New York Medicaid HCBS Waivers 2026: NHTD, TBI & OPWDD

If you are trying to get a parent or yourself onto a Medicaid New York HCBS waiver right now, start with the hardest part: the main one is not taking new people. The Nursing Home Transition and Diversion (NHTD) waiver has hit the participant maximum the federal government approved, so the New York State Department of Health (NYSDOH) is not processing new NHTD referrals and is closing them by letter. That is hard to hear when you are the one already showing up every day. But you are not out of options, and much of what NHTD would have paid for, you can still get another way. This guide covers every Medicaid Home and Community-Based Services (HCBS) waiver operating in New York in 2026, and exactly where to turn when NHTD's door is shut.1

In This Guide

• Can I still get on NHTD in 2026?
• What can I get instead of NHTD?
• Which Medicaid New York HCBS waivers are open right now?
• What is a Medicaid New York HCBS waiver, exactly?
• NHTD: who it is for and how it works
• The TBI waiver: a separate door
• The OPWDD waiver for developmental disabilities
• The Children's Waiver
• Money Follows the Person and Open Doors
• Do you qualify, and what are the 2026 limits?
• How waivers and MLTC fit together
• How to apply for an adult waiver
• Common misconceptions
• Resources and contacts
• Learn More

Can I still get on NHTD in 2026?

For a new applicant, the short answer is no, not right now.1

Here is what happened. NHTD has always run with a ceiling on how many people it can serve, set in its federal waiver agreement. New York amended the waiver to cap it at 9,400 participants for the 2025-26 through 2027-28 waiver years, which the federal Centers for Medicare and Medicaid Services (CMS) approved on December 23, 2025. The State then raised the ceiling: a later amendment, accepted May 15, 2026, lifted the maximum to 14,079 participants. Even at the higher number, the program is at its approved maximum, so NYSDOH says it cannot process additional NHTD referrals at this time and is closing new referrals by letter.1

So if you apply today, expect a letter telling you the program is full rather than a slot. That is a real blow for a family that just learned about NHTD and was counting on it. The good news is that the services NHTD pays for are not the only path to them in New York. The next section is where you want to start.

What can I get instead of NHTD?

The most important fallback is the Community First Choice Option (CFCO). New York elected CFCO under Section 1915(k) of the Social Security Act, which means these services are part of the regular Medicaid State Plan, not a capped waiver. There is no waiver cap and no waiting list.1 There is still a threshold to clear, and it is not simply "you have Medicaid": New York's approved CFCO State Plan Amendment (SPA 13-0035) reaches a person who is in an eligibility group that includes nursing facility services, or whose income is at or below 150% of the federal poverty level.1

CFCO covers the everyday help that most NHTD applicants are really after: hands-on assistance with bathing, dressing, and other daily activities, training to build those skills, backup systems like personal emergency response, transitional help moving from a facility into the community, and some assistive technology and home modifications. CFCO can layer on top of a waiver for people who have one, and it stands alone for people who do not.1

CFCO does not include the waiver-only extras like NHTD's Service Coordination, skills training, or the Structured Day Program. But for most people, CFCO plus regular Medicaid personal care plus a Health Home for care coordination covers a substantial share of what NHTD would have authorized.1

If you are an older adult with new physical-disability needs, the common pairing is Managed Long Term Care (MLTC) plus CFCO. An MLTC plan delivers your personal care, consumer-directed care, home health aide hours, and adult day health on a managed basis; CFCO adds the entitlement services on top.3 To start the MLTC path, call the New York Independent Assessor (NYIA), run by Maximus, at 1-855-222-8350. For free advocacy help along the way, the Independent Consumer Advocacy Network (ICAN) is at 1-844-614-8800. See NY Managed Long-Term Care (MLTC) and How CDPAP Pays You to Care for a Loved One in New York for the full mechanics.

A note on the rules getting tighter. Since September 1, 2025, new MLTC and personal-care applicants have to clear a higher functional-need floor, generally needing help with more than two daily activities (or, with a dementia diagnosis, more than one).3 It is one more reason to get an experienced assessor or advocate involved early.

Which Medicaid New York HCBS waivers are open right now?

Four 1915(c) HCBS waivers operate in New York in 2026. Here is the at-a-glance status, with the freeze front and center.

New York also runs the Community First Choice Option (CFCO) under 1915(k), which is an entitlement rather than a waiver, and it does not operate a stand-alone 1915(i) State Plan HCBS authority, behavioral-health HCBS for Health and Recovery Plan (HARP) members run through the State's 1115 demonstration instead.1 The sections below walk through each one.

