Community of Practice Brain Injury Integration in Medicaid 1115 Reentry Demonstration Waivers

Community of Practice Brain Injury Integration in Medicaid 1115 Reentry Demonstration Waivers

Applications Due February 28, 2025
State Name - Please list the state for which you are applying.*
Lead Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Organization*
Title/Role*
Coalition Team Members

List the key coalition partners from your state. Please provide their name, role, organization, and email address.
Name: State Brain Injury Program/Designated Lead State Agency Representative*

First NameLast Name
Email: State Brain Injury Program/Designated Lead State Agency Representative*
example@example.com
Organization: State Brain Injury Program/Designated Lead State Agency Representative*
Title/Role: State Brain Injury Program/Designated Lead State Agency Representative*
Name: State Advocacy Partner*

First NameLast Name
Email: State Advocacy Partner*
example@example.com
Organization: State Advocacy Partner*
Title/Role: State Advocacy Partner*
Additional Partners (optional): State Brain Injury Advisory Council Members, State Criminal Legal System Partners, Criminal Legal System Professionals, State Medicaid Partners, Medicaid Providers, people with lived experience. Please provide their name, email, organization, and title/role. *
Does your state have an approved 1115 Reentry Demonstration Waiver?*

YesNo (If no, your application will not be considered.)
What specific challenges or gaps does your state face in addressing the needs of people with brain injury reentering the community from incarceration?*

0/200
What are your state’s primary goals in participating in the Community of Practice? What do you hope to achieve through this collaboration?*

0/200
Is your state able to commit to attending all four All-State Meetings and other required events (March, May, July, August, and September)? Please confirm availability for the kick-off meeting on March 25, 2025, from 12:00-1:30 PM EST. Please confirm that you will hold this date. *

YesNo
Does your coalition have the capacity to develop and implement a work plan? *

YesNo
By submitting this application, you confirm that you are authorized to apply on behalf of your state and that your coalition is committed to fulfilling the obligations outlined in this notice.*

YesNo
Please submit your completed application by
February 28, 2025.

If you have any questions or need assistance with this application, please contact Zaida Ricker at zricker@nashia.org.
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Community of Practice Brain Injury Integration in Medicaid 1115 Reentry Demonstration Waivers

Lead Contact Information

Coalition Team Members