How to Pay for Long-Term Care After a Traumatic Brain Injury

The government programs, insurance, benefits, and legal claims that fund long-term TBI care, and the steps families take to access them.

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Younger family member helping an older man work through benefit paperwork at a desk, representing the process of assembling funding for long-term care after a TBI

Caring for someone with a severe traumatic brain injury is expensive in ways most families do not anticipate, and the costs compound over years, not just months. The immediate medical bills are significant, but it is the long-term care (treatment, therapies, residential programs, and medications) that creates a financial burden that can last decades.

If you are a family member or caregiver trying to understand how to pay for long-term care after a traumatic brain injury, this guide maps the major funding sources available and the steps to take to access them.

Key Takeaways

Lifetime care costs for severe TBI, after initial hospitalization, can reach into the millions, far beyond what most families can afford.
Government programs (Medicaid waivers, SSDI, Medicare), private insurance, settlements or verdicts recovered from injury claims, workers’ compensation and veterans benefits can all help contribute to funding.
Accepting a settlement or inheritance without a Special Needs Trust can disqualify a TBI survivor from Medicaid and SSI benefits, which makes structuring finances correctly one of the first decisions to get right.
An experienced TBI attorney can identify compensation claims and funding sources many families miss, secure benefits, and create a Special Needs Trust to protect the right to continue receiving benefits when necessary.

Quick Answer

Long-term care after a traumatic brain injury can be funded through a combination of government programs, private insurance, and money obtained through liability claims (personal injury lawsuits, such as auto accident, falls, products liability and medical/hospital negligence). Among the most common sources include Medicaid Home- and Community-Based Services (HCBS) waivers,¹ Social Security Disability Insurance (SSDI), Medicare (for survivors on SSDI for 24+ months), long-term care insurance, special needs trusts, workers’ compensation, and veterans benefits. Because lifetime treatment costs for a person with a severe TBI can range from $85,000 to $3 million,² identifying every available source early, and connecting them, is what prevents families from leaving tens of thousands of dollars in benefits on the table. Working with an experienced TBI attorney to ensure that any settlement or inheritance is structured to preserve eligibility for government benefits is part of that process.

Why Long-Term TBI Care Is Expensive

The lifetime treatment cost for a person with a severe traumatic brain injury can range from $85,000 to $3 million.² That amount covers residential or supervised living, in-home aides, cognitive and behavioral therapies, adaptive equipment, medications, and ongoing medical management, not a one-time event but a lifetime of recurring costs. For a closer look at how these figures are built, see our breakdown of the lifetime cost of traumatic brain injury and spinal cord injury.

An estimated 5.3 million Americans are living today with a TBI-related disability, and roughly 80,000 more are discharged from the hospital with a TBI-related disability every year.³ For families managing these costs, funding rarely comes from a single source. It is typically assembled from several programs working together. If you are still mapping what help exists, start with our overview of TBI financial assistance options.

Government Programs That Can Cover Long-Term TBI Care

Medicaid and Home- and Community-Based Services (HCBS) Waivers

Standard Medicaid covers basic medical services, but many states have created TBI-specific Home- and Community-Based Services waivers that fund care standard Medicaid does not, including in-home support, case management, behavioral health services, and community residential programs. States such as New York, Indiana, and North Carolina operate dedicated TBI waivers.

The Centers for Medicare and Medicaid Services added traumatic brain injury to its list of chronic conditions for Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs), effective for the January 2025 plan year, which allows those plans to include TBI in coordinated care plans.⁴ Eligibility is income- and asset-based and varies by state, and waitlists are common, so applying early is critical. Contact your state’s Medicaid agency or your local Brain Injury Association chapter to learn about available waivers and current waitlists. For a full overview of government benefits for TBI, including Medicaid eligibility rules, see our detailed guide.

