Waiver Program

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The Medicaid Waiver Program is state-specific, and covers the cost of the program participant’s treatments in the home or other community-based settings. Prior to 1991, the federal Medicaid program would only pay for services if a person lived in an institution, but that changed when the Home and Community Based Services (HCBS) Waiver (also known as1915 (c) Waiver) became part of the Social Security Act. The HCBS Waiver provides financial coverage for services to qualifying participants who reside in a community setting, for example, a home or apartment.

Sunshine Home Care New York is an approved provider of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waiver Services Programs in New York State.

Sunshine’s TBI Waiver Program Services

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Service Coordination (SC)

Sunshine Home Care’s Service Coordinator assists the TBI Waiver participant to ensure that an appropriate service plan is developed that suits the individual’s unique needs and helps the participant reach his/her goals for living, receiving care and achieving maximum independence in the community. The SC remains with the participant to monitor and adjust the service plan as necessary.

Independent Living Skills Training (ILST)

The purpose of ILST is designed to empower the participant with skills to live as independently as possible. ILST focuses on practical skills that include: personal care, medication management, task completion (cooking and shopping), communication, socialization, money management (banking), problem solving, community transportation usage and household maintenance.

Community Integration Counseling (CIC)

CIC is a counseling service for TBI waiver participants to help them cope with their altered level of skills and abilities and their changed roles in relation to family and loved ones.

Positive Behavioral Intervention and Support Services (PBIS)

PBIS is for the TBI waiver participant who is experiencing significant behavioral difficulties that jeopardize their ability to remain in their community. The primary goal of PBIS is to decrease the intensity or frequency of targeted maladaptive behaviors, and to promote more adaptive behavior and responses to their environment.

Structured Day Program Services (SDP)

SDP services are designed on a case-by-case basis to be provided in an outpatient or community setting. The service is intended to strengthen the TBI wavier participant’s skills that are necessary to achieve greater independence and improve productivity. Skills focused on in the SDP include: money management, socialization, communication and interpersonal, cognitive skill building, and task management.

Environmental Modifications (E-Mods)

E-Mods are internal and/or external modifications to the TBI waiver participant’s residence to ensure safe and easy access and promote independent mobility. These E-Mods might include: ramps, hand railings, grab bars, special door knobs, improving accessibility for wheelchairs, etc.