For many older adults and people with physical disabilities, staying at home is preferable to moving into a nursing facility. In New York, Medicaid can help make that possible. For those who qualify, the Nursing Home Transition and Diversion, or NHTD, waiver offers community-based services that support safer, more independent living at home.
Understanding Medicaid benefits and NHTD eligibility can help families make informed decisions about long-term care.
What Medicaid May Cover
Medicaid helps eligible individuals pay for important healthcare services. Standard coverage may include doctor visits, hospital care, prescription medications, and other medically necessary services. For people who need long-term support, Medicaid may also cover community-based long-term care if they meet the program rules.
This matters because many people need more than occasional medical treatment. They may also need ongoing help with safety, mobility, daily tasks, care coordination, or living arrangements.
How the NHTD Waiver Expands Support
The NHTD waiver is a New York Medicaid program for adults who need nursing home-level care but want to live in the community instead. The program is designed to support independence, choice, and quality of life.
Depending on the approved service plan, NHTD services may include:
- Assistive Technology
- Community Integration Counseling
- Environmental Modifications
- Home and Community Support Services
- Independent Living Skills Training
- Respite Services
- Service Coordination
- Social Transportation
- Wellness Counseling
Some participants may also receive other approved services based on individual needs. These supports can help make community living safer and more realistic for people who might otherwise require institutional care.
Who May Be Eligible for NHTD?
NHTD has specific eligibility requirements. In general, an applicant must:
- Be eligible for community-based Medicaid
- Need a nursing home level of care. Be aged 18 to 64 with a verified physical disability, or age 65 or older
- Be able to live safely in the community with available services and supports.
The person must also have an appropriate living arrangement in the community where waiver services can be provided.
Not everyone who qualifies for Medicaid will qualify for NHTD. For example, people living in certain congregate care settings are generally not eligible. In addition, Medicaid does not allow duplication of some long-term care services, so enrollment in programs such as MLTC, PACE, HARP, or Health Homes may affect eligibility unless the individual disenrolls from the overlapping program.
How to Apply for Medicaid Under NHTD
The application process starts with the Regional Resource Development Center, or RRDC. If the person lives in the community, they or a representative can contact the RRDC directly. If the person is in a nursing home or healthcare facility, a discharge planner may help start the referral.
After referral, the process usually includes:
- Intake Meeting
The RRDC explains the program, reviews basic eligibility, and begins required paperwork.
- Service Coordination Selection
The applicant chooses a Service Coordination provider, and a Service Coordinator helps guide the process.
- Assessment and Planning
The applicant completes a level-of-care assessment and works with the Service Coordinator to create an Initial Service Plan and a Plan of Protective Oversight.
- Application Review
The completed packet is submitted to the RRDC for review and a formal decision.
If approved, services may begin once authorization is issued.
One Important Update for Families
As of late 2025, New York increased the approved NHTD capacity to 9,400 participants, but the program has reached its current limit. The state has said additional referrals cannot be processed at this time, and availability will reopen based on program capacity.
If you need help understanding home care options for yourself or a loved one, HouseCalls Home Care is here to help. Call 718-922-9200, email info@HouseCallshc.org, or register here: https://yuz88hfiyh7.typeform.com/to/E5thuv5G?typeform-source=statics.teams.cdn.office.net.
Key Takeaways
Medicaid can help cover long-term care services, and the NHTD waiver may offer added support for eligible New Yorkers who want to remain in the community instead of entering a nursing facility. Eligibility depends on Medicaid status, age or disability, nursing home level of care, and the ability to live safely at home with support in place.
