What Is the NHTD Waiver in New York? Eligibility, Application Steps, and Covered Services
Many people wish to remain in their home while aging or living with a disability. However, many families that live in Brooklyn and throughout New York State may find themselves asking the same question as their family member’s needs become greater: Will we need to put our loved one into a nursing home?
There are other options for those families. A New York Medicaid program known as the Nursing Home Transition and Diversion (NHTD) waiver provides an option to allow individuals to be cared for at home rather than being placed in a long-term care facility. This is a guide to explain what this is, who can qualify for services under this program, what the program covers, and how the process functions.
What Is the NHTD Waiver?
NHTD is a Medicaid Home and Community-Based Services (HCBS) waiver. The program was approved pursuant to Section 1915 (c), of Title XIX of the Social Security Act. The statute allows for states to provide services typically not provided by Medicaid, if they can be demonstrated to prevent institutionalization.
The name of this program illustrates what it aims to accomplish:
- Transition: assisting individuals presently residing in a nursing home or other healthcare facility to transition back to their home environment.
- Diversion: assisting individuals currently living at home to remain there instead of requiring admission to a nursing home.
Current Status: Enrollment Is Limited
Before we continue there is one very important update. All waivers under section 1915(c) have a federal approved maximum number of participants and like other 1915(c) waivers New York has raised this ceiling more than once but instead of processing additional referrals for the program at this time because the state health department stated that it cannot process additional referrals because the approved maximum number of participants has been reached. the Department of Health shares availability updates with the regional centers as spaces become available and referrals are handled on a first-come, first-served basis when spaces become available.
What does this mean to your family?
- Check if spaces are available before you go any further. Contact your Regional Resource Development Center (RRDC) to find out whether or not spaces are available. The list of rrd’s is posted on the Department of Health web site.
- Do not wait until spaces are available to prepare by gathering all required paperwork such as proof of Medicaid coverage and age so that you will be ready when a space opens.
- Explore Other Options while you are waiting. Other ways to get care at home are covered in the “Other Options” section below. Rules and availability change frequently, always confirm current situations with the state prior to making plans.
Who Is Eligible for NHTD?
According to the Department of Health, an applicant must be eligible for community-based Medicaid, be assessed as needing nursing home level of care, and be either 18 to 64 with a verified physical disability or 65 or older. The person must also be able to live safely in the community with the services and supports available.
What does that mean?
- Eligibility for Medicaid.
NHTD is a Medicaid program therefore the applicant must have active Medicaid coverage for community based long term care. If the applicant does not currently have Medicaid they will need to apply through their Local Department of Social Services first. For example, if the applicant lives in New York City, this would be the Human Resources Administration (HRA).
- Functional assessment – not just diagnosis.
This determination is made by a registered nurse completing the state’s Uniform Assessment System (uas- ny) and obtaining a nursing facility level of care score of five. People who are being discharged from hospitals or nursing homes are often evaluated with another tool first.
Who Is Not Eligible?
Many Brooklyn families are surprised by this. A person who is residing within an Assisted Living Program or some other form of licensed congregate care cannot enroll. The same rule applies for individuals who are enrolled in Managed Long Term Care (MLTC), PACE, Health Homes or Health and Recovery Plans. In order to do so; they would have to request being disenrolled from one of those programs first.
Before you make any decisions about dropping a Managed Long Term Care plan which currently supplies them with services, it is essential to discuss these options thoroughly with your loved ones’ care team. Ending a managed long term care plan will require a major life change.
What Services Does NHTD Cover?
A variety of services are available to participants in NHTD. Each participant selects the services they need. Examples include:
- A Service Coordinator is assigned to every participant.
- Home and Community Support Services, including Personal Care and Support
- Meals delivered to your home; Meals served in groups in public locations
- Modifying the environment to make it easier for you to live independently (e.g., installing a ramp into your house or adapting your bathroom)
- Assistance Technology (e.g., computers, wheel chairs, etc.)
