in the care given and in addressing the issues that arise in that respect. Dealing with the lives of the citizens complicates the issue since the policies must address the contemporary problems as well as abide to the ethical concerns that may be raised. The social problems that need to be addressed and which are highlighted by Chambers include hunger, illness, physical or mental disablement, violence and disease. Brain injury which forms this analysis paper is part of the social problems that need to be addressed. Therefore, the Minnesota Brain Injury Waiver Policy addresses a number of social problems which include disease, illness, and mental disablement. Mental disablement which is a result of brain injury is a serious problem since it affects a large portion of the society. For the state government to develop a policy that offers a waiver on brain injury patients, this means that it has affected a great portion of the society. The Annual Rate of TBI (Traumatic Brain Injury) per 100,000 Population in the Olmstead County, Minnesota was 193 during 1934-74 whereas that in the US in 1974 was 200. There was a 22% decline in the TBI-related death rate from 24.6/100,000 U.S. residents in 1979 to 19.3/100,000 in 1992 (CNS, 2015). Firearm-related and motor vehicle related accidents are the major contributors towards brain injury in the United States. Motor vehicle related accidents were the major reasons for brain injuries in the past. However firearm related accidents have already surpassed the motor vehicle related accidents and it is single largest reason for causing brain injuries in the United States at present. The cost of brain injuries can be accounted in two ways; loss of lives or human costs and the monetary costs. It is estimated that the United States government is spending around $ 4.5 billion dollars directly and 33.3 billion dollars indirectly for the victims as per the 1985 statistics (CNS, 2015). These data show that TBI is a social problem that calls for immediate action to be addressed and hence the logic behind the Minnesota’s government passing of the waiver policy. This is a social problem not only from the government’s side but also from the society’s point of view. The government has a role of ensuring the population is healthy so as to abide with the millennium development goals and so in a situation where many people in the society are sick or mentally disabled, then it becomes a social problem. The government has to play a primary role to address the problem. The source problem is caused by the rising number of individuals requiring neurological medical care and the rising medical costs today. This makes it unbearably hard for the individuals to sustain their medical bills making the government develop such a policy. Unemployment and the rising costs of living as well as the medical costs in today’s world has worked hand in hard to expound on the problem. In 1997, the total waiver participants in Minnesota was 16 379, the NH/ICF-MR participants per 1, 000 in population was 9.11 and the waiver participants per 1, 000 of population was 3.49. In the United States, it was estimated that the direct and indirect costs that is used courtesy of the TBI patients is about $70 billion. With such figures, this qualifies to be a social problem that needs well-crafted policies to be addressed. Until 2008, the half of the expenditure necessary for the waiver programs, are given by the federal government. “However, for the period October 1, 2008, through December 31, 2010, the American Recovery and Reinvestment Act provided Minnesota with a higher federal MA percentage” (Punelli, 2013, p.6). Therefore, it is possible for the Minnesota government to include more patients under the coverage of this policy. The following table provides a rough idea about the participation in Minnesota’s Home- and Community-Based Waiver Programs Participation in Minnesota’s Home- and Community-Based Waiver Programs Waiver Program FY 2010 Recipients FY 2011 Recipients FY 2012 Recipients FY 2013 Recipients DD Waiver 15,352 15,841 16,155 16,452 CAC Waiver 406 401 424 445 CADI Waiver 18,416 19,297 20,743 21,164 BI Waiver 1,604 1,514 1,542 1,559 Elderly Waiver 29112 30361 31326 31977 Total 64,890 67,414 70,190 71,597 (Punelli, 2013) From the above table, it is evident that the number of beneficiaries of brain injury (BI) waiver program is less compared to the number of beneficiaries of many of the other waiver programs. Moreover, the number of beneficiaries in this program in 2011, 2012 and 2013 is less compared to that in 2010. The strict norms enforced for getting the benefits of this program is the major reason for the dip in the number of beneficiaries in recent times. As per the views of Chambers & Wedel (2004), the goals and objectives of social services should not be about delivering services, but about achieving a desirable outcome in regard to the targeted social problem. However it seems that the Minnesota government does not have any objectives in terms of implementing this policy. Every year, the government allocates certain amount of money for this program. Once the whole allocated amount of money is used, the government appears happy. Nobody in the government seems to be bothering too much about enquiring whether the outcomes of this policy are at the satisfactory level or not. According to Ellis (2002) the significance of social policy should be brought into the mindset of social work practitioners. However, many of the social service agencies in Minnesota are working primarily for profit making. Therefore, a larger portion of the allocated money for social service activities is going out of the hands of the victims or patients. Historical and Contemporary Context Looking at the results indicated above when the waiver was being put in place there is a significant increase in the number of individuals benefiting from the program. William (2015), notes that in the early 1980’s, Traumatic Brain Injury was known as the silent epidemic due to its invisible disability compared to the more profound disabilities that affected the population. The states have made various developments from that time adopting different policies though New York was