New York Medicaid Waivers & Home and Community Based Programs Overview
- Waiver Policy Analyst
- Nov 25, 2024
- 2 min read
Updated: Apr 2
New York, known as The Empire State, has one of the most comprehensive Medicaid Waiver and Home and Community-Based Services (HCBS) systems in the nation, providing long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.
Administered by the New York State Department of Health (NYSDOH), Office for People With Developmental Disabilities (OPWDD), and the Office of Mental Health (OMH), the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings instead of institutional facilities. Key waiver programs include the 1915(c) Nursing Home Transition and Diversion (NHTD) Waiver, which helps individuals with disabilities and seniors transition from institutional care to community living, and the Traumatic Brain Injury (TBI) Waiver, which provides rehabilitative and supportive services.
The OPWDD Comprehensive HCBS Waiver serves individuals with intellectual and developmental disabilities (IDD), offering residential, employment, and behavioral health support. Additionally, New York’s Children’s Waiver integrates services for medically fragile children and youth with serious emotional disturbances. The Consumer Directed Personal Assistance Program (CDPAP) allows individuals to hire and manage their own caregivers, including family members, for greater flexibility in care.
Regulatory oversight in New York is managed through NYSDOH, OPWDD, and OMH, with additional provider licensing and compliance enforcement by the New York State Office of the Medicaid Inspector General (OMIG) and the Office of Primary Care and Health Systems Management (OPCHSM).
The state operates under both fee-for-service and managed care models, with Medicaid HCBS services integrated into New York’s Managed Long-Term Care (MLTC) and Medicaid Redesign Team (MRT) waiver initiatives to streamline service delivery. New York has also implemented Electronic Visit Verification (EVV) for personal care services, reinforcing compliance and fraud prevention.
Providers must navigate rigorous Medicaid provider enrollment, waiver-specific service authorizations, and stringent quality assurance measures to participate successfully in the state’s HCBS programs. With a strong emphasis on person-centered planning, self-direction, and integrated managed care, New York’s Medicaid waiver system ensures that individuals receive high-quality, community-based supports while promoting independence, dignity, and inclusion across diverse urban, suburban, and rural communities.
Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.
Kommentare