WEST ST. PAUL, Minn. — Acquired brain injuries can change everything in an instant—altering cognitive abilities, physical function, behavior, and independence. For Minnesota residents navigating life after traumatic brain injury, stroke, anoxia, or other acquired brain injuries, the Brain Injury (BI) waiver offers crucial support services designed to help individuals rebuild their lives and maximize independence in community settings.
At BrightPath, we work alongside individuals with brain injuries and their families to access BI waiver services including 24-hour emergency assistance, individualized home supports, and intensive support services. Understanding how the BI waiver works—including eligibility requirements, covered services, and the assessment process—helps families make informed decisions during challenging transitions.
What Is the Brain Injury Waiver?
Minnesota's Brain Injury waiver provides home and community-based services for children and adults who have sustained acquired brain injuries and require nursing facility-level care or neurobehavioral hospital-level care but prefer to live in community settings. The waiver emphasizes person-centered care, self-determination, and community integration rather than institutional placement.
The BI waiver serves individuals with documented brain injuries resulting from:
Traumatic brain injury (TBI) from accidents, falls, or violence
Stroke or cerebrovascular accidents
Anoxic or hypoxic brain injury from oxygen deprivation
Brain tumors (malignant or benign)
Infectious diseases affecting the brain
Toxic exposure affecting brain function
Degenerative diseases where cognitive impairment is present
The injury or condition must be acquired rather than congenital—meaning it cannot have been present at birth. This distinguishes acquired brain injuries from developmental disabilities, often requiring different support approaches focused on adaptation, compensation, and rehabilitation.
Eligibility Requirements
To qualify for the BI waiver in Minnesota, individuals must meet several criteria:
Medical Eligibility: A documented acquired brain injury (not congenital) with resulting functional limitations in areas such as cognition, communication, behavior, physical mobility, or activities of daily living. Individuals must experience significant or severe behavioral and cognitive problems related to the injury or disease.
Rancho Los Amigos Scale Assessment: Individuals must be assessed at Level IV or above on the Rancho Los Amigos Levels of Cognitive Functioning Scale, which measures how well people with brain injuries are functioning and recovering.
Level of Care: Individuals must require the level of care provided in a specialized nursing facility or neurobehavioral hospital as determined through a comprehensive MnCHOICES assessment. This doesn't mean they need to live in a facility—rather, their support needs are significant enough to qualify for institutional care, making community-based waiver services an alternative.
Age Requirement: Individuals must be under age 65 at the time of acceptance to the waiver. Those already receiving BI waiver services may remain eligible for the waiver after turning 65 if all other eligibility criteria are met.
Disability Certification: Individuals must be certified as disabled by the State Medical Review Team (SMRT) or the Social Security Administration (SSA).
Residency: Individuals must be Minnesota residents living in community settings such as their own home, a family home, foster care, board and lodging facilities, or assisted living facilities.
Financial Eligibility: The BI waiver requires eligibility for Medical Assistance (MA), which has income and asset limits, though some individuals may be eligible for the waiver regardless of income through alternative financial methodologies such as MA-EPD (Medical Assistance for Employed Persons with Disabilities).
Functional Capacity: Individuals must be able to function well enough to participate in rehabilitation activities and must need a higher level of service than is available through any other MA-Waiver program.
Services Covered Under the BI Waiver
The BI waiver offers comprehensive services addressing the complex and often changing needs of individuals with acquired brain injuries:
Individualized Home Supports: BrightPath provides individualized home supports focusing on skill development and maintenance in four key areas—community participation, health and wellness, household management, and adaptive skills. For individuals with brain injuries, IHS services often emphasize cognitive compensation strategies, routine establishment, safety awareness, and rebuilding independence in daily activities.
24-Hour Emergency Assistance: Brain injuries can create unpredictable situations requiring immediate support. Our 24-hour emergency assistance provides peace of mind through on-call problem solving, crisis prevention, and in-person response when needed, available to individuals throughout Ramsey County, Hennepin County, and across Minnesota.
Intensive Support Services: For individuals with complex behavioral or cognitive needs following brain injury, BrightPath's intensive support services offer tailored behavioral interventions and habilitation supports delivered by trained staff with specialized experience supporting individuals with acquired brain injuries.
Crisis Respite: Short-term crisis respite services provide behavioral or medical intervention to protect the individual or others while offering relief to family caregivers during particularly challenging periods.
Community Residential Services: BrightPath provides Community Residential Services in licensed homes for individuals with extraordinary needs, offering 24/7 staff support, personalized care, and skill-building based on individualized support plans.
