Explore funding and financials of NHTD waiver program to optimize eligibility and benefits for participants.
October 23, 2024
The Nursing Home Transition and Diversion (NHTD) waiver program provides an array of services and supports to eligible individuals for living safely in the community. This program is funded by Medicaid, the waiver program itself, and various other community resources. The primary goal of the NHTD program is to assist seniors and individuals with physical disabilities by offering comprehensive care services tailored to their unique needs. These services may include personal care assistance, home modifications, community habilitation, respite services, and transportation services. The focus is on promoting independence and inclusion within the community, helping individuals transition from nursing facilities or preventing the need for institutional care altogether [1].
To qualify for the NHTD Waiver Program, individuals must demonstrate a need for a level of care that can be provided in a community setting rather than an institutional one. The eligibility criteria include:
The application process for the NHTD program involves several steps:
Maintaining eligibility requires participants to sustain specific criteria, including remaining Medicaid eligible, requiring nursing facility level of care, engaging in Service Coordination services monthly, and having an approved Service Plan. This plan must be reviewed at least annually [1].
The funding landscape for the Nursing Home Transition and Diversion (NHTD) waiver program is integral to its operation and sustainability. Two primary funding sources underpin the NHTD waivers: the Money Follows the Person Program and the cost-neutral requirement.
The NHTD waiver program is funded through the Money Follows the Person Program, which aims to assist individuals in transitioning from nursing facilities to community living [1]. This funding model reflects a commitment to providing individuals with the services necessary to maintain independence in their communities without the burdensome costs that can accompany such care.
The program enables eligible individuals enrolled with Medicaid to access comprehensive care services without incurring out-of-pocket fees for the services provided. This funding structure alleviates the financial burden typically associated with care services, ensuring access to essential home and community-based options. The NHTD waiver program received approval to deliver services in New York under the "1915(c) Medicaid waiver" in 2007, promoting expanded support for individuals with physical disabilities and seniors.
States implementing the NHTD waiver must fulfill a cost-neutral requirement. This ensures that the combined expenditures per participant for waiver and non-waiver Medicaid services do not exceed the costs of institutional services for individuals requiring the same level of care, as per the mandates set by the Centers for Medicare & Medicaid Services (CMS) [3].
The following table summarizes the necessary considerations regarding cost neutrality in the NHTD Waiver Program:
| Requirement | Description |
|---|---|
| Cost-Neutral Definition | Expenditures for waiver services cannot exceed institutional costs. |
| Oversight Agency | Centers for Medicare & Medicaid Services (CMS). |
| Impact on Service Delivery | Affects budgeting and planning for care services. |
This cost-neutral requirement serves to safeguard both the program's sustainability and the integrity of service provision, ensuring that resources are allocated effectively while meeting the participants' needs.
To maintain eligibility for the NHTD program, participants must meet specific criteria. These requirements ensure that individuals receive the necessary support and services. The key criteria include:
| Eligibility Criteria | Description |
|---|---|
| Medicaid Eligibility | Must remain eligible for Medicaid. |
| Nursing Facility Level of Care | Requires care level equivalent to nursing facilities. |
| Service Coordination | Monthly participation in Service Coordination is required. |
| Approved Service Plan | Must have an annually reviewed approved Service Plan. |
Information sourced from New York State Department of Health.
An essential aspect of the NHTD waiver program is the rights and choices provided to participants. Enrolled individuals have significant autonomy in the following areas:
Service Coordinators working with participants must adhere to conflict-of-interest requirements. This ensures that individuals can make choices independently and without external pressure.
The emphasis on participant autonomy promotes self-reliance and enhances quality of life, wherein participant satisfaction serves as a vital measure of the program's success [2].
Under the NHTD Waiver program, caregiver reimbursement is an essential aspect that ensures eligible family members or friends providing care receive financial support. This reimbursement is facilitated through the Consumer Directed Personal Assistance Program (CDPAP), which is a Medicaid initiative.