- Medical Professionals making home visits to assist you with health concerns
- Respiratory Therapy (when needed)
- Support to Family Caregivers who provide respite
- Training in Independent Living Skills
- Counseling/Wellness Counseling designed to promote social and community integration
- Nutrition Education/Counseling
- Peer Mentoring
- Day Programs
- Transportation (social)
- Relocating Assistance / Transitional Services in the community
- Positive Behavioral Interventions/Solutions
It’s this mix of services that makes NHTD an alternative to traditional “home care” service. In addition to paying for the hands-on help with the daily tasks of living, NHTD can also fund home modification, meal delivery, transportation and coordination. You can see how everyday support at home works on our Homecare Services page.
How to Apply: Step by Step
The process starts with contacting the RRDC in the area in which the individual intends to live. Services cannot be initiated prior to approval by the RRDC of the applicant’s application. This is the basic process:
- Ensure that there is Medicaid available for the applicant. First contact your local Medicaid agency regarding the need for Medicaid.
- Contact the RRDC. Referrals are made to the RRDC via telephone, mail, or the use of a referral form. Family members, guardians, social workers, and nursing home discharge planners may assist with making these referrals.
- Attend the Intake Meeting. At this time the RRDC will explain its programs; review all required documentation (proof of Medicaid, age, and disability for applicants less than 65 years old); and request that the applicant sign a Freedom of Choice document.
- Select a Service Coordination Provider. An applicant has 30 calendar days from receipt of notification of their eligibility determination to identify a Service Coordination provider.
- Complete the Application. With assistance from the applicant’s Service Coordinator, the initial Service Plan and Plan of Protective Oversight will be created. The Plan of Protective Oversight will outline measures to ensure the applicant’s safety and emergency back-up plans. In addition, the applicant’s Nurse Assessment will also occur during this phase of the application process.
- Wait for RRDC Approval. The RRDC has 14 days after receipt of a complete application to make a final determination of eligibility.
- Receive Notification of Eligibility Determination. When an applicant is found eligible, services may begin on the day specified by the RRDC.
How Long Does It Take?
The time frame varies depending on how much the individual needs. For example, if the applicant is moving into his/her own apartment and has adequate informal support along with a service coordinator, it may be as little as one to three months. On the other hand, leaving a nursing home could take several months to complete.
Denial of Application
The decision made by the state does not always represent the last word. A participant who is denied will have the right to schedule a Case Conference. In addition, a participant may also elect to hold a Fair Hearing. As such, there is a 60-day window within which a participant may appeal a denial based upon the application date shown on the denial letter. There are a number of common reasons why applications for NHTD benefits are denied including but limited to; low scores resulting from the level-of-care assessment, inability to provide evidence that they would be able to find a housing location to relocate to, etc.
Other Options While You Wait
If NHTD isn’t available right now, or your loved one doesn’t qualify, you still have routes to explore:
- Medicaid long-term care in the community. Many New Yorkers get personal care at home through Medicaid, often via a Managed Long Term Care plan.
- NY Connects. This is the state’s one-stop line for finding long-term care services and supports in your area.
- Local Area Agencies on Aging. In New York City, NYC Aging can point you to home-delivered meals, in-home services, and caregiver support.
- EISEP. The Expanded In-Home Services for the Elderly Program offers some non-medical in-home help.
- Open Doors. If your loved one is currently in a nursing home or hospital and wants to return home, this free program provides transition support and peer mentors.
- Private pay or long-term care insurance. Some families use these to bridge gaps. For medical needs at home, see our Skilled Services.
If you’re also wondering how Medicare fits in, we explain that in our guide to whether Medicare covers home care in New York.
Frequently Asked Questions
What does NHTD stand for?
Nursing Home Transition and Diversion.
Is NHTD only for seniors?
No. It serves adults aged 18 to 64 with a verified physical disability, as well as people 65 and older. Someone who enrolls before 65 can typically continue after turning 65.
Can I be on NHTD and in an MLTC plan at the same time?
Generally no. The state doesn’t allow duplicated services, so MLTC members must disenroll from their plan to join NHTD.
Does NHTD pay for a family member to provide care?
That depends on the specific service and program rules. Ask your service coordinator or RRDC about the current policy.
Can a family member help with the application?