Additional Services: The BI waiver also covers adult day care, adult companion services, behavioral support, case management, cognitive rehabilitation therapy, employment services, extended home health care services, extended personal care assistance, family counseling and training, foster care, homemaker services, home modifications, respite care, specialized supplies and equipment, and many other services tailored to individual needs.
The Assessment and Enrollment Process
Accessing BI waiver services begins with contacting your county social services or a tribal agency to request a screening. The process typically includes:
Initial Screening: County staff determine potential eligibility and explain available options.
MnCHOICES Assessment: A qualified assessor conducts an in-depth evaluation of functional abilities, support needs, medical conditions, and living situation preferences using Minnesota's standardized MnCHOICES assessment tool.
Rancho Los Amigos Scale Evaluation: Assessment of cognitive functioning level to ensure the individual meets Level IV or above.
Level of Care Determination: The assessment determines whether the individual meets specialized nursing facility or neurobehavioral hospital-level care criteria.
Disability Certification: If not already certified, individuals work with SMRT or SSA to obtain disability certification.
Waiver Allocation: If eligible and waiver slots are available, individuals receive a waiver allocation and work with a case manager to develop a person-centered support plan.
Service Implementation: Once the support plan is approved, individuals connect with qualified providers like BrightPath to begin receiving services.
How Brain Injury Support Differs From Other Waivers
While the BI waiver shares some similarities with other Minnesota disability waivers—including CADI, DD, and CAC programs that BrightPath also serves—brain injury support often requires specialized approaches:
Cognitive Rehabilitation Focus: Many BI waiver services emphasize cognitive compensation strategies, memory aids, executive function support, and adaptation to changed abilities rather than developmental skill-building.
Behavioral Considerations: Personality changes, impulsivity, emotional regulation challenges, and behavioral issues following brain injury may require specialized behavioral support expertise.
Medical Complexity: Individuals with brain injuries may experience seizures, medication management needs, physical limitations, and ongoing medical monitoring requiring coordination between healthcare providers and support staff.
Variable Recovery Trajectories: Unlike stable developmental disabilities, brain injury recovery can involve significant improvement, plateau periods, or gradual changes over time, requiring flexible person-centered planning.
Higher Level of Service: The BI waiver is designed for individuals who need a higher level of service than is available through other MA-Waiver programs due to the severity of cognitive and behavioral impairments.
BrightPath's Approach to Brain Injury Support
As a 245D-licensed service provider in West St. Paul, BrightPath delivers brain injury waiver services through a person-centered, data-driven approach that respects each individual's unique journey. Our qualified staff receive training specific to acquired brain injury support, including cognitive compensation techniques, behavioral management strategies, seizure awareness, and trauma-informed care principles.
We emphasize self-determination, recognizing that individuals with brain injuries often experience loss of control and independence. Our role is to provide the support needed for each person to make their own choices, pursue meaningful activities, and live as independently as possible in settings they choose.
Current Policy Landscape
Minnesota's disability waiver programs continue evolving through legislative changes and policy updates. Recent 2025 legislative sessions addressed service billing, rate adjustments, and long-term system planning affecting all disability waivers including the BI program. The Minnesota Department of Human Services will submit the Brain Injury Waiver renewal application to the Centers for Medicare & Medicaid Services with an effective date of April 1, 2026, as part of the five-year renewal process required to continue the program. Staying informed about these changes helps families and providers adapt to new requirements while maintaining service quality.
Moving Forward
Acquired brain injuries create profound challenges for individuals and families, but Minnesota's BI waiver offers a framework for accessing support that prioritizes independence, dignity, and community integration over institutional placement.
If you or a family member has sustained an acquired brain injury and needs support services, connecting with your county social services office represents the first step toward accessing BI waiver services. BrightPath works alongside case managers and families throughout the assessment and service delivery process, providing the expertise and compassion needed during difficult transitions.
Understanding available support options empowers families to make informed decisions aligned with their values and their loved one's preferences. Whether someone requires minimal support to maintain independence or intensive services addressing complex needs, person-centered planning through the BI waiver system helps individuals chart their own path toward recovery and meaningful community participation.
BrightPath is a 245D-licensed service provider offering Individualized Home Supports, 24-Hour Emergency Assistance, Community Residential Services, Crisis Respite, and Intensive Support Services to individuals enrolled in Minnesota's BI, CADI, DD, and CAC waiver programs. We serve individuals throughout Ramsey County, Hennepin County, and across Minnesota. For more information about our services or to discuss how we can support your journey toward independence, contact our team today.