Case managers and discharge planners who work with NHTD often know the waiver in outline but not in the week-to-week detail — how long each stage actually takes, who is responsible for what, and when a home care provider like Touch of Love Homecare enters the picture. This guide walks through the real process, stage by stage, so you can set accurate expectations with patients and families and know exactly when to loop us in.

What NHTD Is, in Plain Terms

The Nursing Home Transition and Diversion (NHTD) Medicaid waiver is a New York State home and community-based services program for people who meet a nursing-facility level of care but can live safely in the community with the right supports. It serves two groups: people transitioning out of a nursing home, and people at risk of nursing home placement who want to avoid it. To qualify, a person generally must:

• Be enrolled in community-based Medicaid
• Be assessed at a nursing-facility level of care
• Be age 18–64 with a documented physical disability, or age 65 and older
• Be able to live safely in the community with waiver and other services in place
• Not be concurrently enrolled in certain other care-management programs (Health Homes, MLTC, PACE, or HARP)

NHTD covers service coordination, home and community support services (HCSS), respite, meals, environmental modifications, and more. Touch of Love provides the hands-on HCSS staffing (HHA and PCA support) once a participant’s plan authorizes it — we don’t determine eligibility or manage the case, and we want referral partners to know exactly where that line sits.

The Referral and Enrollment Process, Step by Step

1. 1Referral to the Regional Resource Development Center (RRDC). The process starts when the person (or a discharge planner or case manager acting on their behalf) contacts the RRDC covering their region — that date is the official “referral date.” The RRDC has 5 business days to confirm basic eligibility.
2. 2Intake meeting, scheduled within 30 calendar days of referral — the applicant learns how the waiver works and completes the Application for Participation and Freedom of Choice forms.
3. 3Choosing a Service Coordination agency. The applicant has 30 days to interview and select a Service Coordinator — a separate role from a home care provider. Once selected, that agency has 5 business days to respond to the RRDC.
4. 4Application packet development — an Initial Service Plan, a UAS-NY level-of-care evaluation, a Plan of Protective Oversight, and Medicaid/disability verification.
5. 5RRDC eligibility determination. Once the packet is complete, the RRDC has 14 days to issue a formal Notice of Decision.
6. 6Services begin. The Service Coordinator distributes the approved service plan to the selected HCSS/home care provider, and staffing begins — this is the stage where Touch of Love typically enters.

Taken together, referral sources should generally expect two to four months from first contact to services starting, assuming the applicant already has stable housing and no major documentation gaps.

Where a Bridge Matters

Because NHTD enrollment isn’t fast, a common problem is a patient ready to leave a hospital or nursing facility well before their waiver services are authorized. In those cases, private-pay home care ($32/hour, 4-hour minimum) can start immediately and hand off to waiver-funded HCSS once the Notice of Decision comes through — so discharge doesn’t have to wait on the waiver timeline.

What to Send Us When You Have an NHTD Case

• Where the patient is in the process (referred, intake complete, application submitted, or approved)
• The name of the Service Coordination agency involved, if one has been selected
• The patient’s location within our service area (Brooklyn, Queens, Manhattan, the Bronx, Staten Island, Nassau, Suffolk, or Westchester)
• Any known care needs or anticipated hours
• Your direct contact information, so we can coordinate with you as well as the Service Coordinator

See also

• A Quick Reference Guide for Discharge Planners & Case Managers