HCBS waivers in New York are Medicaid programs authorized under Section 1915(c) of the Social Security Act that pay for services letting people with disabilities or serious care needs live at home instead of in a nursing home or intermediate care facility. The state runs four main ones: the OPWDD Comprehensive Waiver for people with intellectual or developmental disabilities, the Nursing Home Transition and Diversion (NHTD) Waiver, the Traumatic Brain Injury (TBI) Waiver, and the Consolidated Children’s Waiver for people under 21. Each is administered by a different agency, has its own clinical criteria, and enrolls one person at a time — you can only be in one waiver at once.
The Four Waivers and Who Runs Them
The OPWDD Comprehensive HCBS Waiver is run by the Office for People With Developmental Disabilities and serves people of any age with an intellectual or developmental disability. It is the largest waiver in the state. In 2024, roughly 134,686 people received services through the OPWDD system overall, and about 37,500 of those used self-directed services.1OPWDD. By the Numbers Report, January 2026
The NHTD Waiver, run by the Department of Health, is for people who would otherwise need nursing home care, including those with physical disabilities.2New York State Department of Health. Nursing Home Transition and Diversion Waiver
The TBI Waiver, also under DOH, serves people with traumatic brain injuries and provides a tailored set of supports, including housing subsidies, service coordination, and structured day programs.3New York State Department of Health. TBI Housing Subsidy Program Manual
The Consolidated Children’s Waiver, managed by DOH, is limited to people under 21 and covers behavioral health, developmental, and medical needs. Care management runs through a Health Home or the Children and Youth Evaluation Service (C-YES).4New York State Department of Health. Overview of Services Available Through the 1915(c) Consolidated Children’s Waiver and 1915(c) Comprehensive OPWDD Waiver
Who Qualifies
Every waiver shares the same three baseline requirements: the applicant has to be eligible for Medicaid, live in New York, and meet the institutional level of care the waiver is designed to divert people away from. Beyond that, the clinical criteria differ.
For the OPWDD waiver, the person must have a developmental disability that began before age 22 and constitutes a “substantial handicap” under New York’s Mental Hygiene Law. They must also meet ICF/IID level of care, be Medicaid-eligible, and not be enrolled in another comprehensive care management program.5OPWDD. Eligibility and Referrals
The NHTD waiver is currently not accepting new participants. The state set a maximum capacity of 9,400 for waiver years 2025–26 through 2027–28, CMS approved that cap on December 23, 2025, and the ceiling has been reached. DOH is not processing additional referrals and is sending letters to prospective applicants closing their referrals.2New York State Department of Health. Nursing Home Transition and Diversion Waiver
How to Apply for the OPWDD Waiver
OPWDD enrollment starts by contacting the “Front Door” at your local Developmental Disabilities Regional Field Office. From there, the person is connected to a Care Coordination Organization, which gathers the required documentation — cognitive testing, adaptive assessments, medical records, and social evaluations — and submits the eligibility application through the state’s CHOICES system.6OPWDD. Individual Eligibility and Enrollment in OPWDD HCBS 1915(c) Waiver Once OPWDD confirms eligibility, the care manager handles the waiver application itself, which requires a Level of Care Eligibility Determination and an in-process Life Plan.
Care Coordination Organizations
CCOs are specialized Health Homes and are required for OPWDD waiver enrollment. Seven operate statewide: Advance Care Alliance, Care Design NY, Life Plan, Person Centered Services, Prime Care Coordination, Southern Tier Connect, and Tri-County Care. As of the end of 2024, they collectively served 123,051 enrollees.7OPWDD. Care Coordination Organization Profile At least two CCOs cover each of the state’s five regions, and OPWDD maintains a coverage chart so you can find the ones available in your area.5OPWDD. Eligibility and Referrals
CCOs offer two service tiers. About 97% of enrollees receive full Health Home Care Management, which is comprehensive and ongoing; the other 3% use Basic HCBS Plan Support, a lighter option for people who don’t need continuous management. CCOs must finalize an initial Life Plan within 90 days of enrollment and complete annual reassessments. The statewide average for on-time annual plan completion was 97% in 2024.7OPWDD. Care Coordination Organization Profile
Self-Direction Under the OPWDD Waiver
Self-direction lets participants control how their services are delivered. They choose between two types of authority, or both. Employer Authority means the participant hires, schedules, and supervises their own staff under a co-employment model. Budget Authority means the participant manages a Personal Resource Account — a budget ceiling based on a needs assessment — and decides which goods, services, and providers to use within it.8OPWDD. Self-Direction Providers
Participants with Budget Authority can spend on Individual Directed Goods and Services (IDGS), which covers items not otherwise available through Medicaid or the waiver but that address needs in the person’s service plan. Annual IDGS spending is capped at $32,000 or the participant’s Personal Resource Account, whichever is less.9OPWDD. Self-Direction Guidance, March 2022 Community classes in art, cooking, or exercise are common examples, but they have to take place in integrated community settings open to the general public and cannot duplicate services the waiver or Medicaid State Plan already covers.8OPWDD. Self-Direction Providers
