By Long Island Senior Advisor Care Team · September 2, 2026
New York's Nursing Home Transition and Diversion waiver runs through a single Long Island office in Medford serving both Nassau and Suffolk. Here is what it pays for, why MLTC enrollment blocks it, and the deadlines that decide the application.
One office in Medford covers both counties
Almost every senior-care phone number on Long Island splits at the Nassau-Suffolk line. Each county runs its own Office for the Aging (Nassau 516-227-8900, Suffolk 631-853-8200), its own Adult Protective Services unit, and its own regional Long-Term Care Ombudsman coordinator. Families learn that pattern the hard way, usually after being told they called the wrong county.
The Nursing Home Transition and Diversion waiver is the exception. New York administers NHTD through nine Regional Resource Development Centers, and one of them — designated simply as the Long Island region — covers Nassau and Suffolk together. That office is the Suffolk Independent Living Organization (SILO), at 3253 Route 112, Building 10, in Medford, reachable at (631) 320-1662 or (631) 880-7929. A family in Great Neck and a family in Riverhead call the same number.
That matters more than it sounds. Every NHTD referral in New York must start at the RRDC. Not with a home care agency, not with a Medicaid managed care plan, not with the nursing home's admissions office. The state's own instruction is blunt: all referrals begin with the RRDC, and waiver services cannot start until the RRDC approves the application.
What the waiver is actually for
NHTD is a 1915(c) home and community-based services waiver run by the New York State Department of Health. Its purpose is in the name: transition someone out of a nursing facility, or divert someone away from entering one, by funding the services that make living at home survivable.
The eligibility test has three parts. The applicant must be eligible for community-based Medicaid; must be assessed as needing nursing home level of care; and must be either 65 or older, or between 18 and 64 with a verified physical disability. They also have to be able to live safely in the community with the services the waiver and other supports can actually provide.
That second criterion is stricter than families expect. The level-of-care determination comes from a community health assessment under the Uniform Assessment System (UAS-NY), signed by a New York registered professional nurse certified to complete it, and it must produce a Nursing Facility Level of Care score of 5. Not close to 5. Five. If the first assessment falls short, the RRDC's own nurse evaluator may complete a second one, but there is no discretionary override.
The service list is longer than home care
Families who have already arranged aides through a managed care plan sometimes assume NHTD is the same thing with more paperwork. It is not. The waiver funds a set of services that ordinary Medicaid home care does not touch.
The approved list includes assistive technology; environmental modifications; home and community support services; independent living skills training; community transitional services; moving assistance; congregate and home-delivered meals; respite; social transportation; structured day program services; peer mentoring; community integration counseling; wellness counseling; nutritional counseling; positive behavioral interventions and supports; respiratory therapy; home visits by medical personnel; and service coordination.
Environmental modifications and moving assistance are the ones that quietly decide cases on Long Island. A 1950s Levittown-era ranch with a step-down den, or a Massapequa split-level where the only full bathroom is upstairs, can be the single reason a discharge planner says home is unsafe. The waiver can pay to change the house. Standard home care cannot.
What NHTD will never pay is rent or a mortgage. The waiver funds services, full stop. If your parent has no residence to return to, that is a housing problem the waiver does not solve, though a service coordinator and the state's Open Doors program can help look.
The MLTC collision nobody warns you about
Here is where Long Island families get stuck. Managed Long Term Care enrollment has been mandatory in Nassau and Suffolk since the 2013 transition, for Medicaid recipients 21 and older who need more than 120 days of community-based long-term care. If your parent has been receiving Medicaid home care on Long Island for months, they are almost certainly already in an MLTC plan.
And New York does not permit duplication of services. Someone enrolled in MLTC, PACE, a Health and Recovery Plan, Health Homes, or receiving Comprehensive Medicaid Case Management is not eligible for the NHTD waiver unless they request disenrollment from that program first. The same exclusion applies to anyone living in, or planning to move into, an Assisted Living Program facility or another licensed congregate care setting.
So the real question for most Long Island families is not "can we get both?" It is a choice. MLTC gives you a plan that coordinates aides, therapies and durable medical equipment inside a network. NHTD gives you a self-directed service plan with environmental modifications, transition funding and an independent service coordinator, but you give up the plan.
