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Nursing Home Transition and Diversion Waiver

What is the Nursing Home Transition and Diversion Waiver?

The NHTD Waiver uses Medicaid funding to provide supports and services to assist individuals with disabilities and seniors toward successful inclusion in the community. NHTD Waiver participants may come from a nursing facility or other institution (transition),or choose to participate in the waiver to prevent institutionalization (diversion). Whether a transition or diversion, the NHTD Waiver allows participants to live in the most appropriate, least restrictive setting, which is usually their home.

View New York State Department of Health Video

Philosophy 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. This includes the right to be in control of their lives, encounter and manage risks and learn from their experiences. This is balanced with the waiver program’s responsibility to assure the waiver participants’ health and welfare.


Waiver services are provided based on the participant’s unique strengths, needs, choices and goals. The individual is the primary decision-maker and works in cooperation with providers to develop a Service Plan. This process leads to personal empowerment, increased independence, greater community inclusion, self-reliance and meaningful productive activities. NHTD Waiver participant satisfaction is a significant measure of success of the NHTD waiver.


To be eligible for the NHTD Waiver an individual must:

  • Be an active Medicaid recipient or be eligible for Medicaid

  • Need nursing home level of care

  • Be between the ages of 18 and 64 with a physical disability, or age 65 or older

  • Be able to live safely in the community

Access To Home Care Services provides the following NHTD Waiver Services:

Service Coordination

When you become an NHTD Waiver participant, you are the primary decision-maker in the development of your goals. Together with your Service Coordinator (SC) and other individuals you choose, you select your service providers and other supports. The key to individual choice and satisfaction is person-centered Service Coordination.


The Service Coordinator:

  • Assists eligible persons to become NHTD Waiver participants

  • Coordinates and oversees the provision of all services in the Service Plan, including NHTD Waiver services and Medicaid State Plan services, as well as other local, state and federally funded educational, vocational, social and medical services.

  • Is responsive to the individual and helps the NHTD Waiver participant identify his or her unique needs and goals

  • Promotes activities which will increase the individual’s independence and life satisfaction, while maintaining the health and welfare of the individual

  • Assists in the integration of the individual in the community of his or her choice

  • Helps in increasing the individual’s productivity and participation in meaningful activities in the home and community

  • Assists in arranging for daily living supports and services to meet the individual’s needs, such as the scheduling of Personal Care Aides (PCA’s) in the home, scheduling medical appointments, and recertifying the participant for Medicaid and food stamps

Home and Community Support Services (HCSS)

Home and Community Support Services (HCSS) are provided when the NHTD Wavier participant needs oversight and supervision as a discreet service to maintain his or her health and welfare to live in the community.  Oversight and supervision may be necessary to protect the NHTD Waiver participant from adverse outcomes related to his or her activities, for example, wandering or leaving the stove unattended.  Oversight and supervision includes cueing, prompting, directing and instructing. 


In addition to oversight and supervision, some NHTD Waiver participants may also be assessed to need assistance with Activities of Daily Living (ADL) and/or Instrumental Activities of Daily Living (IADL). ADL’s include dressing, bathing, hygiene/grooming, toileting, ambulation/mobility, transferring and eating.  IADL’s include housekeeping, shopping, meal preparation and laundry. 

Independent Living Skills Training (ILST)

Independent Living Skills Training helps to improve and maintain the participant’s community living skills so that the individual can live as independently as possible. ILST services assist in recovering skills that have decreased as a result of the onset of the TBI.


The ILST provider will conduct a comprehensive functional assessment of the TBI Waiver participant, identifying the participant’s strengths and weaknesses in performing Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) related to his or her established goals. Based on that assessment, the ILST provider will develop an ILST Detailed Plan, identifying goals to be met by the participant and setting forth the best manner in which to attain the identified goals.


ILST is done primarily in one-on-one training and focuses on the development of practical needs such as self-care, medication management, task completion, communication skills, interpersonal skills, socialization, sensory/motor skills, problem solving skills, shopping, cooking, money management, organization and use of public transportation, and other skills required to maintain a household. ILST is provided in the participant’s residence and in the community.

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