Centers for Medicare and Medicaid Services Officially Recognizes Brain Injury as a Chronic Condition

Fairfax, Va. – In a victory for the brain injury community, the Centers for Medicare and Medicaid Services (CMS) has recognized traumatic brain injury (TBI) as a chronic health condition.

CMS has added TBI to its list of chronic conditions for chronic special needs plans (C-SNPs) through its Medicare Advantage program effective for the January 2025 plan year. The Brain Injury Association of America (BIAA) will continue to fight to expand coverage for all types of brain injury with the ultimate goal of greater coverage across all forms of public and private insurance.

“We are thrilled that CMS agrees with our stance that brain injury is a chronic health condition, and has provided official recognition,” said Rick Willis, President and CEO of the Brain Injury Association of America. “This is an important first step in our fight to expand coverage for brain injury beyond acute care and helps us to make our case that brain injury should be treated by healthcare providers as a chronic condition like heart disease or diabetes.”

The addition of TBI to the list of chronic conditions was included in a rule published in the Federal Register earlier this year. Getting official recognition of TBI as a chronic condition from CMS is a significant step forward and provides validation that brain injury should be more broadly recognized as a chronic condition.

Earlier this year, BIAA published a position paper calling for CMS, along with the Centers for Disease Control and Prevention (CDC), to designate brain injury as a chronic condition. Formal recognition, the paper states, has the potential to provide several advantages for people with brain injury, including the allocation of additional public health resources to focus on the lifelong effects of brain injury as well as health insurance plans, primarily Medicare and Medicaid, providing additional benefits and other supports as they do for other chronic health conditions. The greatest benefit, however, would be an increase in public awareness of the long-term effects of brain injury that affect the estimated 5 million Americans with a brain injury-related disability.

“When we talk about recognizing, treating, and covering brain injury as a chronic condition, that last piece of it is making sure there are resources there to continue providing support once a person with a brain injury leaves the acute care setting,” said Page Melton Ivie, Chair of the BIAA Board of Directors. “There is a lot of support in the hospital, but once you walk out the door, you’re on your own. We need to make sure we are continuing to support survivors and their families, because they are going to have a lot of needs that won’t be covered.”

BIAA is working to equip its affiliates and individual advocates with the tools they need to articulate how healthcare needs to change in order to reflect this recognition, including making sure that providers start treating TBI as a chronic condition.

In the coming weeks, BIAA will share more information on the next steps we can take to increase access to care. We’ll be hosting a live Q&A session to discuss these changes and future tools and resources BIAA will provide to help survivors and their loved ones advocate for further expanding coverage.

To receive updates about the push to recognize brain injury as a chronic health condition, you can join our Advocacy mailing list.

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About the Brain Injury Association of America:

The Brain Injury Association of America is the country’s oldest and largest nationwide brain injury advocacy organization. BIAA’s mission is to advance prevention, awareness, research, treatment, education and advocacy to improve the quality of life for all people affected by brain injury. BIAA is dedicated to increasing access to quality health care and raising awareness and understanding of brain injury.