The CDPAP allows individuals receiving care to select their caregivers, which can include family members or friends. This flexibility supports a personalized care experience while allowing caregivers to be compensated for their services. Medicaid provides reimbursement for the services offered by these caregivers, helping to alleviate the financial burden often associated with caregiving responsibilities.
| Feature | Description |
|---|---|
| Caregiver Selection | Participants can choose family or friends as caregivers. |
| Payment Structure | Caregivers are reimbursed based on their experience and location. |
| Flexibility | Adjusted care plans are implemented according to the individual's needs. |
Reimbursement rates for caregivers under the NHTD Waiver program vary significantly based on factors such as the caregiver's experience and geographical location. The rates can range from $15 per hour for entry-level caregivers to $22 per hour for more experienced caregivers. This structure ensures fair compensation for the significant time and dedication caregivers commit to support their loved ones.
| Caregiver Level | Hourly Rate |
|---|---|
| Entry-Level | $15 |
| Advanced | $22 |
This reimbursement system highlights the financial support available within the NHTD Waiver program for caregiver services, reflecting Medicaid's commitment to valuing the contributions of family caregivers [4].
The TBI/NHTD Housing Program is designed to support eligible individuals with housing needs, offering various financial resources to ensure accessible living conditions. This section outlines the funding and limitations of the program, along with its requirements and available subsidies.
The TBI/NHTD Housing Program operates under limited funding. The initial and continued financial support for housing resources depends on annual appropriations from the New York State Legislature. Consequently, all subsidies undergo an annual review and must be approved in line with the State budget cycle.
Important points regarding the funding of the TBI/NHTD Housing Program include:
| Funding Aspect | Details |
|---|---|
| Initial Funding Availability | Contingent upon annual appropriations |
| Ongoing Funding Review Process | Annual review consistent with the State budget |
| Rental Subsidy Guidelines | Must align with HUD Fair Market Rent guidelines |
To qualify for the TBI/NHTD Housing Program, participants must meet specific requirements. The program prioritizes maintaining independence and community access for those in need.
Notable requirements and details about subsidies include:
| Requirement | Description |
|---|---|
| SNAP and HEAP Application | Required; assistance not counted as income |
| Utility Subsidy Approval | Application to HEAP must be submitted |
| Rental Payment Restrictions | Cannot pay rent to SNT serving as landlord |
| Existing Housing Program Clause | May not exit other subsidy programs |
By understanding the funding structures and requirements of the TBI/NHTD Housing Program, participants can better navigate their housing options and ensure compliance with the necessary guidelines.
The NHTD Waiver Program has seen significant developments recently, especially concerning the implementation of the Spending Plan and enhancements to program services.
The New York State Department of Health has made meaningful progress in implementing the Spending Plan and related narrative submitted to CMS, which concerns certain Medicaid expenditures for Home and Community-Based Services (HCBS) under Section 9817 of the American Rescue Plan Act of 2021 (ARPA). As of April 6, 2023, the Department received approval for 41 separate proposals across three categories, indicating that all initial proposals in the Spending Plan have been accepted by CMS [6].
| Proposal Status | Number of Proposals |
|---|---|
| Approved | 41 |
| Currently Spending | 24 |
The State has begun spending on 24 out of the 41 approved proposals using the increased Federal Medical Assistance Percentage (FMAP) funding. Significant efforts have been made to design foundational components for the 39 approved activities, showcasing the state's commitment to improving HCBS [6].
In addition to the initial funding plans, the State of New York is focused on enhancing program services within the NHTD Waiver Program. This includes preparing to launch new activities, drafting spending authorities, and improving the workforce across various sectors such as Long Term Care and Developmental Disabilities. These enhancements aim to strengthen the Home and Community-Based Services system, ensuring adequate support for those in need [6].
The collaborative effort among six State Partner Agencies overseeing these HCBS, which includes the Department of Health and the Office of Mental Health, has been vital in informing the development of proposals to better serve individuals utilizing NHTD waivers. Stakeholder involvement has further enriched the proposals, allowing for a more comprehensive approach to service enhancement [6].
