How to Apply for NY's NHTD and TBI Waivers?

Understanding NHTD and TBI Waivers

To better understand the NHTD and TBI waivers, it's important to familiarize oneself with the overview of each program.

Overview of NHTD Waiver Program

The NHTD (Nursing Home Transition and Diversion) waiver program is a home and community-based program in New York. It aims to assist Medicaid-eligible seniors and individuals with physical disabilities in receiving comprehensive services while living in a community-based setting, rather than in a nursing home or institution. This program is designed to promote independence and provide individuals with the necessary support to remain in their homes and communities.

Under the NHTD waiver program, eligible participants have access to a range of services tailored to their specific needs. These services may include case management, personal care assistance, home modifications, respite care, and more. By receiving these services, individuals can maintain their autonomy and quality of life while avoiding the need for institutional care.

For more information on the benefits and success stories related to NHTD and TBI waivers in New York, refer to our articles on benefits of NYS NHTD and TBI waivers and success stories: NHTD and TBI waivers in New York.

Overview of TBI Waiver Program

The TBI (Traumatic Brain Injury) waiver program is another home and community-based program available in New York. It is specifically designed to support individuals who have experienced a traumatic brain injury and require a nursing home level of care but wish to remain in their own homes.

Similar to the NHTD waiver program, the TBI waiver program aims to prevent institutionalization by providing comprehensive care services in a community-based setting. Individuals enrolled in the TBI waiver program have access to services such as case management, personal care assistance, home modifications, behavioral health services, and more.

To access the TBI waiver program, individuals can contact the Regional Resource Development Centers (RRDCs) for assistance and guidance. These centers provide valuable information and support throughout the application process and service coordination.

For a detailed comparison between the NYS NHTD and TBI waivers, please refer to our article on comparing NYS NHTD and TBI waivers.

Understanding the NHTD and TBI waivers is the first step towards accessing the appropriate programs and services for individuals in need. By navigating the eligibility criteria, application processes, and available services, individuals can make informed decisions regarding their care options.

Applying for NHTD Waiver

To access the benefits of the NHTD (Nursing Home Transition and Diversion) waiver program in New York, individuals must meet certain eligibility criteria and go through the application process.

Eligibility Criteria for NHTD Program

The NHTD program is available to New York State residents who meet specific criteria. These criteria include:

Medicaid Eligibility: Individuals must be eligible for Medicaid in New York State.
Level of Care: Individuals must require a nursing home level of care but have the desire and ability to live safely in the community with the services and supports offered through Medicaid, the waiver program, and other community resources.
Age or Disability: The program is open to individuals of all ages who meet the level of care requirement and wish to transition from a nursing home or avoid institutionalization.

To determine eligibility for the NHTD program, individuals should contact their Regional Resource Development Center (RRDC). The RRDC will assess their needs and help guide them through the application process.

Application Process for NHTD Program

The application process for the NHTD program varies depending on the individual's current living situation:

Nursing Home Residents: If an individual is currently residing in a nursing home, they should speak to a discharge planner who can make a referral to Open Doors and/or the RRDC. These organizations will assist in the transition process and provide guidance on applying for the NHTD program.
Community Residents: If an individual is already living in the community, they or their representative should reach out directly to the RRDC in their area to initiate the application process. The RRDC will provide the necessary forms and guidance to complete the application.

During the application process, individuals will be required to provide information about their medical history, living situation, and the services they require. It is important to provide accurate and detailed information to ensure that the application is processed correctly.

Once the application is submitted, it will be reviewed by the RRDC and the New York State Department of Health to determine eligibility for the NHTD program. If approved, individuals will be able to access a range of services and supports to help them transition and remain in the community instead of a nursing home.

For more information on the benefits of the NHTD program and success stories in New York, please refer to our articles on benefits of NYS NHTD and TBI waivers and success stories: NHTD and TBI waivers in New York.

The NHTD waiver program provides an opportunity for individuals in New York to receive comprehensive services while living in a community-based setting, promoting independence and quality of life.

Navigating the NHTD Program

Once enrolled in the NHTD (Nursing Home Transition and Diversion) program, participants gain access to a range of services that support their goal of living independently in the community. The NHTD program emphasizes autonomy and flexibility, allowing individuals to have a say in the services they receive and the providers they work with.

