By Maria DelVecchio · July 9, 2026
The Nursing Home Transition and Diversion waiver is one of New York's least-understood Medicaid programs -- a 1915(c) HCBS waiver that can keep a nursing-home-eligible senior at home instead. Here is who qualifies and how it actually works.
What NHTD actually stands for, and why the name is two programs in one
Nursing Home Transition and Diversion -- NHTD -- is a federal 1915(c) Medicaid Home and Community-Based Services (HCBS) waiver, administered in New York through NYSDOH's Regional Resource Development Centers. The name describes two related but distinct uses of the same program: transitioning someone out of a nursing home back into the community, and diverting someone who would otherwise need to enter a nursing home from ever going in at all.
Both uses share the same underlying eligibility test and the same service menu. The difference is simply where a person is starting from -- already living in a nursing facility, or still at home but at real risk of needing one soon.
Who actually qualifies
NHTD is generally available to Medicaid-eligible New Yorkers who are age 65 or older, or younger with a qualifying disability, and who have been assessed as needing nursing-home-level care under New York's standard clinical assessment. That is the same nursing-home-level-of-care threshold used elsewhere in New York's Medicaid long-term-care system, including for the Assisted Living Program.
Meeting the clinical threshold is necessary but not sufficient -- financial eligibility also has to be established through New York's non-MAGI aged/blind/disabled Medicaid pathway, which tests both income and countable assets. A Staten Island family should not assume a parent is automatically ineligible for NHTD just because they are still managing reasonably at home; the program specifically exists for people who are at real risk of nursing home placement but not yet living in one.
Transitioning out of a nursing home
For a resident already living in a nursing facility, NHTD can fund the services and supports needed to move back into the community safely -- a genuinely different track from simply being discharged with no plan. This can include care management, home modifications, assistive technology, and ongoing home and community-based services once the transition happens.
This matters specifically for families dealing with a hospital-to-nursing-home admission that was meant to be short-term rehabilitation but risks becoming a longer stay. NHTD is one of the tools that can support an active plan to bring a parent home rather than defaulting to long-term nursing home placement once short-term rehab benefits, such as Medicare's limited skilled nursing coverage, run out.
Diverting from a nursing home in the first place
For someone still living at home but assessed as needing nursing-home-level care, NHTD's diversion track can fund services that make staying at home a realistic, supported option instead -- rather than a family reluctantly concluding that a nursing home is the only remaining choice once a parent's needs cross a certain threshold.
This is the scenario many Staten Island families never hear about until they are deep into a crisis, in part because primary care providers and hospital discharge planners default to more familiar options first. Asking a discharge planner, or the local NY Connects office, directly and by name whether NHTD diversion applies to a parent's situation is worth doing before assuming a nursing home placement is the only path.
How NHTD interacts with MLTC
New York runs two separate community-based Medicaid long-term-care systems that can overlap in confusing ways: Managed Long Term Care (MLTC) and the NHTD waiver. MLTC -- PACE for those 55 and older, or MLTC Partial Capitation/Medicaid Advantage Plus -- is New York's broader managed-care delivery system for long-term services and supports, and enrollment has been mandatory in New York City, including Richmond County, since 2012.
NHTD, by contrast, is a specific 1915(c) fee-for-service waiver administered through Regional Resource Development Centers rather than through a managed care plan. In practice, a family and their care team need to work out which pathway fits a given situation -- generally not both at once for the same services -- and this is exactly the kind of decision worth making with a benefits counselor or elder law attorney rather than guessing from general information.
The practical difference families notice most is structural: MLTC operates through an enrolled managed care plan that coordinates services, while NHTD operates through a waiver service coordinator working from a person-centered service plan built specifically around that individual's transition or diversion goals. Neither is inherently better -- they are built for somewhat different situations, and the right fit depends on the specific case.
What the person-centered service plan actually covers
Once someone is enrolled, NHTD services are built around an individualized, person-centered service plan developed with a waiver service coordinator -- not a fixed, one-size package. Depending on the plan, this can include home and community support services, environmental modifications to make a home safer, assistive technology, respite for a family caregiver, transportation, and structured day programs, in addition to the transition- or diversion-specific supports described above.
Because the plan is individualized, two NHTD participants with similar diagnoses can end up with meaningfully different service packages, based on their specific home environment, family support, and assessed needs. This is worth knowing going in, so a family does not assume NHTD works like a flat benefit with the same services for everyone.
What NHTD does not do
NHTD does not pay for assisted living room and board -- it is a home and community-based waiver, meaning its services are delivered where a person actually lives in the community, not inside a licensed residential facility. A family looking specifically for Medicaid help with the cost of an assisted living-type setting should look instead at New York's Assisted Living Program (ALP), which operates inside a qualifying Adult Home or Enriched Housing Program setting under an entirely different set of rules.
NHTD also is not a fast, automatic approval. Because it requires both a nursing-home-level-of-care clinical assessment and a financial eligibility determination, plus development of an individualized service plan through a Regional Resource Development Center, families should expect a real application and assessment process -- not a same-week enrollment -- and should start it as early as a need becomes apparent rather than waiting for a crisis.
Why this program is so consistently under-used
NHTD is not a well-known program, even among families who have already done meaningful research into New York's Medicaid system. Part of the reason is structural: because it is a 1915(c) waiver rather than a service embedded in a managed care plan like MLTC, it does not come up automatically the way an MLTC enrollment conversation does once someone is already Medicaid-eligible and dual-eligible for Medicare. A family has to specifically ask about it, or specifically be referred to it by a discharge planner or benefits counselor who knows to mention it.
This matters most at exactly the moment families are least equipped to research it thoroughly -- during or right after a hospital stay, when a discharge planner is working against a tight timeline and often defaults to whichever placement option is fastest to arrange, rather than walking through every available Medicaid pathway. Asking directly and by name, "does the NHTD waiver apply here, as a transition option instead of long-term nursing home placement," is worth doing even under time pressure, because the answer can change the entire trajectory of a parent's care.
Getting started on Staten Island
The most efficient first step for most Staten Island families is the local NY Connects access point: the Community Agency for Senior Citizens (CASC), at (718) 489-3954, 120 Stuyvesant Place, Suite 409, Monday through Friday 9am-5pm (Tuesday to 7pm). CASC can help arrange an initial assessment and point a family toward the right NHTD Regional Resource Development Center contact, or toward NY Medicaid Choice if financial eligibility needs to be established first.
NYC Aging (DFTA), reachable citywide through 311 or (212) 244-6469, is the broader Area Agency on Aging behind CASC's local work and can also help connect a family to case assistance and benefits counseling if the NHTD process feels overwhelming to navigate alone. Given how much this program can change a family's options at a moment when a nursing home placement feels like the only choice left, it is worth the phone call even when a situation feels urgent.
