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New York's In-Home Medicaid Waiver (NHTD), Explained

The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver is New York's primary in-home HCBS waiver for seniors needing nursing-home-level care.

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Short answer

New York's primary in-home Medicaid waiver for seniors needing nursing-home-level care is the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver, a federal 1915(c) HCBS waiver administered by NYSDOH through Regional Resource Development Centers.

What NHTD covers, and what it does not

NHTD funds home and community-based services intended to transition a Medicaid-eligible senior or person with a physical disability out of a nursing facility, or to divert them from institutional placement altogether. It pays for services, not room and board or rent.

In practice, most Nassau and Suffolk seniors needing ongoing community-based long-term care are more commonly directed toward Managed Long Term Care (MLTC) enrollment, which has been mandatory in both counties since 2013 for Medicaid recipients who need more than 120 days of community-based long-term care and can remain safely at home at enrollment.

Who administers it locally

Start with the Nassau County Office for the Aging (516-227-8900) or the Suffolk County Office for the Aging (631-853-8200), both of which serve as local NY Connects access points and can screen for NHTD and MLTC eligibility.

Source: NYSDOH NHTD Waiver program page

Questions families ask

We're running out of money to pay privately for my parent's care - what are our options?

Once private funds are running low, the relevant path for most Nassau and Suffolk families is long-term-care Medicaid, a separate, asset-tested eligibility pathway from general ACA Medicaid, which can cover nursing home care, Managed Long Term Care (MLTC)-coordinated home care, the Assisted Living Program (ALP), or NHTD waiver services, depending on the level of need. The county Office for the Aging (Nassau: 516-227-8900; Suffolk: 631-853-8200) is a starting point for understanding which of these pathways may apply.

How do we know it's actually time to move my parent out of their home?

There's no single trigger, but common signals include a recent fall or hospitalization, a new or worsening dementia diagnosis, the primary family caregiver reaching burnout, or private funds running low relative to ongoing care costs, any of which typically prompts a first call to the Nassau (516-227-8900) or Suffolk (631-853-8200) County Office for the Aging to understand available options before deciding.

What is Nassau County's Area Agency on Aging, and how do I reach them?

Nassau County's Area Agency on Aging is its Office for the Aging, part of the Department of Human Services, located at 60 Charles Lindbergh Blvd., Uniondale, NY 11553, phone 516-227-8900. Nassau was the first county government in the nation to establish a dedicated agency for its 60-plus population.

What is Suffolk County's Area Agency on Aging, and how do I reach them?

Suffolk County's Area Agency on Aging is its Office for the Aging, explicitly designated the Area Agency on Aging under the Older Americans Act, located at the H. Lee Dennison Building, 100 Veterans Memorial Highway, Hauppauge, NY 11788, phone 631-853-8200. The office has administered federal, state, and county aging programs for nearly 50 years.

Which has a bigger senior population - Nassau County or Suffolk County?

Suffolk County has slightly more seniors in raw numbers, about 291,400 residents age 65 and older versus Nassau's roughly 273,100, but Nassau has a slightly higher senior share of its total population, 19.6 percent versus roughly 19 percent in Suffolk. Both figures come from 2024 USAFacts/Census Bureau estimates, and both exceed the New York State average senior share of 18.9 percent.

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