Services Offered under NHTD Waiver

The NHTD program offers a comprehensive array of services to meet the unique needs of participants. These services are designed to provide support and assistance in daily living activities, healthcare management, and transitioning from a nursing home to a community setting. Some of the key services offered under the NHTD waiver program include:

Service Coordination: Each participant is assigned a service coordinator who works closely with them to develop an individualized care plan and ensure that their needs are met. The service coordinator acts as a guide throughout the program, helping participants navigate the different services and resources available to them.
Home and Community Support Services (HCSS): HCSS provides assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, and meal preparation. These services are delivered in the participant's home or community setting, promoting independence and self-care.
Community Transitional Services (CTS): CTS is available to individuals who are transitioning from a nursing home to a community-based living arrangement. This service helps with the process of finding suitable housing, setting up necessary supports, and ensuring a smooth transition into the community.
Skilled Nursing: Skilled nursing services are provided by licensed nurses who offer medical oversight, medication management, wound care, and health monitoring. These services help individuals manage their health conditions and ensure their well-being while living independently.

It's important to note that while the NHTD program may provide a housing subsidy to support living in the community, housing provision itself is not considered a waiver service.

Autonomy and Flexibility in NHTD Program

One of the key benefits of the NHTD program is the level of autonomy and flexibility it offers to participants. Individuals enrolled in the program have the opportunity to make choices regarding the services they receive, the providers they work with, and the outcomes they aim to achieve. This person-centered approach allows participants to take an active role in their care and tailor it to their unique strengths, needs, choices, and goals.

By having the ability to select service providers and actively participate in the decision-making process, participants can create a care plan that aligns with their preferences and supports their desired outcomes. This autonomy and flexibility foster a sense of empowerment and independence, empowering individuals to live their lives on their own terms.

The NHTD program strives to ensure that participants receive the support they need while respecting their autonomy and individuality. By offering a comprehensive range of services and promoting self-determination, the program enables individuals with nursing home-level care needs to live fulfilling lives in their own homes and communities.

To learn more about the benefits of the NHTD and TBI waivers, read our article on benefits of NYS NHTD and TBI waivers. Additionally, you can explore success stories and real-life experiences of individuals who have benefited from these waivers in New York in our article on success stories: NHTD and TBI waivers in New York.

Accessing TBI Waiver Program

To access the Traumatic Brain Injury (TBI) waiver program in New York, individuals can navigate through the Regional Resource Development Centers (RRDC) and benefit from service coordination.

Regional Resource Development Centers (RRDC)

The TBI waiver program is accessed through a network of RRDCs that cater to specific counties across the state of New York. These centers play a vital role in providing various services to support individuals in the community. They act as a central point of contact for individuals seeking information and assistance regarding the TBI waiver program. The RRDCs manage and approve applications for participation in the program and ensure that individuals meet the eligibility criteria set by the New York State Department of Health [2].

To begin the process, individuals can contact the NYS Department of Health HCBS/TBI at (518) 474-5271 to locate the nearest RRDC or visit the DOH website for more information. The RRDCs serve as a valuable resource, guiding individuals through the application process and providing them with the necessary support to access the TBI waiver program.

Service Coordination in TBI Program

Service coordination is an essential component of the TBI waiver program. Once an individual is approved for the program, they are required to select a Service Coordinator from an approved list provided by the RRDC. The Service Coordinator plays a crucial role in helping develop a Service Plan tailored to the individual's needs and goals. They also oversee the provision of selected services and ensure that the individual's needs are met.

The applicant has 30 calendar days from the date of the intake meeting with the RRDC to choose a Service Coordination provider. The RRDC will then send written confirmation of the Service Coordination provider selection. This coordination ensures that individuals receive the appropriate support and services to enhance their quality of life and promote independence.

It's important to note that the RRDC has 14 days after receiving the complete application package to make an eligibility determination for the TBI program. The applicant will be notified of their eligibility or provided with a reason for ineligibility [3].

By leveraging the resources and support provided by the RRDCs and engaging with Service Coordinators, individuals can successfully access the TBI waiver program and avail themselves of the services and assistance they need.

Services under TBI Waiver

The TBI (Traumatic Brain Injury) Waiver program provides a range of essential services and supports to individuals in New York who have experienced a traumatic brain injury. These services are designed to assist participants in maintaining their independence and living in the community rather than in a nursing home or other institutional settings. Here, we will explore the covered services under the TBI Waiver and provide information on how to contact HCBS/TBI for more details.

