A. Eligibility Criteria

An individual applying to participate in the waiver must meet all of the following criteria in order to be approved for the NHTD waiver:

  1. Be a recipient of Medicaid coverage that supports community-based long-term care services. Such coverage includes:
    • All Services except Nursing Facility Service
    • Community Coverage with Community-Based Long Term Care
    • Outpatient Coverage with Community-Based Long Term Care
    • Outpatient Coverage with no Nursing Facility Services

    Note: Type of coverage must be verified by providing a copy of Medicaid verification from the New York State system with the submission of the application packet. (The Service Coordinator attaches this to the Initial Service Plan).

  2. Be between age 18 and 64 with a physical disability, or age 65 and older upon application to the waiver; If under age 65, the physical disability will be documented by:
    1. award letters/determination of:
      • Supplemental Security Income (SSI);
      • Social Security Disability Insurance (SSDI); or
      • Railroad Retirement letter for total permanent disability for SSI benefits.

      Note: Because eligibility is restricted to individuals with physical disabilities, additional information may be needed to verify the existence of such a disability.

    2. a letter from the Local Department of Social Services or local disability team (form LDSS 4141) stating the individual has been determined to have a physical disability;
    3. documentation from the individual's physician, hospital summaries or Nursing Home records verifying the physical disability.
  3. Be assessed to need a nursing home level of care. Nursing home eligibility is determined by the Hospital and Community Patient Review Instrument (H/C PRI) and SCREEN (refer to Appendix F). The forms must be dated within ninety (90) calendar days of the individual's application to the waiver and be completed by an individual certified by the State of New York to administer the tool;
  4. Sign the Freedom of Choice form indicating that he/she chooses to participate in the NHTD waiver (refer to Appendix B – form B.4);
  5. Be able to identify the actual location and living arrangements in which the waiver participant will be living when participating in the waiver;
  6. Complete and submit an Application Packet which includes the Initial Service Plan (refer to section C below - Application) in cooperation with the Service Coordinator. This Initial Service Plan must describe why the individual is at risk for nursing home placement without the services of the waiver and indicate how the available supports and requested waiver services identified in the Plan and how the use of the waiver services will prevent institutionalization. The potential applicant must need at least one waiver service (see section C below - Referral, Intake, Application and Determination processes);
  7. Have a completed Plan for Protective Oversight (PPO) (refer to Appendix C – C.4). Be capable of directing his/her Service Plan or has a legal guardian available to direct the participant's Service Plan;
  8. Services agreed upon in the Initial Service Plan (ISP) must meet regional and statewide cost neutrality; and
  9. Be able to live in the community where health and welfare can be maintained as determined by the RRDS.