Medicaid home care
How MLTC plans and the waivers differ.
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NHTD waiver home care on Long Island
New York's Nursing Home Transition and Diversion (NHTD) Medicaid waiver helps eligible seniors and adults with physical disabilities live at home instead of in a nursing home. Bryan Skilled Home Care Inc., a licensed home care agency in Amityville since 2011, provides NHTD waiver home care in Nassau and Suffolk when it is authorized.
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- Licensed Home Care Services Agency (LHCSA)
- Serving Long Island since 2011
- 24-hour on-call for clients
If someone you love is in a nursing home and wants to come home, or is at home and at risk of needing a facility, the NHTD waiver may be the way to get steady help in the community. This page explains the steps in plain language and where we fit. New York State sets the rules and can change them. The official source is the Department of Health's NHTD page.
What the NHTD waiver is
NHTD is a home and community-based Medicaid waiver. A waiver lets New York pay for services regular Medicaid does not usually offer, as long as they help a person live in the community rather than in an institution. The New York State Department of Health (DOH) oversees it.
NHTD serves Medicaid-eligible seniors and adults with physical disabilities. It can help people move home from a nursing facility (transition) or stay home when they are at risk of needing one (diversion). DOH calls the participant the primary decision maker: participants choose their services, the providers they work with, and their goals.
NHTD or the TBI waiver?
New York runs a separate waiver for adults 18 to 64 whose main need comes from a traumatic brain injury or a related condition. If that sounds like your situation, read our TBI waiver guide, which covers who may qualify, how to apply through SILO, and the home care we provide. DOH's TBI waiver page has the official details.
Brain injury?TBI waiver home care on Long IslandWho may qualify, how to apply through SILO, and the home care we provide in Nassau and Suffolk.Read the TBI waiver guide →Who may be eligible
These are DOH's criteria for NHTD. The Regional Resource Development Center (RRDC) decides eligibility, not a home care agency.
- Eligible for community-based Medicaid
- Assessed as needing a nursing home level of care
- Age 18 to 64 with a verified physical disability, or age 65 or older, when applying
- Able to live safely in the community with the services and supports available through Medicaid, the waiver, and other community resources
Things that can affect eligibility
Someone in a Managed Long Term Care (MLTC) plan, PACE, a Health Home, or a HARP would need to disenroll first. People in an Assisted Living Program or other licensed congregate care setting are not eligible.
NHTD enrollment status
The NYS Department of Health has applied some restrictions to NHTD enrollment. Ask the RRDC for current status. Meanwhile, Medicaid MLTC is another way many Long Island families get aide hours at home. See Medicaid home care on Long Island.
How the NHTD process works
Every referral starts with the RRDC for the area where the person wants to live. For Long Island, DOH lists the Suffolk Independent Living Organization (SILO) in Medford as the RRDC for both Nassau and Suffolk. Contact details are on DOH's RRDC list. The steps follow DOH's NHTD description. (The TBI waiver follows a similar path; see TBI waiver.)
- Medicaid comes first. The person needs Medicaid that covers community-based long-term care, decided before waiver services.
- Referral to the RRDC. The person, a family member, or a discharge planner, social worker, or Open Doors transition specialist calls or writes to the RRDC.
- Intake meeting. The RRDC explains the program and appeal rights, and the applicant signs a Freedom of Choice form.
- Choosing a Service Coordinator. The applicant picks a Service Coordination provider from the RRDC's list. The Service Coordinator gathers assessments and approvals.
- Building the service plan. Together they develop an Initial Service Plan and a Plan of Protective Oversight for safety and backup. The plan names the services needed and the agencies that agreed to provide them.
- Decision. The RRDC reviews the complete application (within 14 days for NHTD) and issues a written Notice of Decision. Services may begin on the date it authorizes. A denial can be appealed through a case conference or Fair Hearing.
DOH says the NHTD process ideally takes about 2 to 4 months when the applicant already has a home, enough informal support, and a Service Coordinator. Leaving a facility can take longer. The service plan is reviewed at least once a year.
