The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver Program

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Welcome to the New York State Department of Health´s webpage for the Nursing Home Transition and Diversion (NHTD) 1915(c) Medicaid waiver program. This page provides information about the NHTD program and the current application process to participate in it. This website is being continuously updated as new resources and program documents become available.

The NHTD waiver program is a home and community-based program that helps New York´s Medicaid-eligible seniors and people with physical disabilities receive comprehensive services they need while they live in a community-based setting, rather than in a nursing home, congregate care setting, or other institution.

Program participants receive services based on their unique strengths, needs, choices, and goals. The participants are the primary decision makers. Participants choose the services they receive, the service providers they will work with, and the outcomes they will achieve.

Contingent upon the availability of funds, waiver participants may also be eligible for a state-funded housing subsidy to help them live in the community. The subsidy is administered through the NHTD program; however, the provision of housing is not a waiver service.

The NHTD Medicaid waiver was developed based on the philosophy that individuals with physical disabilities and seniors have the same rights as others. This includes the right to be in control of their own lives, encounter and manage risks and learn from their experiences. This is balanced with the waiver program´s responsibility to ensure the waiver participants´ health and welfare in the community.

The individual is the primary decision maker and works in cooperation with providers and others they may choose to develop a Service Plan. This process leads to personal empowerment, increased independence, greater community inclusion, self-reliance and meaningful productive activities. Participant satisfaction is a significant measure of success of the NHTD program.

  • Eligible for community-based Medicaid,
  • Assessed as needing nursing home level of care, and
  • Either between the ages of 18-64 and have a verified physical disability or are age 65 or older when applying to the program.

The individual must also be able to live safely in the community with the services and supports offered through Medicaid, the waiver program and other community resources.

If you are interested in becoming a waiver participant and are currently residing in a nursing home, the first step is to talk to a discharge planner about your intentions. The discharge planner can make a referral to Open Doors and/or the Regional Resource Development Center (RRDC) and help you get started. You may also contact the RRDC directly. If you are currently residing in the community and interested in becoming a waiver participant, then you or a representative will reach out to the RRDC in your area to move forward with the application process.

Details about the application process are included on the Applicants & Participants page of this website. As part of the process, the applicant will meet with the RRDC and have an intake meeting. After the meeting, the applicant works with a Service Coordinator (case manager) to develop an Initial Service Plan (ISP), which identifies the services and supports necessary to ensure the participant´s health and welfare while residing in the community.

In 1981, Congress authorized the waiver of certain federal requirements to allow a state to provide home and community-based services (other than room and board) to individuals who would otherwise require institutional or nursing facility care reimbursed by Medicaid. This waiver allows states to provide services not usually offered by the Medicaid program, as long as these services prevent the person from being institutionalized. The NHTD waiver is authorized under section 1915(c) of the Social Security Act. New York requested and received approval from the Centers for Medicare and Medicaid Services (CMS) to provide NHTD waiver services in 2007.