Yes. With the applicant’s approval, a family member, legal guardian, social worker, or discharge planner can assist.
Is NHTD accepting new applicants right now?
Availability changes. The state has reported that enrollment has reached its approved maximum, so call your regional RRDC to ask about current openings.
Need Help Understanding Your Options?
Sorting out Medicaid programs, waivers, and care levels can feel like a second job, especially when you’re already caring for someone you love. If you’d like to talk through what kind of support could work for your family, the team at Angel Care in Brooklyn is happy to help. You can also learn more on our NHTD page.
This article is for general information only and isn’t legal, medical, or financial advice. Eligibility rules and program availability are set by New York State and change over time. Please confirm current details with the New York State Department of Health or your Regional Resource Development Center.
Questions regarding care for parents begin to appear every Fall in many of Brooklyn’s kitchens. In addition to the family member returning home from the hospital, the mail box becomes filled with all of the Medicare plans that are available. Eventually, one person will ask: how are we going to pay for my mom’s in-home support? The above is an honest question. The response is not as simply a “yes” or “no.” It is a great opportunity to clarify exactly what Medicare covers and what it does NOT cover when choosing your Medicare Plan for next year. This can be accomplished now since Medicare Open Enrollment begins on October 15th and runs through December 7th. The Short Answer Medicare will pay for some home care, but by no means all of it. Generally, Medicare will cover medical care in your home (as opposed to hospital) on an intermittent, part-time basis if that care is "skilled" in nature (e.g., nursing visits and/or physical therapy), ordered by your physician, and provided under certain conditions. In contrast, Medicare has little to do with providing long-term assistance for daily living activities such as bathing, dressing, preparing meals, etc. or round-the-clock supervision when that is the primary type of care needed. "Home Care" Means Two Different Things The phrase gets used loosely, but insurers draw a hard line between two types of care. Skilled care is medical. It's provided or supervised by licensed professionals like registered nurses and therapists. Think wound care, injections, monitoring after surgery, or physical therapy to get someone walking again. You can read more about this on our Skilled Services page. Care that is defined as "custodial" or "personal" includes assistance with all aspects of one's daily routine including bathing, dressing, toileting, food preparation, light housekeeping and social interaction/companionship. This is the type of care that most individuals would envision when they hear the term "home health aide." Additionally, this is also the focus of our Homecare Services. Medicare was developed based upon the idea of skilled care. Therefore, Medicare does not cover the vast majority of the care that most senior citizens require for weeks/months/year(s). What Medicare Does Cover Original Medicare (Parts A and B) will cover Home Health Care if all four requirements below are met:1. You have been certified by your Doctor or Practitioner as needing Home Health Care. The certification process should also include developing a Plan of Treatment for you with regular reviews to ensure that you are receiving the appropriate treatment.2. You require Skilled Services in an intermittent or part time manner. This includes; Skilled Nursing, Physical Therapy, Speech-Language Pathology, Occupational Therapy and/or Medical Social Work. 3. You are Home Bound. Your ability to leave home requires significant difficulty and usually assistance from another individual such as a walker, wheelchair, transportation etc.4. The Agency providing the Home Health Care is certified by Medicare You don't need a hospital stay first, either. A doctor's order and a documented need are what count. When you qualify, Medicare can cover: Part-time skilled nursing Physical, occupational, and speech therapy Medical social services Part-time home health aide services, but only while you're also receiving skilled care Medical supplies For these services, you typically pay nothing. Durable medical equipment like walkers or hospital beds usually comes with 20% coinsurance. What Medicare Does Not Cover This is what families need to know first before making decisions about long-term care: Care provided in your own home around-the-clock Care where you just need assistance with daily living skills (bathing, dressing, toileting) Homemaking services; grocery shopping, housekeeping etc. Meals delivered to your home Aides are also an important option. While Medicare covers a Home Health Aide while you receive Skilled Care, the moment the Skilled Care stops so does the Aide coverage. For people who have long term needs due to chronic illness such as Arthritis, Memory Loss or Recovery which takes longer than expected, this can be a large gap. What This Looks Like in Real Life Picture a woman in Flatbush who breaks her hip and spends a week in the