Social Security Disability Insurance (SSDI) and SSI

SSDI provides monthly cash benefits to TBI survivors who have a qualifying work history and whose injury prevents them from performing substantial gainful activity for 12 or more continuous months. SSI provides need-based benefits to those without sufficient work history. Both programs require thorough medical documentation: neuropsychological testing, brain imaging, and functional assessments. SSDI recipients also become eligible for Medicare after 24 months of receiving benefits, which opens additional coverage options. A TBI attorney can help families build the strongest possible application and pursue an appeal if a claim is initially denied.

Medicare

Medicare covers TBI survivors aged 65 and older, as well as those who have been receiving SSDI benefits for at least 24 months.⁵ It pays for inpatient rehabilitation, skilled nursing, physician services, and some home health care. However, Medicare does not cover custodial long-term care, the daily assistance with bathing, dressing, and eating that many TBI survivors need. Families who rely solely on Medicare for long-term care will face significant out-of-pocket costs. This is one of the most common planning mistakes.

Private Funding Sources

Long-Term Care Insurance

If a long-term care insurance policy was in place before the injury occurred, it may cover in-home care, assisted living, or nursing facility costs. Standard health insurance policies do not cover custodial long-term care, making dedicated long-term care coverage one of the few private options that directly addresses these expenses. Review the policy carefully, including elimination periods, daily benefit limits, inflation provisions, and covered care settings, before counting on this source.

Special Needs Trusts

A Special Needs Trust (SNT) is the tool that keeps government benefits intact when a TBI survivor receives a settlement, inheritance, or gift. Without an SNT, any funds exceeding the program’s asset limits can disqualify the survivor from Medicaid and SSI entirely. A properly drafted SNT holds those funds separately, allowing them to pay for supplemental needs, such as adaptive technology, private therapies, transportation, and recreation, while preserving Medicaid and SSI eligibility.

First-party SNTs are funded with the survivor’s own settlement proceeds. Third-party SNTs are funded by family members. Pooled trusts, administered by nonprofit organizations, offer a lower-cost alternative for smaller accounts. This document must be drafted by an experienced attorney. Structural errors can cost the survivor years of benefits. For more on planning tools designed for TBI survivors, see our guide to TBI life care planning and estate planning.

Paying for a lifetime of TBI care starts with knowing what you are entitled to. Get the free book for more on benefits, care planning, and legal options.

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Work-Related and Veterans Sources

Workers’ Compensation

If the TBI occurred on the job, workers’ compensation may cover medical treatment, rehabilitation costs, and a portion of lost wages. Deadlines are short, in some states as few as 30 days from the date of injury, so act as soon as possible. See our full guide to workers’ compensation and veterans benefits for TBI for state-specific guidance.

Veterans Benefits

Veterans who sustained a TBI in military service may qualify for VA disability compensation, tax-free monthly payments rated from 0 to 100 percent based on disability severity, along with VA healthcare and access to residential rehabilitation through the VA’s Polytrauma System of Care, including Polytrauma Rehabilitation Centers and Polytrauma Transitional Rehabilitation Programs.⁶ ⁷ Family members caring for eligible veterans may qualify for the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC), which provides a monthly stipend, health insurance through CHAMPVA, mental health counseling, and caregiver training. PCAFC eligibility now covers veterans who sustained a serious injury in the line of duty during any service era, not only post-9/11 veterans.⁸ Applying for VA benefits requires medical documentation linking the TBI to service. An experienced TBI attorney or accredited VA claims agent can help establish service connection and pursue the appropriate disability rating.

If Someone Else Caused the Injury

When a TBI results from another party’s negligence (a car accident, a defective product, a fall on unsafe property, or medical malpractice), a personal injury claim can be one of the most significant sources of long-term care funding. A successful settlement or judgment can fund a lifetime care plan, compensate for lost earning capacity, and cover care costs that government programs do not.

However, receiving settlement funds without proper planning can disqualify a TBI survivor from Medicaid and SSI. Structuring any settlement through a Special Needs Trust is the right move, and it requires an attorney experienced in both TBI law and public benefits. If someone else may be responsible for the injury, speak with an experienced TBI attorney before accepting any settlement.

