New York Nursing Home Transition and Diversion Waiver: New York 2026 Guide

New York’s Nursing Home Transition and Diversion (NHTD) waiver helps older adults and adults with physical disabilities leave a nursing home, or avoid entering one, by providing home and community-based services and service coordination. It is administered by the New York State Department of Health through Regional Resource Development Centers.

Below we cover the 2026 eligibility rules for the NHTD waiver, the services it can pay for, the steps to apply, how waiting lists work, and how the program sits alongside nursing home Medicaid in New York. For the full statewide rules on income, assets, spouses and the look-back, see our New York Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What the NHTD waiver is

NHTD is a 1915(c) waiver that emphasizes choice and independence. Each participant chooses a service coordinator, who helps write a service plan with the participant. The plan describes which waiver services will be used, alongside regular Medicaid services such as home care. NHTD can pay for services that most other New York programs do not, such as community transitional services to set up a home and moving assistance. New York has proposed moving NHTD services into managed care, so the program’s structure could change.

In federal terms, the NHTD waiver is a home and community-based services (HCBS) waiver. That label means New York received approval to bend some usual Medicaid rules, most importantly the link between long-term care and a nursing home bed. Waivers are optional for states, so each sets its own services and, often, a limit on enrollment. Unlike regular Medicaid, a waiver is usually not an entitlement: qualifying does not guarantee an opening.

Who qualifies in 2026

To get the NHTD waiver, a person generally has to pass two separate tests, one about care need and one about money, and then receive an opening. In general, an applicant must:

• be 65 or older, or 18 to 64 with a physical disability;
• be eligible for New York Medicaid, including community-based long-term care coverage;
• meet a nursing facility level of care;
• be able to live safely in the community with the services in the plan; and
• choose to live in the most integrated setting appropriate to their needs.

Financial rules. For the NHTD waiver, New York State Medicaid (your local LDSS or HRA) applies the long-term care Medicaid rules for income and assets, generally the same ones used for nursing home care. Savings, investments and real estate other than the home count; the home, a car, belongings and some burial funds usually do not. The five-year look-back on gifts and below-value transfers applies here too, so large gifts in the past five years can delay services.

NHTD follows New York’s community Medicaid financial rules: in 2026, about $1,836 a month of income for one person and $33,038 in assets, with spend-down or a pooled trust above the income level. Spousal impoverishment protections apply to married waiver participants.

The main New York long-term care figures for 2026, taken from our state guide, are below.

If you are married. The spouse who stays home is protected: federal spousal impoverishment rules let them keep a share of the couple’s assets and, if their own income is low, part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services the NHTD waiver can cover

The care plan picks from a menu of services. For the NHTD waiver, that menu includes:

• service coordination
• assistive technology
• community integration counseling
• community transitional services, such as security deposits and basic furnishings
• environmental modifications
• home and community support services
• home-delivered and congregate meals
• independent living skills training
• moving assistance
• peer mentoring
• positive behavioral interventions
• respiratory therapy and nutritional counseling
• respite care
• structured day programs
• wellness counseling

Limits to keep in mind. the NHTD waiver does not pay for rent, groceries or utilities; in residential settings, room and board is the resident’s responsibility. Family help is usually factored into the plan, and medical coverage runs alongside the waiver as before.

How to apply for the NHTD waiver

Here is how applying for the NHTD waiver usually works. Filing the Medicaid application and the waiver request together saves time.

1. Contact the Regional Resource Development Center for your area, or ask a nursing home social worker, to request an NHTD intake.
2. Apply for Medicaid with community-based long-term care coverage, if not already enrolled.
3. Choose a service coordination agency.
4. Work with the service coordinator to write a service plan, which the Regional Resource Development Center reviews.
5. Services start once the plan is approved.

Practical tips. Keep copies of everything you send and note the name of each person you speak with. During the assessment, describe a typical bad day rather than a good day, and have a family member present who knows how much help is really needed. Cognitive problems and fall risk count toward need. If services are denied, the notice lists the deadline to appeal.

Waiting lists and timing

NHTD has a set capacity. In some regions, applicants wait for service coordination or for approval. Moving from a nursing home can take several months to arrange housing and supports.

Getting on a list early, before a crisis, is usually wise. While waiting, other options can help: state plan personal care, adult day programs, PACE where offered, Older Americans Act services through the Area Agency on Aging, and family caregiver support. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

Because participants meet a nursing home level of care, the NHTD waiver is a substitute for nursing home care, not a step below it. Nursing home Medicaid is an entitlement for people who qualify, so it has no waiting list, while a waiver may. A participant who later needs a nursing home keeps Medicaid, though more of their income then goes toward care. People leaving a nursing home often get priority for waiver openings, with help from Money Follows the Person.

Tips for families

Begin before the situation is urgent; every step takes longer than families expect. Have five years of records ready and write down daily care needs for a couple of weeks before the visit. Income over the limit can often be handled with a Miller trust or spend-down, and any recent gifts deserve review before filing. If needs change, request a reassessment rather than waiting for the yearly review.

Because the NHTD waiver combines a care test, a money test and sometimes a wait, a Certified Medicaid Planner familiar with New York can be a real help: checking finances against the 2026 limits, flagging look-back issues and keeping the application on track. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.

Related pages

• New York Medicaid guide
• New York Managed Long Term Care
• Money Follows the Person
• HCBS waivers explained
• Applying for a waiver
• Nursing home level of care
• Waiver waiting lists
• The five-year look-back

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.