A quick word on what is not active, because old guides still list these: the Long Term Home Health Care Program (the "Lombardi" waiver) was terminated, with the wind-down to MLTC complete by 2016; the old OPWDD "Care at Home" lines and the various children's waivers were folded into the Children's Waiver in 2019; and the "People First Waiver" proposed years ago was effectively abandoned. If a source tells you to apply for any of those, it is out of date.

What is a Medicaid New York HCBS waiver, exactly?

Section 1915 of the Social Security Act lets a state "waive" some normal Medicaid rules so it can pay for care in your home and community instead of a nursing home or institution. That is the whole idea behind these programs.

The workhorse authority is Section 1915(c) (42 USC § 1396n(c)). It lets New York bend three rules at once: services do not have to be offered in every county, they do not have to be identical for every recipient, and the State can apply institutional income-and-resource rules to people living at home. That last one matters a lot, it is what makes Medicaid reachable for people who would otherwise be counted out.

In return, the State has to serve a group that needs an institutional level of care, keep average waiver costs at or below institutional costs, and meet federal rules on person-centered planning and settings. The federal regulations for 1915(c) waivers live at 42 CFR Part 441 Subpart G, and the HCBS Settings Rule at 42 CFR § 441.301(c)(4) requires every setting to be integrated in the community, chosen by you, and protective of your rights.1

Here is how New York uses each of the federal authorities.

NHTD: who it is for and how it works

NHTD has long been New York's main HCBS path for adults who are not served by OPWDD and are not children, the seniors and younger physically-disabled adults who want to stay in the community instead of a nursing home. It is run by NYSDOH through Regional Resource Development Centers (RRDCs), many of which are operated by Independent Living Centers under contract.1

To qualify, all four of these have to be true:

1. You are eligible for community (non-MAGI) Medicaid.
2. You are 18-64 with a documented permanent physical disability, or 65 or older.
3. You meet a nursing-facility level of care under 18 NYCRR § 360-4.10, usually established through the Hospital and Community Patient Review Instrument and the UAS-NY assessment.
4. You sign a Freedom of Choice form saying you chose home and community care over a nursing facility.

The application path runs through your county's RRDC: an intake, you pick a Service Coordinator, the two of you build an Initial Service Plan, the packet goes to the RRDC and then NYSDOH, and you get a Notice of Decision. If you are denied, you have 60 days to ask for a Fair Hearing under 18 NYCRR Part 358.

What NHTD pays for is broad: Service Coordination, combined personal care and oversight (Home and Community Support Services), respite, skills training, a Structured Day Program, behavioral supports, home and vehicle modifications, assistive technology, community transition help, and more. Rates differ between New York City and the rest of the state and shift with minimum-wage step-ups, so pull the exact hourly figures from NYSDOH's official rate schedule before quoting them.

Remember the headline, though: as covered above, NHTD is at its approved maximum and not taking new referrals in 2026.1 If you are already enrolled, you keep your services; if you are new, you are looking at CFCO and MLTC.

The TBI waiver: a separate door

The Traumatic Brain Injury (TBI) waiver is its own 1915(c) waiver, and NYSDOH's referral closure names the Nursing Home Transition and Diversion waiver specifically, not this one.1 Its CMS waiver number is NY.0269 (some old provider materials cite NY.0014, which is obsolete, use NY.0269).1 We have not been able to confirm TBI's current enrollment capacity or referral status from a New York primary source, so ask NYSDOH directly at tbi@health.ny.gov, or ask your RRDC, before you build a plan around it. It is one of New York's oldest waivers, first approved back in 1995, and it runs through the same RRDCs that handle NHTD.

The catch is in the name: it is for traumatic brain injury, meaning an external mechanical force, with onset between ages 18 and 64. A stroke, a brain tumor, oxygen loss at birth, an infection, those are not traumatic brain injuries and generally do not qualify for this waiver. People with non-traumatic brain injuries would normally be pointed to NHTD if they meet that waiver's criteria, though of course NHTD's freeze blocks new entry there in 2026.

Eligibility otherwise tracks NHTD: community Medicaid, a nursing-facility level of care, a documented TBI, and a signed Freedom of Choice form. The application steps, fair-hearing rights, and most of the service array are the same as NHTD's, with a few brain-injury-specific additions. And in 2026 there is a practical reason to look hard at TBI eligibility: NHTD is closed to new referrals, and TBI is not named in that closure.

