HCBS Medicaid Waivers in New York: NHTD, TBI, and What Families Can Do Next
When someone you love needs more help at home, the terms can pile up fast: HCBS, NHTD, TBI, RRDC. You may be trying to understand whether Medicaid can help them stay safe in the community and what to do first.
In New York, HCBS waivers can support eligible people who need nursing-home level care but want to live at home or in another community setting. NHTD and TBI serve different groups, and referrals and available services can change. This guide explains the differences, the questions to ask, and other steps to consider when a waiver is unavailable.
What is an HCBS Medicaid waiver?
An HCBS Medicaid waiver allows a state to offer certain long-term services and supports to eligible people who would otherwise need an institutional level of care. The goal is to help participants receive appropriate support in a home or another qualifying community setting.
New York’s NHTD and TBI programs are examples of HCBS waivers authorized under Section 1915(c) of the Social Security Act. Medicaid coverage is one part of the process. Each waiver also has its own eligibility requirements, assessment, and service-planning steps.
Some home and community-based services are available through other Medicaid programs as well. The right path depends on the person’s coverage, care needs, and circumstances. For a broader overview, see what Medicaid covers in New York.
Is the NHTD waiver accepting new referrals?
As of November 13, 2026, the New York State Department of Health’s NHTD page says the program has reached its approved participant maximum and cannot process additional referrals at this time. The state says referrals received during this period will be closed by letter and will not move forward to intake.
But availability can change: the state says it monitors the number of participants and tells Regional Resource Development Centers (RRDCs) when space is available. Contact the RRDC for your region for the current position and ask what steps to take. Do not assume that a closed referral reserves a place for a future opening.
If care is needed now, ask about other Medicaid and community supports while you check waiver availability. The pause described here concerns NHTD; ask the RRDC separately about the TBI waiver.
NHTD vs. TBI: Which program might fit?
Both waivers support eligible adults who need a nursing-home level of care and want to live in the community. They serve different groups, and each application is reviewed individually.
- NHTD: At application, a person must be age 65 or older, or age 18 to 64 with a documented physical disability. The person must have appropriate Medicaid coverage, need a nursing-home level of care, and be able to live safely in the community with available supports. NHTD can help people move out of a nursing home or remain in the community.
- TBI: The waiver is for eligible adults with a traumatic brain injury or a qualifying related condition. Applicants generally must be 18 to 64 at the time of application, have appropriate Medicaid coverage, and need a nursing-home level of care related to the injury. The RRDC can explain how the diagnosis and other requirements apply to a particular person.
A brain injury does not automatically establish TBI waiver eligibility, and age or disability alone does not establish NHTD eligibility. Ask the RRDC to review the full circumstances. New York’s NHTD overview and TBI program information provide further details.
What services might a waiver provide?
A waiver service plan is built around the participant’s assessed needs and goals. Depending on the program and the approved plan, services may include help coordinating care, support with daily activities, independent-living skills training, respite, assistive technology, or changes to a home that improve access.
For example, someone moving out of a nursing home may need help coordinating services and preparing a suitable place to live. Someone already at home may need support to continue living in the community. The RRDC and service coordinator can explain which services are available under the relevant program.
A listed service is not automatically approved for every participant. Services depend on eligibility, assessment, the approved plan, and available providers. Housing assistance has separate requirements and funding rules.
How to start: a family’s checklist
You do not need to solve everything before you make the first call. Start with the care situation in front of you, then ask the people involved what information will help them guide you.
- Describe the care needed. Note where your loved one lives, what help they need each day, and whether a move home is being considered.
- Check Medicaid coverage. Ask whether the person has coverage that supports community-based long-term care. If Medicaid is not yet in place, learn how to apply and what documents may be needed.
- Contact the regional RRDC. Ask about the relevant waiver, current referral availability, and the information needed to begin. For someone in a nursing home, a discharge planner or Open Doors transition specialist may also help with a referral.
- Gather relevant information. Medicaid coverage details, medical records, disability or brain-injury documentation, and information about daily care needs may be useful. Ask the RRDC what is required for the specific application.
- Discuss assessment and a service plan. When a referral can proceed, the applicant works with the RRDC and a selected service coordinator on the application and a plan for living safely in the community.
Our New York Medicaid application guide explains general application preparation. Medicaid enrollment and waiver enrollment are separate processes, so ask about both.
What if NHTD is full or a waiver is not the right fit?
A pause in NHTD referrals can feel discouraging when your family is trying to arrange care. Your loved one still needs a plan for today. Ask the RRDC about current availability and other resources. If your loved one is in a facility, a discharge planner or Open Doors transition specialist can also help explore a move to the community.
Other routes may include Community Medicaid, home care through a Medicaid plan, or other state and local supports. Each has its own eligibility rules, assessment process, and covered services. Ask what support is available for the person’s needs now, including while you explore a waiver. New York’s NHTD resources page can help you find contacts.
An appeal or Fair Hearing may be relevant if an applicant or participant receives a Notice of Decision that denies, reduces, or ends a waiver-related service or another Medicaid benefit. It is not a way to bypass an NHTD referral pause. Read the notice promptly because the process and deadline depend on the decision. The RRDC, service coordinator, or the notice itself can explain the available review options.
If a brain injury is involved, ask the RRDC whether the TBI waiver may be appropriate. The NHTD referral pause does not tell you whether TBI referrals are available.
Questions Families Often Ask Us About HCBS Medicaid Waivers in NY
Medicare can cover certain home health services when its requirements are met, but it generally does not pay for ongoing custodial help with daily activities as the only care needed. Medicaid and its HCBS programs have different eligibility and coverage rules. A person may have both Medicare and Medicaid. Check each program’s current rules for the services involved.
No. NHTD can help eligible people who already live in the community remain there, as well as people seeking to leave a nursing home. A nursing-home level-of-care assessment describes the level of support a person needs. It does not mean the person must first move into a nursing home.
Some programs may allow eligible family members to be paid for certain care, but the rules depend on the program, the service, and the caregiver’s relationship to the person receiving care. Ask the RRDC or the appropriate Medicaid program which options apply to your situation before making arrangements.
The Regional Resource Development Center (RRDC) helps administer the waiver in your region. Its staff review the application and the proposed service plan under New York State rules. Medicaid eligibility and coverage are also part of the process. A service coordinator helps prepare the plan, but a diagnosis or referral alone does not guarantee approval.
When to speak with Emics Elder Care
Finding the right support can take time, especially when a loved one needs care now. Emics Elder Care helps New York families understand Community Medicaid eligibility, prepare applications, and think through care in the community.
If you would like to talk through your circumstances, schedule a consultation with Emics. We can help you identify the questions to ask, prepare for the next steps, and understand which decisions belong with the RRDC and New York State.