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Washington State Institute for Public Policy

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Traumatic Brain Injury and Long-Term Services and Supports in Washington State

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Benjamin MacCormack-Gelles, Amani Rashid - June 2025

Long-term support services (LTSS) include a range of resources to help people with chronic conditions maintain their quality of life. These services can be adapted to meet the specific needs of adults who have sustained a traumatic brain injury (TBI).

We conducted a review of Medicaid programs states use to provide LTSS. Programs that specifically target adults with brain injury are more likely to offer employment and behavioral support. Facility-based services are commonly provided in group home settings and may specify transitional or lifelong support goals. Many states integrate participant self-direction into community-based TBI services. Several states are carefully integrating adults with complex chronic conditions, such as TBI, into managed LTSS.

We used administrative data to estimate the incidence of TBI in Washington, demographics of adults with TBIs, and healthcare outcomes. Older adults are most vulnerable to TBIs, but younger adults represent a large proportion of total injuries. Medicaid-insured adults are hospitalized for TBI at a higher rate than privately insured adults. Privately insured adults account for a larger proportion of TBIs diagnosed in outpatient settings. Rates vary across counties but are not correlated with rurality at that scale.

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