Ask the RRDC to walk through the trade for your parent's specific situation before anyone signs a disenrollment form. If the deciding factor is a wheelchair ramp and a first-floor bathroom, NHTD may be the right instrument. If it is 40 hours a week of aide coverage, it may not be. See how Managed Long Term Care works in New York before you decide.
The seven steps, and how long each one really takes
The application has a defined sequence, and the deadlines run against the family as much as against the state.
Step 1 — Referral. A phone call, letter, or referral form to SILO. A nursing home discharge planner, social worker, guardian, family member, or the applicant can initiate it. RRDC staff confirm basic eligibility and take consent on that call.
Step 2 — Intake meeting. The RRDC explains the program, available services, the role of the service coordinator, and the fair hearing and complaint processes. They complete the intake form, review Medicaid verification, verification of age, and — for anyone under 65 — verification of physical disability. The applicant signs a Freedom of Choice form.
Step 3 — Choosing a service coordination provider. The clock here is the one families miss. The applicant is expected to contact, interview and select a provider within 14 days of intake, and has 30 calendar days total before the RRDC starts chasing them. Interview more than one. This person will build the service plan.
Step 4 — Building the application. The service coordinator develops an Initial Service Plan and a Plan of Protective Oversight, secures the UAS-NY community health assessment for level of care, and submits the packet — within 60 days of the RRDC's approval date on the provider selection form. For someone transitioning directly out of a nursing home or hospital, an alternate assessment (the HC-PRI and SCREEN) may be used, with the full UAS-NY completed within 90 days of enrollment.
Steps 5 through 7 — Decision and renewal. The RRDC has 14 days after receiving a complete packet to determine eligibility, then issues a written Notice of Decision. Services start on the authorization date. Eligibility is reviewed at least annually, and the participant has to keep meeting Medicaid eligibility, keep requiring nursing facility level of care, participate in service coordination monthly, and keep living in the community.
The state's own estimate for the whole process is roughly two to four months when the applicant already has a residence, informal supports and a service coordinator. If your parent is currently in a nursing home, expect longer.
The Plan of Protective Oversight is the document that decides it
Most families focus on the service plan — what aides, how many hours. Denials more often turn on the other document.
The Plan of Protective Oversight assesses safety risk. It identifies fire and safety issues, back-up plans, who responds in an emergency, and specifically who is responsible for helping with daily activities, medication management, and financial transactions. It is the RRDC's evidence that the applicant can be safely served at home.
Two of the listed denial reasons are, in plain terms, failures of this document: the RRDC determining the applicant cannot be safely served in the community with available waiver services and supports, and the applicant being unable to identify an HCBS-compliant community residence. The third is a level-of-care score below 5.
Long Island's geography puts pressure on the back-up plan question. Adult children in Manhattan or New Jersey, a house at the end of a South Shore block that lost power for days after the last nor'easter, an East End address 40 minutes from the nearest emergency department — all of that belongs in the PPO honestly, with a written answer for who arrives and how fast. Understating the risk to get an approval is how a family ends up back in a hospital in February.
If you are denied
A denial arrives as a Notice of Decision that must state the reason and explain due process rights. You have two remedies and they are not mutually exclusive: request a case conference with the RRDC, and request a Fair Hearing through the New York State Office of Temporary and Disability Assistance.
The Fair Hearing deadline is 60 days from the date of the Notice of Decision. OTDA must notify you of the time, date and place at least 10 calendar days before the hearing. The same appeal rights attach to any adverse action later on — a discontinuation notice, or a service plan the RRDC authorizes at fewer hours than requested.
Before appealing, get the reason in writing and match it to the three denial categories. A level-of-care score problem is a clinical dispute and needs clinical evidence. A safety determination is an argument about the Plan of Protective Oversight, which you can strengthen. A residence problem is a housing search, not an appeal.
And keep the arithmetic in view while you decide. CareScout's 2025 survey puts the New York state median for a semi-private nursing home room at $15,528 a month and assisted living at $7,110 a month — state figures, not Long Island figures, because no Long Island-specific median is published anywhere. NHTD exists precisely because keeping someone home is usually the cheaper outcome for the state too. That alignment of interests is worth remembering when the paperwork feels adversarial. For the broader picture, see how Long Island families pay for senior care.
