CHARLESTON, W.Va. -- After a years-long court battle, West Virginia residents will be able to enroll in the state's new Medicaid waiver program for people with traumatic brain injuries.

Under the waiver, brain injury survivors will be able to receive care in their homes and communities rather than being institutionalized. But some advocates for those survivors say the program is too small and won't do enough.

In April 2011, the state Supreme Court upheld a 2009 ruling from Kanawha Circuit Judge Duke Bloom, who ordered the state Department of Health and Human Resources to apply for the waiver.

In both 2001 and 2007, DHHR had agreed to apply for the waiver, but did not follow through with those plans.

"It's something that's extremely needed and the parties agreed on it 10 years ago and there was a great deal of foot-dragging," Bloom said Monday. "This is going to be a godsend for so many people."

The judge said the majority of the costs associated with the waiver will be picked up by the federal government. It was not clear Monday exactly how much the program would cost.

"It's a wonderful thing," Bloom said. "At long last these folks are going to get the services."

But advocates for brain injury survivors criticized the program. They argued that it will only help a small number of those who need it.

"It's taken us 25 years to get [the waiver] in place and it is sorely lacking," said Mike Davis, president of the Brain Injury Association of West Virginia. "They didn't rely upon the experts who work with this stuff day in and day out to design this waiver."

The program will begin accepting enrollees on Wednesday. It will accept 75 people in its first year, 100 people the second and 125 in the third year, said Cindy Beane, deputy commissioner at the state Bureau for Medical Services.

Beane said patients will be re-evaluated periodically to determine their need for services. "Unless they would improve to the point where they don't need services, technically they could receive services for a number of years," she said.

She called the program a "huge step forward" for those with TBI.

The program requires patients to be in a licensed nursing facility, inpatient hospital or licensed rehabilitation facility when they apply for the waiver.

Beane said the state wanted to target the people who need the waiver most. If there are fewer than 75 people who apply for the waiver while in hospital, nursing home or rehabilitation center care, the requirements could be revised to allow others to apply, she said.

Davis also criticized the amount of training required for direct patient care. The waiver requires direct care staff to have at least eight hours of training working on direct care service delivery to people with TBI -- which Davis says isn't enough.

"To not require that people have that basic level of understanding about brain injury is ludicrous," he said. "We've fought for 25 years [for a TBI waiver]. Judge Bloom has mandated this. This is the only person that's come and really advocated to get it done and now they're going to implement something that can't even be utilized."

It also requires training in CPR training, first aid, federal Occupational Safety and Health Administration rules, crisis intervention training and other training.

Beane said she would need to review the waiver to comment on the training requirements.

Also, Davis said, the requirements for cognitive therapists, who work to increase brain function after an injury, are so high that no one in the state can provide the therapy.

"It's adding insult to injury when they do this stuff," Davis said of the waiver. "It absolutely pours salt in the wound ... the Bureau for Medical Services and the Department of Health and Human Resources is an absolute oxymoron. There's no health and humanness to this at all."

Beane said the requirements for cognitive therapists had been brought to the attention of the Bureau of Medical Services, which is revising those requirements.

Ginger Dearth, chairwoman of the West Virginia Traumatic Brain and Spinal Cord Injury Rehabilitation Fund Board, agreed the waiver in its current form is very limited.

"It's not going to meet the needs of all survivors of TBI in the state of West Virginia, as we have determined through multiply needs assessments throughout the state," Dearth said.

Reach Lori Kersey at lori.ker...@wvgazette.com or 304-348-1240.