NHTD and TBI Waivers in New York: What They Are, Who Qualifies, and Why NHTD Is Closed to New Referrals

What is a Medicaid waiver program?

A Medicaid waiver is a federal permission, under section 1915(c) of the Social Security Act, for a state to pay for home and community-based services for a defined group of people who would otherwise qualify for institutional care. The state “waives” some standard Medicaid rules for that group, sets a maximum number of participants, and gets federal approval for the package.

The point is a trade. The person meets a nursing home level of need, and instead of paying for a facility, Medicaid pays for the mix of services that makes living at home possible: someone to coordinate care, training to live independently, modifications to an apartment, respite for family caregivers.

New York has several 1915(c) waivers. For adults who are not served by the developmental disabilities system, the two that matter are NHTD and TBI. Both sit outside Managed Long Term Care: NY Health Access says waiver enrollees are exempt from mainstream managed care and excluded from MLTC. A planned move of both waivers into MLTC was postponed and then, in NY Health Access’s April 2026 update, described as delayed indefinitely; watch for a state notice before assuming either way.

What is NHTD?

The Nursing Home Transition and Diversion waiver is the Health Department’s program to help Medicaid-eligible seniors and people with physical disabilities get the services they need while living in a community setting rather than a nursing home or other institution. The word “transition” covers people moving out of a nursing home; “diversion” covers people trying not to enter one.

The state describes the participant as the primary decision maker: you choose the services, the providers and the goals in your service plan. Depending on available funds, participants may also qualify for a state-funded housing subsidy administered through the program, although housing itself is not a waiver service.

Why NHTD is closed to new referrals in 2026

Every 1915(c) waiver has a maximum number of participants approved by the federal government, and the state cannot exceed it. The Health Department’s NHTD page explains the sequence: the cap for waiver years 2025-26 through 2027-28 was set at 9,400, approved December 23, 2025; the state then amended the waiver on March 31, 2026, and the amendment, accepted May 15, 2026, raised the cap to 14,079.

Even so, the department says it has reached the approved maximum and cannot process additional referrals. Referrals received are closed by letter and do not move to intake. The department monitors the census and tells the RRDCs when space opens, and the RRDCs process referrals for available slots first come, first served.

What this means for a family in New York City today: an NHTD referral will not start services soon, and you should pursue another route at the same time. The state’s own page points people to their local Independent Living Center, the Open Doors transition program, ICAN at (844) 614-8800, and New York Connects at (800) 614-8800, and to MLTC and PACE.

What is the TBI waiver?

The Traumatic Brain Injury waiver serves people whose brain injury creates a need for nursing home level care. The Health Department lists four eligibility conditions: a diagnosis of TBI or a related condition, eligibility for nursing facility level of care, enrollment in Medicaid, and age between 18 and 64, with the injury occurring after age 18.

The state describes the TBI waiver as providing Medicaid-funded services used together with regular Medicaid services, plus possible rent subsidies, housing supports and a limited one-time payment for furniture and household supplies. Each person must be offered the choice between living in the community or in a nursing facility.

A Regional Resource Development Specialist explains the program, helps the applicant pick a service coordinator and approves every service plan, reviewing it every six months. The age rule names 18 to 64. If a participant is close to 65, ask the RRDC in writing what happens to services at that birthday, since NHTD is the waiver for people 65 and older and is currently closed to new referrals.

Services the two waivers pay for

The service lists follow NY Health Access’s summary of the two waivers. The waivers add to regular Medicaid; personal care, home health and doctor visits still come through Medicaid itself.

How to apply through an RRDC

On the first call, say the waiver by name:

“I am calling about a referral to the TBI waiver for my brother, who is 34, has Medicaid, and had a brain injury in a car crash two years ago. What do you need from us to start, and can you send the list of service coordination agencies?”

Money rules: transfers and the spouse at home

Two rules make the waivers different from a nursing home application.

No look-back for waiver applicants. NY Health Access states that there is no transfer penalty or look-back period for applicants to New York’s home and community-based waivers. The state’s 30-month community look-back, enacted in 2020 and not yet in operation, does not cover the TBI and NHTD waivers either. A nursing home application later on still uses the 60-month rule. How the look-back works.

Spousal impoverishment protection. The Health Department’s 2026 notice to married couples applies its protections to people receiving 1915(c) waiver services likely to last at least 30 days, not only to nursing home residents. In 2026 the spouse at home keeps resources of at least $74,820 and up to $162,660, and income up to $4,066.50 a month. NY Health Access says this budgeting can remove a spend-down that would otherwise apply.

If the answer is no

A Medicaid denial, or a decision about waiver eligibility or services, comes with a written notice and the right to a state fair hearing, generally requested within 60 days of the notice. To keep services running during an appeal, the request must be made before the change takes effect and must ask for aid continuing. For NHTD in 2026, a closed referral because the waiver is full is a capacity decision; meanwhile, ask about Medicaid home care through an MLTC plan.