Stakeholder Group Meets Again on NHTD Waiver Enrollment Cap
(September 15, 2025) Staff representing the Executive Chamber, the State Department of Health, the Nursing Home Transition and Diversion Program (NHTD) unit, and state associations and leaders representing waiver providers and participants, met again to share and discuss progress and challenges regarding potential ways to curtail spending on the NHTD program. The 2025-26 State Budget enacted $18.2M (FY2026) and $75.3M (FY2027) in savings to bring the program to a budget neutral status.
The State Department of Health said they are finalizing public comment on the waiver amendment which proposes an enrollment cap on the program. It will be published soon and then sent to CMS for approval. It's expected to be approved in December. The amendment calls for an enrollment cap set at 9400. In June enrollment was 8900. It does not provide the ability for DOH to establish a waiting list for those applying for services. When the limit is reached, new applicants will receive a communication regarding the cap and alternative options for services. They will be asked to check back on availability.
There are roughly 50 participants that leave the waiver program every month. It will not be a one for one regional admittance to the waiver when someone leaves. DOH will distribute new applicants proportionately to regions based on enrollment. Individuals will not be allowed to add their name to an informal waiting list and DOH will not be tracking application numbers. Group attendees expressed support to have DOH amend the waiver to allow for a waiting list.
The group discussed Home and Community Support Services (HCSS) which makes up the bulk of the care provided under the waiver - personal care and supervision. DOH stated that it plans to prohibit assessments for HCSS to be completed by an RN employed by the same agency that is providing the HCSS hours. This policy change is a long term goal.
DOH will also do a review of high hour cases by sampling participants with 12+ hours. HCSS is 98% of the services provided by the waiver. DOH is now training individuals to complete this review process. DOH will be working on developing ways to reduce excessive hours with the use of informal supports and access to other services.
The Department also said it is considering using the 13 hour rule for participants who require 24/7 care. This would allow the State to pay live -in aides for 13 hours instead of full 24 hours if the aide receives 8 hours of sleep with 5 hours uninterrupted. This would require an amendment to the waiver. Attendees shared their concerns with this approach and its potential to violate the Fair Labor Standards Act.
Some suggested live in foster care as another resource to save costs. Another asked if there is an individual cost cap, with DOH responding in the negative. There was discussion regarding options to supplant in person care with subscription services for food and laundry, e-mods, assistive technology and technology that provides prompting and cueing. The state is starting a demonstration on Long Island to implement and track saving from e-modifications.
There was little discussion regarding where individuals turned away from the waiver will receive services. Attendees shared there is only so much savings that can be generated for care of this growing complex population.
The Department did state that the waiver can reserve capacity for those participants who end up being admitted to the hospital or nursing home and then return to the waiver.
Members with questions, concerns and recommendations are reminded to reach out to LeadingAge New York staff.
Contact: Meg Everett, meverett@leadingageny.org.