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New York's In-Home Medicaid Pathways, Explained

Managed Long Term Care (MLTC) and the NHTD waiver are New York's primary Medicaid routes for care delivered at home rather than inside a facility.

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Short answer

New York pays for in-home long-term care mainly through Managed Long Term Care (MLTC) and the Nursing Home Transition and Diversion (NHTD) Medicaid waiver. Neither pays for assisted living room and board -- both are for services delivered at home.

Managed Long Term Care (MLTC)

MLTC is New York's managed-care delivery system for Medicaid long-term care: PACE (age 55+) or MLTC Partial Capitation / Medicaid Advantage Plus. Enrollment has been mandatory in New York City, including Richmond County, since 2012 -- NYC was the first region in the state to require it.

Nursing Home Transition and Diversion (NHTD) Waiver

NHTD is a 1915(c) Medicaid HCBS waiver administered through NYSDOH Regional Resource Development Centers, for Medicaid-eligible people 65+ (or younger with a disability) assessed as needing nursing-home-level care, to receive services in the community instead.

Who administers it locally

NYC Aging (DFTA) and the local NY Connects access point (CASC, (718) 489-3954) can help a Staten Island family start either process.

Source: NYSDOH Managed Long Term Care

Source: NYSDOH NHTD Waiver

Questions families ask

I live off Staten Island and I'm managing my parent's care from a distance. What's the priority?

Build a plan that survives a bad week -- one where you cannot get there quickly and no one nearby can safely check in. Recruit local eyes (a regular visitor, a Meals on Wheels driver, a trusted neighbor), get medical power of attorney and HIPAA authorizations in place early, and establish one local point of contact you can reach quickly.

The money is running out for my parent's care. What's the realistic timeline to act?

Work out the actual runway now -- current balance, monthly burn rate including any care-level fees, and expected increases -- then contact NY Medicaid Choice or NYC Aging (DFTA)/CASC about MLTC and NHTD program timelines immediately, since enrollment and assessment steps take real time and should not wait until funds are nearly exhausted.

My spouse needs more care than I can safely provide alone. What are our options?

Look at communities that keep couples together across care levels, be honest with yourself about your own health and capacity (spousal caregivers routinely under-report their own decline), and understand New York's specific spousal Medicaid protections -- the Community Spouse Resource Allowance and Minimum Monthly Maintenance Needs Allowance -- before assuming a spouse's care will exhaust shared savings.

I'm exhausted and I don't think I can keep doing this alone. What should I actually do?

Take the exhaustion seriously as a real, measurable risk factor -- caregiver strain predicts worse outcomes for both the caregiver and the person receiving care. Use respite and adult day health care before reaching a breaking point, contact NYC Aging (DFTA) through CASC for free local support programs, and get an outside, objective opinion on the current care plan.

What county is Staten Island, and does that matter for senior care planning?

Staten Island IS Richmond County -- New York City's smallest borough by population, at roughly 495,747 residents per the 2020 Census, and its only borough that is also a single, standalone county. That matters because every county-level resource on this site -- APS, the ombudsman, NY Connects -- applies uniformly across the whole borough.

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