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New York's In-Home Medicaid Waiver (NHTD), Explained

The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver is New York's primary in-home HCBS waiver for seniors needing nursing-home-level care.

HomeState RulesNew York's In-Home Medicaid Waiver (NHTD), Explained
Short answer

New York's primary in-home Medicaid waiver for seniors needing nursing-home-level care is the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver, a federal 1915(c) HCBS waiver administered by NYSDOH through Regional Resource Development Centers.

What NHTD covers, and what it does not

NHTD funds home and community-based services intended to transition a Medicaid-eligible senior or person with a physical disability out of a nursing facility, or to divert them from institutional placement altogether. It pays for services, not room and board or rent.

In practice, most Nassau and Suffolk seniors needing ongoing community-based long-term care are more commonly directed toward Managed Long Term Care (MLTC) enrollment, which has been mandatory in both counties since 2013 for Medicaid recipients who need more than 120 days of community-based long-term care and can remain safely at home at enrollment.

Who administers it locally

Start with the Nassau County Office for the Aging (516-227-8900) or the Suffolk County Office for the Aging (631-853-8200), both of which serve as local NY Connects access points and can screen for NHTD and MLTC eligibility.

Source: NYSDOH NHTD Waiver program page

Questions families ask

Is there a local New York State office that oversees senior care facilities specifically on Long Island?

Yes. Long Island Adult Care Facilities fall under NYSDOH's Metropolitan Area Regional Office - Long Island (MARO-LI), located at 320 Carleton Avenue, Suite 5000, Central Islip, NY 11722, phone 631-851-3098. This regional office handles licensing oversight and inspections for Nassau and Suffolk County facilities rather than families needing to go through a statewide-only office.

Do I have to enroll in an MLTC plan for home care in Nassau or Suffolk County?

Yes - Managed Long Term Care (MLTC) enrollment is mandatory in both Nassau and Suffolk counties for dual-eligible Medicaid recipients age 21 and older who need community-based long-term care services for more than 120 days. NYSDOH extended mandatory MLTC enrollment to Nassau, Suffolk, and Westchester counties beginning in the 2013 transition period, and that mandatory enrollment structure remains in effect. MLTC plans coordinate home care, adult day care, nursing home care, and related services through a single managed care plan rather than fee-for-service Medicaid.

What is the NHTD Medicaid waiver and could it help my parent stay out of a nursing home?

The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver is a federal 1915(c) Home and Community-Based Services waiver administered by NYSDOH through Regional Resource Development Centers. It helps Medicaid-eligible people age 65 and older, and younger people with physical disabilities, who have been assessed as needing nursing-home-level care receive services in the community instead, either transitioning out of a nursing facility or diverting from being admitted to one in the first place.

What is New York's Assisted Living Program (ALP) and how is it different from private-pay assisted living?

The Assisted Living Program (ALP) is New York's Medicaid-funded alternative to nursing home placement, operating inside licensed Adult Homes or Enriched Housing Programs rather than as a separate building type. It serves people who are medically eligible for nursing home care but can safely be served in a less medically intensive, lower-cost setting, covering personal care, room and board, housekeeping, home health aides, nursing, therapy, medical equipment, adult day health care, and RN case management. ALP is regulated under 18 NYCRR Part 494.

My mom is 68 with a low income - does New York's ACA Medicaid expansion cover her nursing home or home care costs?

No. New York's 2014 ACA Medicaid expansion covers a different population: adults ages 19-64 without dependent children, up to 138% of the federal poverty level, with no asset test. Long-term care Medicaid for seniors is a completely separate eligibility pathway - it is asset and resource-tested, applies to people 65 and older or those needing institutional-level care, and is what actually covers nursing home care, MLTC, the ALP, and NHTD waiver services.

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