hospital. When she comes home, Medicare-covered home health can send a nurse and a physical therapist to help her recover. That's exactly what the benefit is for. A few weeks later, she's stronger but still can't bathe safely on her own or manage meals. Her therapy goals have been met, so the skilled visits wind down. Now she needs someone a few hours a day, or more, and Medicare no longer pays for it. That's the moment many families start looking at other options. Knowing about it before it happens makes those decisions a lot less stressful. Original Medicare vs. Medicare Advantage Before you weigh your options during this Open Enrollment period, consider these important aspects of home care when comparing Medicare Advantage Plans: All Medicare Advantage (MA) plans will cover all of the services that are included with Original Medicare, which includes home health. The way in which you access services may be different from one MA Plan to another. For example, some MA Plans may only allow in-network providers to provide home health services while others may require prior authorization before home health care begins. In addition, a limited number of MA Plans have "extra" benefits such as a brief amount of short term assistance at home post-hospitalization. However, these "extra" benefits are typically not the same as ongoing long-term care benefits. You can make changes during Open Enrollment through Dec. 15th; your new benefits will go into place on Jan. 1st, 2027. Questions to Ask Before You Choose a Plan Are the home health agencies we'd want to use in the plan's network? Does the plan require prior authorization for home health visits? What are the out-of-pocket limits if care runs long? Does the plan offer any in-home support benefits, and what are the exact limits? (Check the plan's Evidence of Coverage document, not just the marketing summary.) Free, unbiased Medicare counseling is available in New York through HIICAP. You can also call 1-800-MEDICARE or visit Medicare.gov. How New York Families Pay for Long-Term Home Care There are ways to get the ongoing support your family member needs if Medicare does not provide coverage. Many families choose to take advantage of multiple resources together: Medicaid. People may be able to qualify for New York Medicaid (which includes long-term home care) if they qualify financially/asset wise; many of these plans also include a managed long term care plan. The city has agencies like NYC Aging and HRA that can assist in finding what next steps you should take. NHTD waiver. The Nursing Home Transition and Diversion program allows eligible older adults & individuals with physical disabilities to access services in their homes as opposed to a nursing facility. Please view information about this program on our NHTD page. Long-term care insurance. If your family member purchased an LTC policy years ago, it is likely to be time to pull up that policy & assess both the benefits and waiting period. Veteran Benefits. Eligible Veterans and surviving spouses can apply for various programs from the VA such as Aid & Attendance which could benefit them. Private Pay. Families sometimes will privately fund all or part of their schedules or use private funds to supplement gaps. Frequently Asked Questions Are home health aides paid by medicare?Only under very specific circumstances. In order to receive coverage by medicare for a part-time home health aide, you must be getting skilled nursing care or skilled therapy. Will medicare pay for full time (24 hour) care at home?No. Medicare will only pay for part time/intermittent care at home. They do not pay for full time care at home. For how long will medicare cover home health care?There is no set time limit to medicare covering home health care. Your coverage can continue as long as you are meeting all of the required criteria and your physician is continuing to certify your plan of care which is done every so often. Also, the care provided cannot exceed what is medically necessary and it must be part time. Will medicare pay for home health services for someone with dementia?No. However if there was some medical necessity associated with their dementia, such as requiring skilled care from a nurse after they were discharged from the hospital, then the skilled portion of that care may be paid for by medicare. Most ongoing supervision of a person with dementia along with most ongoing personal care would not qualify. Are Medicare Advantage plans better than traditional medicare when it comes to home health care?Neither. The best option for you and your family will depend upon many factors including your medical condition(s), who your physicians and home health agencies are, and your financial situation. Not Sure What Kind of Care Fits? Figuring out coverage is stressful enough without also trying to decode which type of care your loved one needs. If you'd like to talk it through, the team at Angel Care in Brooklyn is happy to help you understand the options and what a care plan could look like for your family. This article is for general information only and isn't medical, legal, or insurance advice. Medicare rules and plan details change, so confirm current coverage at Medicare.gov or by calling 1-800-MEDICARE.
