Medicaid Traumatic Brain Injury Memorandum of Understanding (MOU) Program
Medicaid will cover short-term, post-acute, comprehensive, intensive, goal-directed rehabilitation services for persons 21 or older with a brain injury.
A specialized program of integrated services is not otherwise available outside of an institutional rehabilitation setting. When the beneficiary presents a documented need for continued specialized rehabilitation services and the complexity of the case indicates the need for a comprehensive, multidisciplinary team approach then services may be authorized in a Medicaid approved residential or outpatient rehabilitation program.
The Hospital Acute Care Case Manager and MDHHS Case Worker will need to submit to the MDHHS Medical Service Administration, medical records and other personal history documents to determine needs and eligibility. To qualify for this program, the beneficiary must:
- Have suffered a brain injury that was traumatic in nature within the past 15 months
- Be able to complete 21 hours of intense therapy per week
- Be at a Rancho Level 5-6
- Need stand-by assist only
- Be Medicaid eligible as determined MDHHS
- Have exhausted all other available resources
The Medicaid TBI MOU Program will not reimburse for room and board payment while in the MOU Program. If the beneficiary is receiving Supplemental Security Income (SSI), the beneficiary is responsible for room and board payments.
Rehabilitation must be medically necessary and ordered by a Michigan licensed physician. Additional functional criteria must be met as well. For information regarding the Medicaid Traumatic Brain Injury Memorandum of Understanding Program, call 517-241-1680.