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NHTD Waiver


The Nursing Home Transition and Diversion Waiver for Individuals with Disability was created in 2008. This was a response to New York State legislation that authorized New York to provide a cost-effective community-based alternative to nursing facility care. The state’s “commitment to serve all persons in the least restrictive setting, appropriate to their needs”. Each person receives “person centered” care in the community, based on their goals and desires for remaining as independent as possible for as long as possible.

The NHTD Waiver was developed with the following philosophy:

That a person with disabilities has the same right to be in control of his or her life as anyone else in our society, being able to choose who provides their services, where to live, and with whom.  By living in the community he/she regains the right to incur and manage the risks associated with independence, and learn from the experiences of, both, successes and failures.

To be eligible for the NHTD Waiver a person must:

  • Be capable of living in the community with needed assistance from available informal supports, non-Medicaid supports and/or Medicaid State Plan services and be in need of one or more waiver service
  • Be eligible for nursing home level of care
  • Be authorized to receive Medicaid Community Based Long Term Care
  • Be at least 18 years of age
  • Choose to live in the community as a participant in this waiver rather than in a nursing home

NHTD Waiver services offered:

  1. Service Coordination (SC)
  2. Home and Community Support Services (HCSS)
  3. Community Integration Counseling (CIC)
  4. Independent Living Skills (ILST)
  5. Positive Behavioral Intervention and Support (PBIS)
  6. Structured Day Program (SDP – Not offered by Allwel)

Referral process:

  • Allwel will forward referral inquiries to the appropriate region’s Regional Resource Development Center (RRDC-Single Point of Entry)
  • RRDC will set an appointment with individual and/or family (if desired) to assess eligibility based on medical documentation of disability and anticipated level of care
  • Individual and/or family is provided a list of provider agencies to interview for services
  • Individual selects a provider agency or agencies for the desired service(s)
  • Agency’s Service Coordinator develops the Initial Service Plan (ISP)
  • Agency sends a nurse to complete an evaluation to determine the level of needs
  • Nurse works with family and individual to develop a plan of care and assess the number of required hours
  • During the ISP development process, the Service Coordinator interviews the participant and any family to select the appropriate/desired program supports, as well as review all other available community supports
  • Agency submits the ISP for review by the RRDC and for approval/authorization
  • Upon approval of ISP, the Agency will begin services with the participant

The process from selection of Service Coordinator to first day of service generally takes around 30 days, depending on how quickly medical and supporting documentation can be obtained, housing is located (if needed and if available in the location requested), and the availability of the individual and family to provide their time during the ISP information gathering process.

What to expect

  • Agency’s Schedulers work with the individual and family to adjust the service schedule as needed
  • When services begin, the nurse introduces the staff and provides training on the plan of care in the home
  • Agency care team reviews the progress of the participant on a weekly basis during team meetings and recommends solutions to any challenges or adjustments to services as necessary
  • Service Coordinator and Nurse facilitate ongoing communication with family and medical providers as requested/necessary
  • Service Coordinator provides an updated plan of care to the RRDC for the review process every 180 days. Agency and RRDS certification of continued need every 180 days is a requirement of the program

How can we help?

Feel good knowing we’re there when you can’t be there.

Some of Our Team

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Debbie McDermitt, LCSW

Debbie oversees the implementation of Waiver Services throughout our New York City region. Debbie has extensive social work experience including in-home counseling and crisis intervention services, as well as educational advocacy and training for prospective Foster and Adoptive Parents. In addition, Debbie has provided Clinical Supervision services to Illinois Department of Children and Families staff. Debbie had a private practice for several years, providing therapy services to individuals, couples, and families, as well as having worked with the US military being a Military and Family Life Consultant at military installations domestic and abroad. Debbie holds a Masters in Social Work from the University of Illinois at Chicago’s Jane Addams College of Social Work, and received her License in Clinical Social Work in 1998.

Director of Waiver Services


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Julie Krieger, MADS, CBIST

Julie has over 18 years of experience working with adults who have acquired brain injuries, neurological disorders, dementia, and children with autism spectrum disorders. Julie co-authored a chapter in a recently published textbook “Genetic Syndromes and Applied Behavior Analysis”. While training staff is her “second heartbeat”, she has significant experience in program management, clinical supervision, training, compliance, and accreditation in multiple facilities (post-acute and long term rehabilitation, residential and community-based environments) across the United States and Canada. She began her service at Allwel as the Director of Waiver Services in January 2003 and transitioned in June 2008 to Chief Compliance and Privacy Officer, where she ensures our Agency’s adherence to the regulations, best practices, and privacy requirements throughout our programs.

Corporate Compliance and Privacy Officer
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Meghan Canfield, MSW

Meghan is Allwel’s western New York Senior Service Coordinator, and is responsible for ensuring partnerships between our participants and their families, friends, and any other caregivers or service providers to create comprehensive person-centered service plans. Meghan oversees the Service Coordination team in their building these partnerships through being advocates, educators, brokers, and facilitators.

Meghan graduated from the University at Buffalo with her Master’s in Social Work in 2013, and is also currently working on the Clinical Foundations of Trauma-Informed Care Certificate Program. Meghan also draws from experience with the Buffalo Schools providing counseling to adolescents using Solution Focused Therapy, as well as working in a residential setting providing direct care for adolescents with severe mental illnesses.

Senior Service Coordinator