Approximately 5 million Americans are living with a brain injury-related disability. Traumatic brain injury (TBI) patients usually have long-term care needs, such as rehabilitation, neurological care, vocational needs, psychological needs and community-based service care. Many individuals who experience a TBI remain disabled after 5 years.
In a victory for the brain injury community, the Centers for Medicare and Medicaid Services (CMS) officially recognized traumatic brain injury (TBI) as a chronic health condition in 2024, marking a significant milestone for brain injury survivors and caregivers. This designation took effect in January 2025, when TBI became included in the list of chronic conditions covered by Chronic Special Needs Plans (C-SNPs) under the Medicare Advantage program.
The inclusion of TBI as a “chronic condition” was included in a final rule published by CMS in the June 2024 Federal Register.
What does this mean for TBI survivors? First, this represents a significant step forward, providing validation that brain injury should be more broadly recognized as a chronic condition.
The decision also acknowledges the lifelong impacts of TBI, including ongoing medical needs and limitations in daily activities. The new designation is expected to improve access to care, increase public awareness, and extend insurance benefits for Americans living with brain injury-related disabilities.
Scientific Evidence: A 21-Year Study
One prominent study supporting this position, authored by Harvard professor and Brigham & Women’s neurologist Saef Izzy, MD and published in JAMA Network Open , suggested that TBI is not just an acute injury, but a chronic disease and impacts far more than just the brain. Dr. Izzy’s study found a remarkable increase in incidences of cardiovascular, endocrine, neurological and psychiatric complications in TBI patients compared to patients without a TBI. The conditions with an increased risk due to TBI included diabetes, coronary artery disease, hyperlipidemia, obesity, dementia, psychotic disorders, anxiety disorders, stroke, hypertension and seizure disorders.
In an interview discussing his findings, Dr. Izzy observed that “we are finding that TBI is not just an acute injury, but a chronic disease and multisystem condition that affects far more than just the brain. Comorbidities linked to TBI can complicate the course of recovery, increase mortality and add to overall healthcare costs.”
CMS’ recent inclusion of TBI in C-SNPs will provide enhanced health insurance coverage, including coordinated care among multiple specialists, reduced cost-sharing for services, and additional benefits like transportation and over-the-counter items. This change aligns with broader efforts to treat brain injuries as dynamic conditions requiring long-term management rather than single traumatic events.
If you have been injured, it can be world-changing to consult with an attorney who is well-versed in traumatic brain injury. The best TBI attorneys know that medical knowledge can make a difference in the outcome of a case, which is why we spend many hours collaborating with expert physicians from UW Medicine, Harborview, Virginia Mason, and much more. The attorneys at Adler Giersch are happy to help-just call 206.682.0300 to schedule a free and confidential consultation.
Community Resources
Brain Northwest (formerly Brain Injury Alliance of Washington) is a nonprofit organization dedicated to increasing public awareness, support, and providing hope for those affected by brain injury.
Adler Giersch is thrilled to offer this free book, Understanding Traumatic Brain Injury, A Guide for Survivors and Families as a resource for those recovering from brain trauma, their families, caregivers, and health care professionals.
This book is a heartfelt effort by founding attorney, Richard H. Adler. This book includes critical input from client champions and the TBI community.