Services the NHTD waiver can include
Examples DOH lists:
- Service coordination
- Home and Community Support Services (HCSS)
- Independent Living Skills Training (ILST)
- Community Integration Counseling (CIC)
- Positive Behavioral Interventions and Supports (PBIS)
- Structured day programs
- Environmental modifications and assistive technology
- Respite
- Community transitional services for people moving out of a facility
- Transportation
Bryan Skilled Home Care does not provide every service on this list. Your Service Coordinator helps you find a provider for each one.
What Bryan Skilled Home Care provides
We are a Licensed Home Care Services Agency (LHCSA) and provide NHTD waiver home care in Nassau and Suffolk when it is authorized. Our part is the care at home.
- Home and community support. Authorized aide hours for supervision and help with daily activities, such as bathing, dressing, grooming, meals, and moving safely around the home.
- Nursing. A nurse helps shape the plan of care and oversees the aide's work. Our nurses make skilled nursing visits when they are authorized.
- Medication reminders. Aides give reminders only, with nurse oversight, when medication management is part of the authorized plan.
- Working with your Service Coordinator. Aides report changes to our nurse, and we work with your Service Coordinator as needs change.
We staff what the waiver authorizes. We do not set waiver hours or decide eligibility; the RRDC does. Waiver services through this agency are offered in Nassau and Suffolk only, not in Queens. Already approved, or close? Call us. Once hours are authorized, we match an aide to the schedule.
NHTD waiver home care in Nassau and Suffolk
Our office is at 15 Albany Avenue in Amityville, at the Nassau-Suffolk line. We provide waiver home care across Nassau County: Hempstead, North Hempstead, Oyster Bay, Glen Cove, and Long Beach. In Suffolk we serve towns across the county, and care on the East End towns of Riverhead, Southampton, East Hampton, and Southold is offered based on availability. Town lists are on our Nassau County page and our home care in Suffolk County page.
How to get started
- Call us at (631) 608-8523, or send a Care Request online. Tell us whether the person is in the NHTD waiver, referred, or exploring. Online, share only basic contact details; a coordinator will call back. The office is open Monday to Friday, 9 to 5.
- Not enrolled yet? Contact the Long Island RRDC, or ask the discharge planner or social worker to refer. We can explain the steps.
- Choose us as your home care provider. Tell your Service Coordinator. Once services are authorized, we match an aide to the plan and schedule.
Discharge planners and Service Coordinators can send a referral through Refer a Patient.
Related pages
Suffolk County
Home care across Suffolk, including the East End (based on availability).
Suffolk County home careNassau County
Home care in all three Nassau towns plus Glen Cove and Long Beach.
Nassau County home careNHTD waiver questions
What is the difference between the NHTD and TBI waivers?
NHTD is for seniors 65 or older and adults 18 to 64 with a verified physical disability. TBI is for adults 18 to 64 at application with a traumatic brain injury or related condition. Both require Medicaid and a nursing home level of care, and both run through the RRDC and a Service Coordinator.
What is the current status of NHTD enrollment?
The NYS Department of Health has applied some restrictions to NHTD enrollment. Ask the Long Island RRDC for current status, and call (631) 608-8523 to talk through Medicaid MLTC or private pay.
Can someone be in an MLTC plan and the NHTD or TBI waiver at the same time?
No. Under DOH rules, a person in a Managed Long Term Care (MLTC) plan is not eligible for the waiver unless they disenroll. We work with both MLTC plans and the waivers and can explain the difference.
Who decides how many home care hours a waiver participant gets?
The service plan, built with the Service Coordinator and authorized by the RRDC. We staff the authorized hours. For extra hours beyond the plan, private pay is an option. Call (631) 608-8523 for rates.
Can I choose Bryan Skilled Home Care as my waiver provider?
Yes, in Nassau or Suffolk. Participants choose their providers in the service plan, and we provide waiver home care in both counties when it is authorized. Tell your Service Coordinator, or call (631) 608-8523. We do not provide waiver services in Queens.
How quickly can waiver home care start?
Services can begin on the date the RRDC's Notice of Decision authorizes. Once hours are authorized, we match an aide to the schedule. Enrollment itself takes longer; DOH says about 2 to 4 months for NHTD in straightforward cases.