State & Federal TBI Services Overview
The Department of Health & Human Services
The Department of Health and Human Services is further broken down into divisions to provide targeted service efforts. The Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS) is the state agency charged with determining policies and practices used by mental health, developmental disability, and substance abuse services programs that operate with state funds. State-Funded Services, formerly IPRS (Integrated Payment and Reporting System) allow the state of North Carolina to directly fund some services, which are then managed by Local Management Entities/Managed Care Organizations (LME/MCOs).
Within the Division is a specific traumatic brain injury (TBI) Team to address the needs of individuals and their families affected by brain injury and provide funds directly to specific TBI providers, pilot projects, and state associations through grants and allocations.
Other divisions that may be able to provide assistance may include:
- Aging and Adult Services: responsible for planning, administering, and evaluating activities and programs for older adults.
- Child Development and Early Education: implements standards for child care and increases access to families/children.
- Disability Determination Services (DDS): funded by the federal government's Social Security Administration.
- Health Benefits (NC Medicaid): helps low-income parents, children, seniors and people with disabilities receive physical and behavioral care and services to improve their health and well being.
- Health Service Regulation: provides effective regulatory activities for health and safety (includes consultation, training, and improved access to health care delivery systems).
- Office of Economic Opportunity: helps low-income individuals and families achieve self-sufficiency.
- Office of Minority Health and Health Disparities: promotes and advocates for the elimination of health disparities among all racial and ethnic minorities and other underserved populations in NC.
- Office of Rural Health: assists rural and underserved communities by providing supports to improve health care access, quality and cost-effectiveness.
- Public Health: promotes disease prevention, health services and health promotion programs that protect communities from communicable diseases, epidemics, and contaminated food and water.
- Services for the Blind: provides services to people who are blind or visually impaired to help them reach their goals of independence and employment.
- Services for the Deaf and Hard of Hearing: provides information, skills and tools needed to achieve effective communication and access to resources in your community for independence and full participation in society.
- Social Services: provides direct services that address issues of poverty, family violence and exploitation. Local offices can help to apply for Medicaid.
- State Operated Healthcare Facilities: oversees and manages 14 state operated healthcare facilities that treat adults and children with mental illness, developmental disabilities, substance use disorders and neuro-medical needs.
- Vocational Rehabilitation Services: provides counseling, training, education, transportation, job placement, assistive technology and other support services to people with disabilities.
Local Management Entities/Managed Care Organizations (LME/MCOs)
Local Management Entities/Managed-Care Organizations (LME/MCOs) are agencies of local government that are paid a set amount of money to manage care in North Carolina and responsible for managing, coordinating, facilitating, and monitoring the provision of mental health, developmental disabilities and substance abuse services in the catchment area served.
LME/MCOs offer consumers 24/7/365 access to services, develop and oversee providers, and handle consumer complaints and grievances. In NC, traumatic brain injury (or TBI) has been defined as a Developmental Disability, meaning that an individuals with a disability related to TBI may receive services depending on need and meeting of eligibility criteria.
The first step is to receiving services is to call the “Access Line” for your local office. After an initial crisis screening, tell them that you (or your family member if you are calling for someone) have a TBI. They may ask for medical documentation of the TBI and for financial information such as Medicaid eligibility. When contacting your LME/MCO, make sure that you tell the person about any challenges or difficulties that you or your family member is experiencing, particularly if you are at risk for homelessness or other safety concerns.
What services might be available?
- Day services
- Personal Care
- Mental health
- Substance use
- Behavioral & Crisis
- Natural supports
- Assistive Technology
- Medical equipment
- Transition services
- and more!
What funding is out there?
- North Carolina Medicaid and Health Choice offer different ways that may help pay for some or all of the cost of health care. Each program helps people and families with certain health needs, and income and resource limits. You can apply for Medicaid through your county office of the Division of Social Services (DSS). Waivers are available for special populations to help widen the span of eligibility for Medicaid.
- The NC Innovations Waiver is a Federally approved 1915 C Medicaid Home and Community-Based Services Waiver (HCBS Waiver) designed to meet the needs of Individuals with Intellectual or Development Disabilities (I/DD) who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. Services may include but are not limited to respite, day services, employment, residential, and personal care.
State Funded Services
- If you meet financial eligibility requirements as well as functional limitation requirements, you may be able to receive some limited services. Your local office will determine this and discuss it with you.
Money Follows the Person
- Money Follows the Person (MFP) is a state project that helps Medicaid-eligible North Carolinians who live in inpatient facilities move into their own homes and communities with supports.
CAP-C, CAP-DA, & CAP-Choice
- The Community Alternatives Program for Children (CAP/C) provides home- and community-based services to children at risk for institutionalization in a nursing home.
- The Community Alternatives Program for Disabled Adults (CAP/DA) is for adults with disabilities who prefer to remain in their primary private residences rather than nursing home placement.
- CAP-Choice allows for a care advisor, a personal assistant, and financial management services.
- The TBI Waiver is available for individuals with a traumatic brain injury that occurred after or on the age of 22. If you reside in Wake, Durham, Johnston, or Cumberland counties and have Medicaid or may be eligible for Medicaid, contact Alliance Health at (800) 510-9132.