Stakeholder Group Meets Again on NHTD Waiver Enrollment Cap
(Sept. 15, 2025) Staff representing the Executive Chamber, the Department of Health (DOH), the Nursing Home Transition and Diversion (NHTD) Waiver Program 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 Waiver Program. The 2025-26 State Budget enacted $18.2 million (Fiscal Year (FY) 2026) and $75.3 million (FY 2027) in savings to bring the program to a budget-neutral status.
DOH said that it is finalizing public comment on the waiver amendment, which proposes an enrollment cap on the program. It will be published soon and then sent to the Centers for Medicare and Medicaid Services (CMS) for approval. It is expected to be approved in December. The amendment calls for an enrollment cap set at 9,400. In June, enrollment was 8,900. 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 who 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 a Registered Nurse (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 that 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 a 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 (FLSA).
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, environmental modifications (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-Mods.
There was little discussion regarding where individuals turned away from the waiver will receive services. Attendees shared that 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 NY staff.
Contact: Meg Everett, meverett@leadingageny.org