Nursing Home Transition and Diversion (NHTD) Program Directory

  • Directory is also available in Portable Document Format (PDF)

The following directory describes each of the people and organizations that can help you learn about the NHTD program and apply to participate in it.

Discharge Planner The Discharge Planner is a person in a nursing home or other health care facility responsible for transition of care needs, and for developing a discharge plan for each resident that promotes effective continuation of care to support long-term health. The Discharge Planner assists with transition from nursing facilities, hospitals or health care facilities to the community. If you are interested in becoming a waiver participant and are currently residing in a nursing home or other health care facility, the first step is to talk to your facility´s discharge planner.
Open Doors (and Open Doors Transition Specialists) The Open Doors program is focused on assisting people living in nursing homes and intermediate care facilities to receive individualized home and community-based services. This includes providing people with free, objective information about services and supports that are available in their local community. Staff who work for Open Doors are called Open Doors Transition Specialists. Open Doors can help you learn more about participating in the NHTD program. Open Doors can be reached by phone at (844) 545-7108, by email at, or online here.
Regional Resource Development Center (RRDC), Regional Resource Development Specialist (RDS), and Nurse Evaluator (NE) The RRDCs have an extensive knowledge of community-based long-term care services. RRDCs are grant-funded contractors of the NYS Department of Health that manage the application, participation, and renewal processes of the NHTD program. The RRDCs employ Regional Resource Development Specialists (RRDS) and Nurse Evaluators (NEs) to enroll participants and service providers, approve service plans, develop regional resources and administer the NHTD waiver in each respective region. The list of RRDCs and their contact information is available here.
Peer Support Open Doors offers peer support. Peers are people who live independent lives in the community. By sharing their life experiences in transitioning from facilities to the community, peers provide support during the transition process and can assist with community integration.
Representative A representative can be anyone the individual wishes, and can include a family member, legal guardian, nursing home discharge planner, social worker, or an Open Doors Transition Specialist who is supporting the individual. This is someone who helps the applicant with the NHTD program application process.
Service Coordinator NHTD program applicants choose a Service Coordinator during the application process. The Service Coordinator helps the applicant complete the NHTD application process while providing unbiased and comprehensive information about available services and providers. The Service Coordinator helps an applicant identify the services and supports necessary to ensure the participant´s health and welfare while residing in the community. Additionally, the Service Coordinator works with the applicant to obtain all necessary referrals, assessments, approvals, and authorizations.
Social Services Department (or local Departments of Social Services) These Departments enroll eligible New Yorkers into Medicaid. In order to apply for NHTD waiver services, New Yorkers who are not already enrolled in the Medicaid program need to apply for Medicaid through their local Department of Social Services and have their Medicaid eligibility determined before beginning the NHTD application process.A list of the local Departments of Social Services and their contact information is available here.