Where to Start: 4 Steps for Families

If you are trying to build a long-term care funding plan for a TBI survivor, these four steps provide a practical starting point.

Map every current and potential benefit. List every insurance policy, government benefit, and income source the TBI survivor currently has or may qualify for. This includes private health insurance, long-term care insurance, employer disability coverage, Medicaid, Medicare, SSDI, SSI, and any veterans benefits.
Consult a TBI attorney. An experienced brain injury lawyer can identify whether a legal claim exists, ensure that any settlement is structured to preserve public benefits, and help families avoid costly mistakes with trusts and benefit applications.
Explore your state’s Medicaid TBI waiver. Contact your state’s Medicaid agency or the Brain Injury Association chapter to ask about TBI-specific HCBS waivers, eligibility requirements, and waitlists. Many have waitlists measured in months or years. Learn more about caring for a loved one with TBI and the support programs available.
Engage a life care planner. A certified life care planner can assess future care needs and produce a detailed cost projection, a document that supports insurance claims, legal settlements, and Medicare set-aside arrangements.

Frequently Asked Questions

Does Medicare cover long-term care for TBI survivors?

Medicare covers skilled nursing care, inpatient rehabilitation, and some home health services, but it does not cover custodial long-term care, the daily assistance with activities such as bathing, dressing, and eating that many TBI survivors need. TBI survivors under 65 may qualify for Medicare after receiving SSDI benefits for 24 months. Those who qualify for both Medicare and Medicaid, referred to as dual eligibles, gain access to a broader range of long-term services and support that neither program provides on its own.

What is a TBI Medicaid waiver and how do I apply?

HCBS TBI waivers are state-administered Medicaid programs designed specifically for TBI survivors. They fund services that standard Medicaid does not cover, including in-home support workers, case management, community residential programs, and behavioral health services. Availability, eligibility criteria, and application processes vary by state. To find out what your state offers, contact your state’s Medicaid agency or the Brain Injury Association of America chapter in your state.⁹ Many programs have waitlists, so applying as soon as possible is important.

Can a family member get paid to care for someone with TBI?

Yes. Certain Medicaid HCBS waiver programs allow family members to be paid as personal care providers for TBI survivors, depending on the state program. For veterans, the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides a monthly stipend, health insurance, mental health services, and caregiver training to eligible family members of qualifying veterans with TBI.

How do I qualify for SSDI after a traumatic brain injury?

To qualify for SSDI, the TBI survivor must have a work history with sufficient Social Security credits and medical documentation demonstrating that the injury prevents substantial gainful activity for 12 or more continuous months. Neuropsychological evaluations, brain imaging, and functional assessments all support the application. If an initial claim is denied, which is common, an appeal is possible, and an experienced attorney can substantially improve the chances of approval.

Will receiving a legal settlement affect Medicaid or SSI eligibility?

Yes, it can, unless the settlement funds are placed into a properly structured Special Needs Trust. If settlement funds exceed the asset limits for Medicaid or SSI without an SNT in place, the survivor can lose eligibility for those benefits until the funds are spent down to the qualifying threshold. Protecting benefits through an SNT is one of the most critical reasons to involve a TBI attorney before any settlement is finalized.

Are there grants or nonprofit funds available for TBI long-term care?

State TBI Trust Funds, enacted by legislation in roughly 25 states, provide supplemental funding for services not covered by insurance or government programs.¹⁰ These funds are typically administered by state agencies and the Brain Injury Association chapter in each state. Availability, eligibility, and funding levels vary widely. Your state’s Brain Injury Association chapter is the best starting point for identifying what is available locally.

What does a life care planner do for TBI families?

A certified life care planner reviews medical records, functional assessments, and existing insurance and benefit coverage to produce a detailed estimate of the TBI survivor’s lifetime care costs. This plan supports workers’ compensation claims, personal injury litigation, insurance negotiations, and Medicare set-aside calculations. It provides a clear, documented picture of what care will cost over time, which is useful for legal settlements and long-term financial planning.