Who Qualifies for the NHTD and TBI Medicare Waiver Programs?

The NHTD (Nursing Home Transition and Diversion) and TBI (Traumatic Brain Injury) Medicaid Waiver Programs have specific eligibility criteria. Here’s an overview of the qualifications for each program from the New York State Department of Health website:

NHTD Medicaid Waiver Program:

To be considered for the NHTD program, an individual must meet the following criteria:

Eligible for community-based Medicaid: The applicant must be eligible for Medicaid, which provides health coverage for low-income individuals.

Need for nursing home level of care: The applicant must be assessed as requiring a level of care typically provided in a nursing home setting. This assessment determines the individual’s functional needs and determines if they can be met with community-based services.

Age requirement: The applicant must either be between the ages of 18 and 64 with a verified physical disability or be 65 years or older when applying to the program.

Ability to live safely in the community: The applicant must demonstrate the ability to live safely in the community with the support of services and resources available through Medicaid, the NHTD waiver program, and other community resources.

Note: Individuals residing in or planning to reside in an Assisted Living Program (ALP) or other licensed or certified congregate care setting are not eligible for the NHTD waiver. Additionally, individuals already enrolled in certain Medicaid programs, such as Health and Recovery Plans (HARPs), Health Homes, Managed Long Term Care (MLTC) Program, or Program of All-Inclusive Care for the Elderly (PACE), may not be eligible unless they request to be disenrolled from the applicable program.

TBI Medicaid Waiver Program:

The eligibility criteria for the TBI program are similar to the NHTD program, with the primary difference being the focus on individuals with traumatic brain injuries. The specific qualifications are as follows:

Eligible for community-based Medicaid: The applicant must be eligible for Medicaid coverage.

Need for nursing home level of care: The applicant must be assessed as requiring a level of care typically provided in a nursing home due to their traumatic brain injury.

Age requirement: There is no age restriction for the TBI program. Individuals of any age with a traumatic brain injury can apply.

Ability to live safely in the community: The applicant must demonstrate the ability to live safely in the community with the support of services and resources available through Medicaid, the TBI waiver program, and other community resources.

It’s important to note that eligibility criteria may vary by state, as Medicaid is a joint federal and state program. Therefore, it is recommended to consult the specific guidelines and requirements set by your state’s Medicaid program or contact the Regional Resource Development Center (RRDC) for more accurate and detailed information regarding eligibility for the NHTD and TBI Medicaid Waiver Programs in your area.