Covered Services in TBI Waiver

The HCBS/TBI (Home and Community-Based Services/Traumatic Brain Injury) Waiver program offers a comprehensive array of services to support individuals with traumatic brain injuries. These services aim to enhance their quality of life and promote community integration. The covered services under the TBI Waiver include:

Service Coordination: Participants in the TBI Waiver program receive assistance from a Service Coordinator who helps develop a personalized Service Plan and oversees the provision of selected services. They act as a central point of contact and help coordinate and monitor the participant's care.
Independent Living Skills Training and Development (ILST): ILST services focus on enhancing and maintaining the individual's ability to live independently. This may include training in activities of daily living, home management skills, and community integration skills.
Structured Day Program Services: Structured day programs provide a structured, therapeutic environment where participants engage in activities that support their cognitive, physical, and emotional well-being.
Substance Abuse Program Services: These services are designed to address substance abuse issues and help participants access necessary treatment and support.
Positive Behavioral Interventions and Support Services (PBIS): PBIS services aim to manage challenging behaviors and promote positive changes through behavioral strategies and interventions.
Community Integration Counseling (CIC): CIC services help participants navigate community resources, develop social skills, and establish meaningful connections within their communities.
Home and Community Support Services (HCSS): HCSS services provide assistance with personal care, household tasks, and other activities necessary for maintaining a safe and healthy living environment.
Environmental Modifications (e-mods): E-mods involve making physical modifications to a participant's home or living environment to enhance accessibility and safety.
Respite Services: Respite services offer temporary relief to caregivers by providing short-term care for the participant, allowing caregivers time to recharge and attend to their own needs.
Assistive Technology (AT): AT services involve the provision of devices, equipment, or systems that assist individuals with their daily activities and promote independence.
Waiver Transportation: Waiver transportation services assist participants in accessing medical appointments, community activities, and other essential services.
Community Transitional Services (CTS): CTS services support individuals transitioning from nursing homes or other institutional settings to community living. These services help with housing assistance, setting up community supports, and other necessary resources.

For more information on the covered services under the TBI Waiver, individuals can contact HCBS/TBI by calling (518) 474-5271. Additionally, they can visit the New York State Department of Health website to locate the nearest Regional Resource Development Center or to access further information about the program.

By utilizing the services provided under the TBI Waiver, individuals with traumatic brain injuries can receive the necessary support to live independently and participate actively in their communities.

Transitioning to Managed Care

As part of the ongoing efforts to improve the delivery of long-term care services, the state of New York is transitioning participants from the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver programs to managed care programs operated by the state. This transition aims to provide individuals with a more streamlined and comprehensive approach to receiving the care they need. In this section, we will explore the timeline for transitioning programs and the enrollment process in managed long-term care.

Timeline for Transitioning Programs

The timeline for transitioning participants from the NHTD and TBI waiver programs into managed care programs has been adjusted several times, with the current target date set for the transition to begin on January 1, 2018. This timeline allows for careful planning and coordination to ensure a smooth transition for all individuals involved [4].

During the transition period, the New York State Department of Health (NYSDOH) has proposed a two-year continuity-of-care period for participants and service providers. This means that Managed Care Organizations (MCOs) will be required to contract with current waiver service providers for a minimum of two years, ensuring rate protection for providers through April 1, 2020 [4].

Enrollment in Managed Long Term Care

To continue receiving services, individuals currently enrolled in the NHTD and TBI waiver programs must enroll in one of two managed care programs: Managed Long Term Care (MLTC) or Medicaid Managed Care (MMC). The choice of program depends on individual circumstances and eligibility.

Managed Long Term Care (MLTC) is a system designed to deliver long-term care services to individuals who are chronically ill or disabled and wish to reside safely in their homes and communities. Enrollment in a MLTC plan may be mandatory or voluntary, depending on individual circumstances. This program streamlines the delivery of services and offers comprehensive care coordination to ensure the needs of participants are met [4].

Medicaid Managed Care (MMC) is another option for individuals who are Medicaid eligible. This program provides Medicaid State plan benefits through a managed care delivery system comprised of Managed Care Organizations (MCOs). With few exceptions, all Medicaid recipients must enroll in an MMC plan. The MMC program aims to provide accessible and coordinated care to individuals in need of Medicaid services [4].

Enrolling in managed long-term care ensures that individuals can continue receiving the necessary services and supports while benefiting from the comprehensive care coordination provided by these programs. It is important for participants to understand their options and consult with their healthcare providers or case managers to determine the best course of action during the transition period.

For more information on the benefits of the NHTD and TBI waivers, success stories, or a comparison between the programs, please refer to our related articles on introduction to NYS NHTD and TBI waivers, benefits of NYS NHTD and TBI waivers, and success stories: NHTD and TBI waivers in New York.