The OPWDD waiver for developmental disabilities

New York's largest waiver by far serves people with intellectual and developmental disabilities through the Office for People With Developmental Disabilities (OPWDD). Its CMS number is NY.0238, and it is the largest of New York's four waivers.1 It is not touched by the NHTD referral closure, though the June 2026 assessment change below applies to everyone on it.

Who qualifies: someone with a documented intellectual or developmental disability that began before age 22, things like intellectual disability, autism spectrum disorder, cerebral palsy, or epilepsy with substantial functional impairment, as defined under NY Mental Hygiene Law § 1.03(22). You also need an ICF/IID level of care and Medicaid eligibility.

How you get in: you start at the OPWDD "Front Door." Call 1-866-946-9733 or your local Developmental Disability Regional Office, OPWDD determines eligibility, you pick a Care Coordination Organization (CCO), and your CCO Care Manager builds your Life Plan. Services flow from that plan.

The service array is broad, residential supports, community habilitation, day services, supported employment, respite, behavioral supports, and modifications, and OPWDD offers a Self-Direction option that lets you build your own budget and hire your own staff through a fiscal intermediary.

One date to circle: June 1, 2026. Starting then, OPWDD requires a current standardized assessment on file before it will review anyone's budget, the CANS (Child and Adolescent Needs and Strengths) for participants under 18, completed annually, and the CAS (Coordinated Assessment System) for those 18 and older, completed every two years. No valid assessment means OPWDD will not review the budget, so service authorizations stall. Your CCO Care Manager schedules it, so if your family member is on this waiver, ask about it now rather than at renewal.

One more note: OPWDD keeps a functional wait list for residential placement (group-home settings in particular) driven by bed capacity, and that wait can run years. Day services and community habilitation have not historically been wait-listed.

The Children's Waiver

For kids under 21, New York runs a single consolidated Children's Waiver (CMS # NY.4125), led by NYSDOH with OCFS, OPWDD, and OMH. It pulled six older children's waivers into one program in 2019, a genuine simplification for families who used to face six separate sets of rules. It serves children under 21 who are on or eligible for Medicaid, need an institutional level of care, and have a serious emotional disturbance, medical fragility, developmental disability, or a foster-care HCBS need. Services run from care coordination through a Health Home Serving Children to community habilitation, respite, family and youth peer support, modifications, and palliative care.

What changed on April 1, 2026. Two things. First, Maximus no longer runs the HCBS eligibility check for Medicaid-enrolled children, those kids are now referred to a Health Home Care Manager, while a State-operated program called C-YES (Children and Youth Evaluation Services) handles children not yet on Medicaid.1 Second, Day Habilitation was folded into Community Habilitation, which now covers the same needs without the certified-site restriction. NYSDOH's approval announcement confirms both.

For a child with a developmental disability, there is a choice to make: the Children's Waiver or the OPWDD Comprehensive Waiver. A child cannot be in both, and the right one depends on the primary disability and which service array fits. A Health Home Care Manager or CCO can help you sort it out.

A note on money for kids: for children under 18, New York applies a TEFRA-like rule that disregards the parents' income and resources when the child is determined disabled and has waiver approval. That is the mechanism that puts Medicaid HCBS within reach for middle-income families, without it, the parents' income would disqualify most kids who need waiver services.

Money Follows the Person and Open Doors

If your parent is in a nursing home and wants to come home, Money Follows the Person (MFP) is the program built to help. In New York it is branded Open Doors Transition Center, run by NYSDOH with OPWDD and the New York Association on Independent Living (NYAIL).

Open Doors is a transition-support service, not a separate Medicaid program: it helps find housing, secure a lease, coordinate services, and manage the move, plus peer support from people who have made the same move themselves. Everything it does layers on top of whatever waiver or State Plan services your parent moves onto, and it is free and voluntary. To start, and to check who qualifies for the enhanced federal funding behind it, reach NYAIL Open Doors.

Do you qualify, and what are the 2026 limits?

For most adults, getting onto any of these waivers runs through New York's community (non-MAGI) Medicaid. Here is how the money side actually works in 2026.

Those are the figures in NYSDOH's January 2026 standards after the 2026 Federal Poverty Levels were applied.2

Over the income limit? You are not necessarily out. New York is a medically-needy state: the standards chart directs an applicant whose income is above a category's level to spend down to the Medicaid Income Level.2 For an unmarried community Medicaid or waiver applicant, the standard tool for handling that excess is a pooled income trust: you deposit the income above $1,836/month into the trust and use it to pay your living expenses, while Medicaid covers your care.4 See NY Pooled Income Trust for the mechanics.

