Nursing Home Transition and Diversion (NHTD) Waiver Programs

The Home and Community-Based Services (HCBS) Medicaid Waiver for Nursing Home Transition and Diversion (NHTD) is one of the options available to New Yorkers with disabilities and seniors so they may receive services in the most appropriate, least restrictive setting. This summary provides a general overview of the NHTD waiver.


The NHTD Medicaid waiver was developed based on the philosophy that individuals with disabilities and/or seniors have the same rights as others to:

  • Be in control of their lives.
  • Encounter and manage risks and learn from their experiences.

Why did New York State Develop the NHTD Medicaid Waiver?

  • State legislation authorized a new HCBS Medicaid waiver to provide a cost-effective community-based alternative to nursing facility care, reflecting the State's commitment to serve all persons in the least restrictive setting, appropriate to their needs.
  • Individuals with disabilities and seniors, their families and other interested persons advocated for additional options for community-based services and supports.
  • Otherwise existing Medicaid services and other supports may not be sufficient or most efficient to meet the needs of some individuals with disabilities and seniors to transition into or remain in the community.

What are the Expected Outcomes?

  • Participants will have an additional community-based choice.
  • Participants will have opportunities to live meaningful and productive lives in their communities.
  • Families and other informal caregivers will have access to additional supports to assist them in their caregiver roles.

To be Eligible for the NHTD Medicaid Waiver an Individual Must:

  • Be capable of living in the community with needed assistance from available informal supports, non-Medicaid supports and/or Medicaid State Plan services and be in need of one or more waiver service;
  • Be eligible for nursing home level of care;
  • Be authorized to receive Medicaid Community Based Long Term Care;
  • Be at least 18 years of age or older;
  • Be considered part of an aggregate group that can be cared for at less cost in the community than a similar group in a nursing home;
  • Choose to live in the community as a participant in this waiver rather than in a nursing home; and
  • Not participate in another HCBS waiver.

VI. Regional Resource Development Centers (RRDC)

The NHTD waiver is administered through a network of Regional Resource Development Centers (RRDC), each covering specific counties throughout the State. The contact person at the RRDC is the Regional Resource Development Specialist (RRDS). Additionally, the RRDC employs a Nurse Evaluator (NE).

Responsibilities of the RRDS include:

  • Interviewing potential waiver participants;
  • Assisting participants to access approved providers for Service Coordination;
  • Reviewing Service Plans for approval;
  • Determining whether an applicant participant meets all non-financial eligibility requirements for the waiver;
  • Maintaining regional budgets for waiver services; and
  • Issuing Notice of Decision forms to applicants to approve or deny waiver participation and to participants as necessary for ongoing participation.

Responsibilities of the NE include:

  • Utilizing clinical expertise to review medically complex Service Plans;
  • Providing technical assistance to the RRDS and waiver service providers; and
  • Resolving issues associated with level of care determinations.

Quality Management Specialists (QMS)

The NHTD waiver relies on a network of Quality Management Specialists (QMS) throughout NYS, each covering specific regions. The primary responsibility of the Specialists is to assure quality under the waiver through a range of functions, including:

  • Assisting in the retrospective review of Service Plans;
  • Reviewing Service Plans over $300 per day;
  • Overseeing the incident reporting process;
  • Conducting participant satisfaction surveys; and
  • Performing trend analysis in their regions with recommendations for improvements.