Two roles support people who self-direct. A Support Broker helps build the person’s “Circle of Support,” develop the budget, and navigate the system. Brokers complete a seven-class virtual training through OPWDD regional offices and are reauthorized annually. Compensation is negotiated with the participant, with an hourly maximum of $40 and a start-up brokerage cap of $2,400. Household family members and parents of the person receiving services cannot be paid brokers.9OPWDD. Self-Direction Guidance, March 2022
A Fiscal Intermediary handles the money side: billing, paying for approved goods and services, running payroll for self-hired staff, fiscal accounting, and Medicaid compliance. The FI is the employer of record for self-hired workers and is encouraged to purchase items directly for the participant rather than making them pay out of pocket and wait for reimbursement.8OPWDD. Self-Direction Providers
Community First Choice Option Alongside the Waivers
The Community First Choice Option (CFCO) is a Medicaid State Plan benefit under Section 1915(k), created by the Affordable Care Act and available to states since October 2011. States that adopt it get a six-percentage-point increase in federal matching funds for those services.10Federal Register. Medicaid Program: Community First Choice Option
Unlike a 1915(c) waiver, CFCO has to be offered statewide and cannot be capped at a set number of participants. It covers assistance with activities of daily living, instrumental activities of daily living, and health-related tasks. In New York, CFCO services include assistive technology, environmental modifications, and vehicle modifications, each capped at $15,000 per year without prior DOH approval, plus community transitional services and moving assistance, each capped at a one-time $5,000 expense. CFCO and the waivers coexist. If someone in a waiver doesn’t meet CFCO’s separate eligibility rules, they keep receiving services under their waiver.11New York State Department of Health. CFCO LDSS Rate Code Training
Housing Subsidies for TBI and NHTD Participants
New York offers rental subsidies for people in the TBI and NHTD waivers, designed as a resource of last resort. To qualify you have to be an active waiver participant with Medicaid HCBS coverage, show financial need, and have exhausted other federal, state, and local housing resources, including HUD Housing Choice Vouchers. Participants contribute one-third of their monthly income (after spend-down) toward rent, and housing has to fall within HUD Fair Market Rent guidelines for the area.3New York State Department of Health. TBI Housing Subsidy Program Manual
The subsidy only covers rent in integrated community settings. Congregate care, assisted living, and residences housing four or more unrelated people are excluded, and mortgage payments, rent-to-own arrangements, and homeownership expenses aren’t covered. Utility help is available, but you have to apply for the Home Energy Assistance Program first. Funding depends on annual state appropriations, so availability shifts from year to year.3New York State Department of Health. TBI Housing Subsidy Program Manual
If You Are Denied or Your Services Are Cut
Anyone denied services, disenrolled, or facing a reduction can challenge the decision through a Fair Hearing conducted by the Office of Temporary and Disability Assistance. For most Medicaid service decisions, you have 60 calendar days from the notice date to request the hearing. To keep your current services in place while the appeal is pending — “aid continuing” — you generally have to file within 10 days of the notice or before the action’s effective date.12Legal Aid Society of New York City. What You Need to Know About Medicaid and Fair Hearings
For Health Home and Children’s Waiver HCBS decisions, agencies have to mail written notice at least 10 calendar days before the action takes effect, and members have the right to examine their case records and get copies of the evidence packet at no cost. The agency must send a representative to the Fair Hearing with authority to make binding decisions, including withdrawing the challenged determination.13New York State Department of Health. Health Homes Fair Hearing and Notice of Determination Policy
Hearings are run by an Administrative Law Judge and are usually held by phone, though you can request in person. Request one by calling 800-342-3334 or through the OTDA website. Decisions are typically mailed within three weeks. If an agency doesn’t comply with a decision in your favor, you can file a compliance complaint online or by calling 877-209-1134.12Legal Aid Society of New York City. What You Need to Know About Medicaid and Fair Hearings
Managed Care and the TBI and NHTD Waivers
TBI and NHTD waiver services are not delivered through Medicaid Managed Care. In February 2025, Governor Hochul signed S806 into law (Chapter 41 of the Laws of 2025), permanently carving the TBI waiver out of managed care and extending the NHTD carve-out through at least April 1, 2027. The law halted what had been a pending transition of those services into managed care plans.14New York State Senate. S806 The NHTD waiver’s own webpage lists Managed Long Term Care and Programs of All Inclusive Care for the Elderly as alternative community-based options, but neither replaces the waiver.2New York State Department of Health. Nursing Home Transition and Diversion Waiver