Under Section 1915(c) of the Social Security Act, Medicaid law authorizes the Secretary of the U.S. Department of Health and Human Services to waive certain Medicaid statutory requirements. These waivers enable States to cover a broad array of home and community-based services (HCBS) for targeted populations as an alternative to institutionalization. Waiver services may be optional State Plan services that either are not covered by a particular State or that enhance the Stateís coverage. Waivers may also include services not covered through the State Plan such as respite care, environmental modifications, or family training.
To be a waiver participant, an individual must be medically and/or age qualified, certified for the waiver's institutional level of care, choose to enroll in the waiver as an alternative to institutionalization, cost Medicaid no more in the community under the waiver than he or she would have cost Medicaid in an institution, and be financially eligible for Medicaid that supports Long Term Care services.
A Regional Resource Development Specialist (RRDS) educates the individual about the waiver program, helps the applicant select a service coordinator, and approves all service plans. A service coordinator compiles all documentation needed to establish eligibility, and in conjunction with the individual develops a Service Plan which describes his/her interests, strengths, and goals.
Providers of TBI Waiver services must demonstrate to the RRDS that they meet program qualifications, which include assessments of character, competence, and ability to deliver services according to the Waiver's standards. Each waiver participant has an individualized service plan which the RRDS reviews every six months to ensure the health and welfare of the participant and to ensure that all necessary services are provided. The NYS Department of Health oversees the program.
The Home and Community-Based Services (HCBS) Medicaid Waiver for Nursing Home Transition and Diversion (NHTD) is one of the options available to New Yorkers with disabilities and seniors so they may receive services in the most appropriate, least restrictive setting. This summary provides a general overview of the NHTD waiver.
The NHTD Medicaid waiver was developed based on the philosophy that individuals with disabilities and/or seniors have the same rights as others to:
What is an HCBS Medicaid Waiver?
Why did New York State Develop the NHTD Medicaid Waiver?
State legislation authorized a new HCBS Medicaid waiver to provide a cost-effective community-based alternative to nursing facility care, reflecting the State's commitment to serve all persons in the least restrictive setting, appropriate to their needs.
Individuals with disabilities and seniors, their families and other interested persons advocated for additional options for community-based services and supports.
Otherwise existing Medicaid services and other supports may not be sufficient or most efficient to meet the needs of some individuals with disabilities and seniors to transition into or remain in the community.
What are the Expected Outcomes?
To be Eligible for the NHTD Medicaid Waiver an Individual Must:
Be capable of living in the community with needed assistance from available informal supports, non-Medicaid supports and/or Medicaid State Plan services and be in need of one or more waiver service;
Regional Resource Development Centers (RRDC)
The NHTD waiver is administered through a network of Regional Resource Development Centers (RRDC), each covering specific counties throughout the State. The contact person at the RRDC is the Regional Resource Development Specialist (RRDS). Additionally, the RRDC employs a Nurse Evaluator (NE).
Responsibilities of the RRDS include:
Responsibilities of the Nurse Evaluator include:
The following represents AIMís participation in the New York State Waiver programs:
Allegany, Chemung, Schuyler, Steuben, Tioga, Tompkins
Independent Living Skills Training
Allegany, Chemung, Schuyler, Steuben, Tioga,
Independent Living Skills Training
For information regarding Medicaid Waiver programming at AIM, please contact Rhona Johnson, at 1.888.962.8244 x228 or firstname.lastname@example.org