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A Look at TBI Trust Fund Programs

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What are TBI Trust Funds?
Trust funds are accounts established by law and earmarked for specific purposes. As State
revenue sources become more difficult to obtain, TBI trust funds offer an additional way to serve
individuals who have sustained a traumatic brain injury.

The earliest TBI trust fund legislation occurred in 1985 in Pennsylvania. Today, twenty-two
states have trust funds, ten of which also benefit individuals with spinal cord injuries.

While all the programs are not specifically called “trust funds,” they do share these similarities:
• They are established by legislation and dedicated for activities benefiting individuals with
brain injury.
• They are supported by revenues from a fee, fine, or surcharge.
• Revenue is placed in an interest-bearing, non-reverting account.

How do they work?
Despite the fact that a trust fund is an account dedicated for a specific purpose, many States
require legislative approval to use TBI funds. Gaining this approval involves establishing an
annual budget and presenting it before a budget or finance committee in the General Assembly.
Estimated revenue varies widely for established programs, from less than $1 million to $22
million. The average is between $1 million and $4 million annually.

The sources of revenue are most often tied to traffic-related issues or offenses. Here are some
examples:
• Penalty assessments on infractions such as DUI, speeding, reckless driving, accidents causing
bodily injury or death
• Assessments on violations of child safety restraint laws, helmet laws
• Surcharges on motorcycle or motor vehicle license tag fees
• Surcharges on vehicle registration fees, driver’s license reinstatement fees
• Penalty assessments on criminal or civil infractions

Just as revenue for trust funds varies, so do their uses. Many programs provide funding for
individual consumer needs while others devote funds to projects selected through a request for
proposal (RFP) process. Some combine trust fund monies with general revenue or other sources
to expand their capacity to provide services. The following list demonstrates the diversity in
uses of trust funds:
• Acute care
• Inpatient, outpatient, and post-acute rehabilitation
• Community-based services
• Case management
• Resource facilitation
• Information and Referral
• Registry
• Research
• Education and Training
• Public Awareness
• Prevention
• Medicaid match
• Funds to match the HRSA federal TBI grants
• Support to the advisory council
• Grants for demonstration projects

While there may be no direct relationship between the HRSA Federal TBI Grant Program and
the evolution of TBI trust fund programs, the increase in exchange of information between States
has most likely stimulated interest in their development. For some States, the Federal program
also provides for the continued presence of an individual or advisory body able to initiate
development of such a fund when the time is right.

Click HERE for a PDF version of the complete report. 
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