The Nursing Home Transition and Diversion (NHTD) Waiver was developed by the disability community to provide a unique and essential set of community-based services to individuals currently in nursing homes or at risk of institutional placement.  Services include: Home and Community Support Services (HCSS), Structured Day Program, Home Modification Transportation, Assistive Technology, Service Coordination, and more.

Federal law requires that NHTD remain cost-neutral, meaning the average cost of services in the community cannot exceed the cost of institutional care.

The for-profit corporations that administer the Managed Long Term Care (MLTC) plans have predictably figured out a way to game the system.  They are paid by Medicaid the same amount per person, whether that person's care is high-cost or low-cost.  They make little or even lose money on the high-cost patients, and make lots of money on the low-cost ones.  These firms learned that the NHTD alternative was available to all consumers regardless of cost, and that all who are eligible for NHTD were approved for it.  So, they started shifting all their high-cost people to the NHTD waiver to improve their bottom line.  Hey, we can't even really blame them: they are for-profit companies; making money is their job, and it is not their job to maintain the cost-neutrality of NHTD.

However, loading up the NHTD program with disproportionately high-cost people did wreck its cost-neutrality.  Addressing the imbalance is the responsibility of New York State, which oversees both the NHTD and MLTC programs.  Rather than implementing stronger oversight of MLTC plans to prevent this cost-shifting, New York chose to cap NHTD enrollment statewide, an approach that restricts access to services without addressing the underlying problem.  This has had serious consequences:

• People who qualify for NHTD are now being turned away.
• Individuals are left without services and/or pushed toward institutional care.
• New York State may ultimately face higher costs due to unnecessary institutionalization.

Our legislators are doing their jobs to redirect New York to a better course.  Assemblymember Paulin and Senator Rivera have introduced A.10403/S.9573, which is now in the Ways and Means Committee. This bill establishes a region-specific waitlist for the NHTD waiver while the enrollment cap is in place.  This will begin to repair the damage the cap is inflicting on our state.  (The ultimate solution is to dispense with the cap altogether.)  The New York Association for Independent Living has created a one-page explainer about what the NHTD waiver is and why access to this important program must be restored. You can read it here.

These bills must be part of the final budget currently in negotiation between the Governor, the State Senate, and the State Assembly.  We urge you to contact the following and ask them to ensure A.10403/S/9573 is included in the final state budget.

• Your State Senator
• Your Assembly Member
• Senate Majority Leader Andrea Stewart-Cousins
• Assembly Speaker Carl Heastie
• Governor Kathy Hochul

We have taken steps to make this easy for you.  Click the "Take Action Now" button to find a sample letter to these five officeholders; of course, you may alter or add to the letter any way you see fit, and then send an email instantly to all five.

We are, as always, deeply grateful for your advocacy.