Policy Solutions for Traumatic Brain Injury: Advancing New York State's First TBI Special Needs Assisted Living Program

Traumatic Brain Injury (TBI) presents long-term challenges that are poorly addressed by traditional assisted living and nursing home models. In New York State, individuals with moderate to severe TBI are often placed in settings unequipped to provide cognitive, behavioral, and neurorehabilitative care. This policy and advocacy paper proposes the establishment of a Special Needs Assisted Living Program (SNALP) specifically for individuals with TBI. Drawing from clinical expertise, stakeholder engagement, and a discontinued but promising pilot program, this manuscript outlines the systemic barriers to TBI-specific care, including regulatory gaps, lack of Medicaid reimbursement, and limited public awareness. The proposed model integrates occupational therapy (OT)-led services, interdisciplinary care, and neuroplasticity-informed rehabilitation. Key policy recommendations include Medicaid waiver reform, legislative action to recognize TBI in SNALP regulation, and the establishment of an additional pilot program to collect cost-savings and outcomes data. Grounded in OT values of person-centered, community-integrated care, this manuscript offers actionable strategies to align policy, funding, and service delivery to better meet the needs of TBI survivors and their families.