Married and heading into MLTC? The trust may not do the job. NYSDOH's own consumer notice says that if you are married and your Medicaid eligibility is determined under spousal impoverishment budgeting with post-eligibility rules, which is what happens when you enroll in a Managed Long Term Care plan, any income you place in a trust still counts in determining your eligibility.4 That bites here, because MLTC plus CFCO is exactly the path this guide sends most NHTD-blocked families down. For married couples the usual income-protection route is spousal refusal under Social Services Law § 366(3)(a), covered at NY Spousal Refusal.

Now the resource (asset) side.

The CSRA, what the at-home spouse may keep when the other spouse needs institutional care, is the greater of New York's state-elected minimum of $74,820 or the spousal share (one-half of the couple's countable resources), capped at the federal maximum of $162,660.2

About the lookback. A worry families always raise: will moving money count against us? Two rules are in play, and only one of them is settled. The federal 60-month lookback under 42 USC § 1396p(c) applies to nursing-home (institutional) Medicaid.2 New York separately authorized a 30-month lookback for community-based long-term care in an April 2020 statutory change, conditioned on federal approval; as of July 2026, CMS still lists New York's request for it as a pending application on the State's 1115 demonstration record.3

A pending request is not a guarantee, and this is the one place in this guide where being wrong cannot be undone. Do not treat a gift or transfer as penalty-free on the strength of this page. Confirm the current community-based transfer rules with your local district or a New York elder-law attorney first.2 See NY 30-Month Community Medicaid Lookback for where this stands.

How waivers and MLTC fit together

This trips up a lot of families, so let's be clear about it.

NHTD, TBI, and OPWDD participants are excluded from mandatory MLTC enrollment. NY Public Health Law § 4403-f(7)(b)(v) names participants in the NHTD waiver, participants in the TBI waiver, and people enrolled in OPWDD's home and community based waiver programs on its list of recipients the MLTC mandate does not reach.3 In practice that means their personal care comes through fee-for-service Medicaid, and for OPWDD through the waiver's own service array, rather than through a plan. Children on the Children's Waiver are generally too young for MLTC.

You also cannot be in two 1915(c) waivers at once. But you can be in a waiver and still get State Plan services like CFCO, personal care, and Health Home care management at the same time, that layering is normal and expected.

The exclusion is why you do not see families running MLTC and NHTD side by side: the waiver track is the fee-for-service track. There has long been talk of eventually "carving in" NHTD to MLTC, but as of 2026 that has not happened, and New York's 1115 demonstration (which authorizes MLTC and the HARP behavioral-health benefit) runs through March 31, 2027 with renewal talks underway.3 For new applicants blocked by the NHTD freeze, the takeaway is simple: MLTC is the managed path for ongoing community long-term care, and CFCO is the entitlement that layers on top. See NY Managed Long-Term Care (MLTC).

How to apply for an adult waiver

For the two adult waivers (NHTD and TBI), everything runs through the Regional Resource Development Center (RRDC) that serves your county.1 Even though NHTD is closed to new referrals in 2026, the steps below are how TBI applications, and any future NHTD reopening, work.

If your services are being reduced rather than newly denied, "Aid Continuing" under 18 NYCRR § 358-3.6 can keep them in place while you appeal, as long as you request the hearing in time. You have a right to representation, and legal-aid groups like the Independent Consumer Advocacy Network can help.

Common misconceptions

A few things families hear that are not quite right.

"Any brain injury qualifies for the TBI waiver." No. It has to be a traumatic brain injury with onset between 18 and 64. Strokes, tumors, and oxygen-loss injuries are not covered there.

"I can just get on a waiting list for NHTD." Not in 2026. The program is at its approved maximum and is closing new referrals by letter rather than queuing them.1

"The Lombardi waiver is still around." It was terminated; the transition to MLTC was complete by 2016. The same goes for the old "Care at Home" lines and the "People First Waiver," all gone or absorbed.

"New York has a 1915(i) waiver." It does not. Behavioral-health HCBS for HARP members runs under the 1115 demonstration; some federal write-ups call it "1915(i)-like," but it is not an actual 1915(i).1

Resources and contacts

Learn More

Find personalized help navigating New York Medicaid HCBS waivers at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.