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New York's In-Home Medicaid Waiver (NHTD), Explained

The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver is New York's primary in-home HCBS waiver for seniors needing nursing-home-level care.

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Short answer

New York's primary in-home Medicaid waiver for seniors needing nursing-home-level care is the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver, a federal 1915(c) HCBS waiver administered by NYSDOH through Regional Resource Development Centers.

What NHTD covers, and what it does not

NHTD funds home and community-based services intended to transition a Medicaid-eligible senior or person with a physical disability out of a nursing facility, or to divert them from institutional placement altogether. It pays for services, not room and board or rent.

In practice, most Nassau and Suffolk seniors needing ongoing community-based long-term care are more commonly directed toward Managed Long Term Care (MLTC) enrollment, which has been mandatory in both counties since 2013 for Medicaid recipients who need more than 120 days of community-based long-term care and can remain safely at home at enrollment.

Who administers it locally

Start with the Nassau County Office for the Aging (516-227-8900) or the Suffolk County Office for the Aging (631-853-8200), both of which serve as local NY Connects access points and can screen for NHTD and MLTC eligibility.

Source: NYSDOH NHTD Waiver program page

Questions families ask

How do I check if a Long Island assisted living facility has a clean inspection record?

New York State publishes licensing status and inspection history for every Adult Care Facility, including Assisted Living Residences, on the NYS Health Profiles website (profiles.health.ny.gov/acf), searchable by county, name, or facility type. Each facility's profile page includes an Inspections tab showing survey results. NYSDOH also publishes a statewide Consumer Information Guide: Assisted Living Residence that explains how to read these records.

Is memory care a licensed category in New York, or just a marketing term?

New York does not have a separate memory care license. Dementia and cognitive-impairment care is addressed through the Special Needs Assisted Living Residence (SNALR) certification, an additional certification layered onto an existing Assisted Living Residence license under 10 NYCRR Part 1001. Families should verify a facility's actual SNALR certification on NYS Health Profiles rather than relying on a memory care sign or brochure.

What state regulations govern nursing homes on Long Island?

Nursing homes in New York are licensed and regulated by NYSDOH under 10 NYCRR Part 415, Nursing Homes - Minimum Standards, a completely separate rule set from the Adult Care Facility regulations that govern assisted living. Families can search and compare Nassau and Suffolk nursing homes through the NYS Health Profiles Nursing Home Profiles tool. Note that as of mid-2025, CMS's migration to a new federal inspection database (iQIES) temporarily affected how current some posted inspection data is, so it's worth confirming a record's date.

What is an Enhanced Assisted Living Residence (EALR) and when would my parent need one?

An Enhanced Assisted Living Residence (EALR) is an additional certification an Assisted Living Residence can obtain to let residents age in place despite higher physical needs, specifically those who chronically need physical help walking or using stairs, depend on medical equipment requiring frequent professional assistance, or have chronic, unmanaged bowel or bladder incontinence. EALR care is delivered per an Individualized Service Plan and is regulated under the same 10 NYCRR Part 1001 rules as standard ALR and SNALR certifications.

Is there a local New York State office that oversees senior care facilities specifically on Long Island?

Yes. Long Island Adult Care Facilities fall under NYSDOH's Metropolitan Area Regional Office - Long Island (MARO-LI), located at 320 Carleton Avenue, Suite 5000, Central Islip, NY 11722, phone 631-851-3098. This regional office handles licensing oversight and inspections for Nassau and Suffolk County facilities rather than families needing to go through a statewide-only office.

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