the first to show effort in the field. In 2014, the lead causes of Traumatic Brain Injury were listed as falls, motor vehicle clashes and assaults (National Conference of State Legislatures, 2014). The same conference produced devastating statistics which show that about 2.5 million people suffer from TBI with 0.02 succumbing. Realizing the social problem, Minnesota has developed the policies that are aimed at effectively preventing and diagnosing cases of Traumatic Brain Injury and ensure that the patients are rehabilitated. Minnesota established a Traumatic Brain Injury which later yielded the Brain Injury Interagency Leadership Council in 1997. This was formed after a series of signed Interagency Cooperative Agreements. The stakeholders in this policy making process include the federal government, the US Department of Health and Human Services, and the Health Resources and Services Administration. The Federal government has put in place the Federal Traumatic Brain Injury Program administers and the State Traumatic Brain Injury Implementation partnership Grant as well as the State Traumatic Brain Injury Protection and Advocacy Grant Programs all of which are aimed at ensuring that the waiver policies are followed and the problem is addressed in the best way possible (Brain Injury Interagency Leadership Council, 2010). The Traumatic Brain Injury Act of 1996 was developed to ensure that the correct amount of emphasis is put in the efforts to address the TBI menace. Until 1981, Medicaid, or Medical Assistance (MA) was the only health care program available Minnesota to provide necessary medical services for low-income families, children, pregnant women, and people who are elderly (65 or older) or have disabilities (Punelli, 2013). However, the scenario has changed in November of 1981 when President Ronald Reagan came to know an incident in which a poor girl struggling to get medical aids because of the injudicious policies of the government. Policy Analysis Though the Minnesota Brain Injury Waiver has been instrumental in serving individuals suffering from brain injuries, irrespective of whether the victim is receiving treatment at their home or in the hospital. A screening process will be conducted before the allocation of free medical aids to the victims. Some of the requirements for receiving for free medical aids as part of this policy are: 1) the victim should have their conditions at Level IV or above on the Rancho Los Amigos Levels of Cognitive Functioning Scale, 2) the victim should be certified as disabled by the State Medical Review Team, 3) the victim should be below the age of 65, and 4) the victim should experience significant/severe behavioral and cognitive problems (Punelli, 2013). The Minnesota Brain Injury Waiver policy requires a lot of modifications. At present, this program serves only those victims who have their conditions at Level IV or above on the Rancho Los Amigos Levels of Cognitive Functioning Scale. It should be noted that the victims who have their conditions below the Level IV may not get any benefits as part of this policy. In fact, the conditions of such victims are severer than the conditions of other victims. In other words, Level I to III is the most serious stages as far as cognitive functions are concerned. Patients, who show no response, are included in Level I and patients’ who show limited responses are included in Level II. On the other hand patients who show agitated responses are included in Level III. (Rancho Los Amigos Scale aka Level of Cognitive Functioning Scale (LCFS), n.d.). The conditions of the patients included above the Level III are far better than others. It is necessary to allow all patients to get the benefits of this policy irrespective of whether they are included at Level IV or above. It is totally illogical to provide medical aids purely based on the chances of the recovery of the patients. It is necessary to make this policy more humanitarian in nature even though such a move would cost the government a little bit more. Conclusion and Recommendations The Minnesota Brain Injury Waiver Policy is definitely a good policy in terms of delivering health care benefits to poor and needy people or patients. However, this policy should be implemented more comprehensively in order to make sure that none of the patients with head injuries in the state failed to get proper medical attention because of lack of money. At present many of the social service agencies which are working as part of this policy are more interested in profit making. The government should make sure that the funds allocated for the benefits of head injury patients reach their hands fully. Instead of limiting the scope of this policy to a particular type of head injury patients, the government should expand the scope of this policy to a larger community. The government should make sure that none of head injury patients in the state struggle to get benefits from this policy because of the constraints related to age or severity of the injury. References Brain Injury Interagency Leadership Council (2010). Minnesota Brain Injury Statewide Action Plan. Strategic Plan 2010-2015. Chambers, D.E & Wedel, K.R. (2005). Social Policy and Social Programs A Method for the Practical Public Policy Analyst. Publisher: Pearson/Allyn & Bacon, 2005 - Political Science CNS (Centre for Neuro Skills) (2015). Epidemiology of Traumatic Brain Injury, Retrieved from http://www.neuroskills.com/brain-injury/epidemiology-of-traumatic-brain-injury.php Nashia, 2015. Medicaid Balancing Incentive Program: Recommendations for Core Assessment Tools for Individuals with Brain Injury. February 2015. National Conference of State Legislatures. (2014). Traumatic Brain Injury Legislation. Retrieved from. http://www.ncsl.org/research/health/traumatic-brain-injury-legislation.aspx Punelli, D (2013). Medicaid Home- and Community-Based Waiver Programs. Information Brief, Research Department Minnesota House of Representatives. November 2013 Rancho Los Amigos Scale Aka Level of Cognitive Functioning Scale (LCFS), (N.d.) Retrieved from http://www.tbims.org/combi/lcfs/lcfs.pdf William, R. E. (2015). Traumatic Brain Injury, American Rehabilitation, 19(2). Read More