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Seniors and Disability Care: NHTD Program vs. Nursing Home Options

Last Updated: April 1, 2024

When you or your elderly parents are faced with aging challenges that require a more intensive level of care, the natural choice is to turn to residential nursing home services. But what if you could receive the quality and professional care of a nursing home from within your familiar, comfortable home?

This article will explore the benefits and disadvantages of both options and allow you to make a better-informed decision.

What Is The NHTD Program?

The NHTD Waiver Program is a New York-based, Medicaid-funded program for seniors who require nursing-home-level care but wish to remain in the comfort of their own homes. This is in contrast to Nursing Home Care, a 24/7 residential care option for individuals who require frequent assistance and professional care.

If you want more control and choice on who gets to care for you, you might benefit from the CDPAP Program.

NHTD Eligibility

Individuals who wish to enroll in the NHTD program must fit all of the following criteria:

  • Require a nursing home level of care
  • Enrolled with Medicaid (Not enrolled? We can help you with that.)
  • Aged 18-64 and are registered as having a physical disability OR aged 65+
  • Sign the Freedom of Choice form
  • Have an identified living arrangement

Nursing Home Eligibility

In order to register for full-time Nursing Home Care, seniors must require a level of care that can only be provided in a nursing home, or have medical needs that require skilled nursing services.

In addition, individuals must meet the financial requirements set up by Medicaid in order to qualify.

What Is Medicaid?

Medicaid is a combined federal and state program that covers certain medical, health, and social service costs for those with limited income. Approval for Medicaid is the first step towards joining the NHTD Waiver Program or applying for Nursing Home Care.

Step-by-step Guide to Joining the NHTD Program

Senior Woman with Her Home Caregiver

Step 1: Get Approved for Medicaid

You can do this individually through Medicaid’s agency, or through a home health agency like Americare.

Step 2: Submit an Application

This application form can be obtained from your local Medicaid office or via an NHTD program coordinator.

Step 3: Assessment

Your application will be reviewed and you will undergo an assessment to determine your specific needs and the level of care required.

Step 4: Establish a Care Plan

A tailored care plan will be developed based on your assessment, outlining the services and support you will receive through the NHTD program. This plan may include services such as home health care, personal care, and assistive technology.

Step 5. Care Plan Approval

Your care plan will be reviewed for approval by the NHTD program coordinator or a similar authority. Only once approved can services be implemented.

Step 6: Implement the Plan (Can Take Up to 4-6 Months)

Once your care plan has gained approval, the NHTD program can take up to 4-6 months to implement the plan. This may involve arranging for home health aides, assistive devices, and more.

Medicaid with Nursing Home Care

To qualify for Medicaid coverage for nursing home care, individuals must meet certain eligibility criteria:


Medicaid has strict rules regarding individual assets in order to qualify for coverage. Individuals may need to ‘spend down’ their assets on medical expenses, or contribute some income toward the cost of their care before being eligible for Medicaid to cover the cost of their nursing home care.

Once eligible, Medicaid will cover nursing home care costs, including room and board and care services.

Nursing Home Choice

Seniors can choose from any nursing home that meets Medicaid’s requirements. However, it is necessary to note that not all nursing homes accept individuals being covered by Medicaid. Therefore, it is important to look for a nursing home that does.


Medicaid eligibility for Nursing Home Care must typically be recertified every six months to a year, in order to verify that the individual still meets the eligibility criteria.

Pros and cons: NHTD Waiver Program vs. Nursing Home Care

Let’s explore the similarities and differences between the NHTD Waiver Program and Nursing Home Care, so you can decide which option is best suited to your unique needs.


NHTD Program Services

  • Service Coordinator: Developing a personalized care plan for participants.
  • Home and Community Support Services (HCSS): Including all activities of daily living (ADLs).
  • Community Transitional Services (CTS): Assisting individuals in moving from a nursing home to their own home.
  • Skilled Nursing: Medication management, wound care, health monitoring, and other such services provided by a licensed nurse.

Nursing Home Services

  • 24/7 Supervision and Oversight: Individuals have round-the-clock supervision and services, including wound care, medication management, and administration, as well as ADLs.
  • Therapies: Seniors residing in a nursing home get access to a full range of therapies and services, including occupational therapy, speech therapy, and physical therapy.
  • Social engagement: Nursing home residents get the chance to socialize and become part of a community within their residential environment.
  • Support for families: The individual’s family is supported by a professional nursing home team, giving them peace of mind that their loved one is receiving quality care.


Both the NHTD Program and Nursing Home Care offer excellent medical and skilled assistance. However, the degree of involvement seniors have in making their own healthcare decisions varies.

The NHTD Program allows individuals and their families to be heavily involved in the development of their care plans. Service providers work closely with the individuals to identify their needs and preferences, giving them the chance to have an input on the types of services and supports they receive, as well as the providers they choose.

In contrast, nursing home care gives less room for seniors and their families to be directly involved in the day-to-day management of their care. However, they still have the right to participate in care plan meetings and discuss their preferences and concerns with the services provided.

Oversight and Independence

The NHTD Program offers a more individualized approach, with more flexibility in meeting individual needs and promoting independence and community integration.

Nursing homes are subject to stricter regulation by state and federal authorities and personal care is limited due to facility policies and regulations.

Americare Can Help

The choice between joining the NHTD Program or nursing home care heavily depends on the level of care required, personal preferences, and financial setup.

At Americare, we help individuals in New York find the best care path for their needs. If you’re wondering which option is right for you, or your elderly parents, reach out to Americare today.

Get Started With Americare