Nursing Home Transition & Diversion (NHTD) Medicaid Waiver Services

The Home and Community Based Services (HCBS) Medicaid Waiver for Nursing Home Transition and Diversion (NHTD) allows New Yorkers with disabilities and seniors to receive appropriate home care services that permit them to live in the most appropriate, least restrictive setting, which is usually their home rather than an institution. The NHTD program is targeted at individuals either already in nursing homes and wanting to return to their community, or those being considered for nursing home placement but who would prefer to avoid institutional care and remain in their own homes.  

The Department of Health NHTD Waiver program is driven by participant choice. The participant is considered an intricate part of all aspects of service plan development. The participant has the choice, throughout the enrollment process and beyond, to express personal goals and to interview / choose their approved NHTD Waiver service providers. The Regional Resource Development Center (RRDC) provides quality assurance / improvement and oversight on a program-wide basis, as well as advocates for program participants navigating the Waiver system.

 

Each program participant is viewed as an individual with unique strengths as life experiences. By participating in the NHTD Waiver, it is anticipated that the individual will increase his/her independence and self-reliance. The waiver participant is considered the center of all waiver services, with success measured by the individual's satisfaction. The Waiver participant's dignity, right to risk and right to fail must be respected throughout his/her involvement with the waiver.

Eligibility:

To be eligible for the NHTD Waiver program, a participant must:

  • Be enrolled in NYS Medicaid.
  • Be capable of living in the community with assistance from available informal supports, non-Medicaid supports and/or Medicaid State Plan services.
  • Be at least 18 years old at the time of application.
  • Be assessed to be in need of a nursing facility level of care.

Service Philosophy:

  • A program participant may have a menu of services that best meets their individual needs and desires. These service can be a combination of NHTD Waiver, state plan Medicaid (ie. Home Health Aides, Substance Abuse Counseling, Consumer Directed Personal Care, etc..), natural supports and other community-based agencies. NHTD Waiver services should be considered “last resort” on the available spectrum of community services.
  • Services are provided on an individual basis. A program participant may have one or all the outlined NHTD Waiver services, dependent on need and necessity at the time.
  • Services are meant to be "fluid" and to flow with the program participant’s life needs.
  • NHTD Waiver services are encouraged to be provided in an “unbundled” model. A program participant may chose to have a service from one agency and a different service from another agency. This is the choice of the waiver participant. The Service Coordinator will assist, as necessary, the participant to coordinate, manage and solidify their chosen team.

Access to Independence Services:

  • Service Coordination: The Service Coordinator supports and encourages the individual to increase his/her ability to problem solve, be in control of life situations, and be as independent as possible. This is balanced by the need to assure the Waiver participant’s health, safety, well being, and inclusion in the community. The Service Coordinator develops, with the individual, the Initial Service Plan, outlining all needed services, as well as required six month reviews and addendums. Independent Living Skills Training and Development Independent Living Skills Training and Development are services individually designed to improve the ability of the individual to live as independently as possible in the community. These services are specifically designed to instruct and re-train the participant in life-skills that may have been lost or diminished due to their injury. Services may be provided in the individual’s residence and/or in the community, but are always be provided in the environmental context of the goal, to encourage learning and continuity.
  • Environmental Modifications and Special Medical Equipment: State Plan Medicaid supports and all other funding sources need to be researched and exhausted prior to these services being requested. A budgetary cap is in place, per program participant per year, for all Environmental Modification requests.
  • Independent Living Skills Training and Development: Independent Living Skills Training and Development are services individually designed to improve the ability of the individual to live as independently as possible in the community. These services are specifically designed to instruct and re-train the participant in life-skills that may have been lost or diminished due to their injury. Services may be provided in the individual’s residence and/or in the community, but are always be provided in the environmental context of the goal, to encourage learning and continuity.