Key takeaway
New Hampshire pays family caregivers primarily through the Choices for Independence (CFI) Medicaid Waiver. Veterans benefits and qualifying long-term care insurance provide additional funding pathways.
- Medicaid: Choices for Independence (CFI) Waiver is the main path for paid family caregiving in New Hampshire.
- CFI uses Participant-Directed and Managed Services to let the participant hire family caregivers.
- Spouses and legal guardians are generally excluded from CFI paid-caregiver roles.
- Veterans benefits, including Veteran Directed Care, may pay a spouse caregiver.
Overview
New Hampshire’s Department of Health and Human Services (DHHS) administers the Choices for Independence (CFI) Waiver, the state’s primary Medicaid Home and Community-Based Services program for older adults and adults with chronic illness or disability. CFI funds in-home personal care, homemaker, respite, and other supports so participants can remain in their communities.
A defining feature of New Hampshire’s program is its Participant-Directed and Managed Services (PDMS) option, which lets the care recipient choose and supervise a personal care attendant — often a family member. Veterans, surviving spouses, and households with qualifying long-term care insurance have additional pathways to fund family caregiving.
Programs that pay family caregivers in New Hampshire
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Choices for Independence (CFI) Waiver (Medicaid HCBS Waiver) | Age 65+ or 18+ with a disability or chronic illness; meets nursing-facility level of care; income up to 300% of SSI; assets within Medicaid limits. | Funds personal care, homemaker, respite, adult medical day, and home-delivered meals. Participant-Directed and Managed Services (PDMS) lets the participant hire family caregivers other than spouses. |
| Personal Care Attendant (PCA) Services (Medicaid (within CFI)) | CFI enrollees who choose the self-directed model. | Participant recruits, hires, trains, and supervises their PCA. Family caregivers other than spouses or legal guardians may be hired. |
| Acquired Brain Disorder (ABD) Waiver (Medicaid HCBS Waiver) | Adults with an acquired brain disorder who meet ICF/IID level of care. | Funds personal supports and respite. Family caregivers may be paid in some circumstances through the participant’s service plan. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse needing help with activities of daily living and meeting VA pension rules. | Increases the monthly VA pension; can be used to pay an adult child or relative caregiver. |
| Veteran Directed Care (VDC) (VA program) | Veterans enrolled in VA health care who need nursing-facility level of care and live within a participating VAMC area. | Veteran manages a flexible monthly budget to hire caregivers, including a spouse. |
| Long-Term Care Insurance (Private) | Policy must cover in-home care and allow payment to the policyholder or a chosen caregiver. | Cash/indemnity policies can usually pay a family caregiver directly; reimbursement-style policies may require a licensed agency. |
New Hampshire Medicaid programs
New Hampshire Medicaid’s primary path to paid family caregiving is the Choices for Independence (CFI) Waiver. Adults with acquired brain disorders may also qualify for the ABD Waiver, which can include family-delivered supports.
Choices for Independence (CFI) Waiver
CFI is New Hampshire’s 1915(c) HCBS waiver. It funds in-home personal care, homemaker, respite, and other supports so eligible adults can avoid nursing-facility placement.
- Age 65+ or 18+ with a qualifying disability or chronic illness.
- Meets nursing-facility level of care based on the DHHS assessment.
- Income up to 300% of SSI; assets within Medicaid limits.
- Participant-Directed and Managed Services (PDMS) lets the participant hire family caregivers other than spouses or legal guardians.
Participant-Directed and Managed Services (PDMS)
PDMS is the self-directed service model within CFI. The participant (or a designated representative) recruits, hires, trains, schedules, and supervises a personal care attendant, often a family member.
- Open to CFI participants who choose self-direction.
- Family caregivers other than spouses and legal guardians may be hired.
- A financial management service handles payroll, taxes, and reporting.
Acquired Brain Disorder (ABD) Waiver
New Hampshire also operates an HCBS waiver for adults with acquired brain disorders. It can fund personal supports, respite, and other services that family members may help deliver.
- Adults with a documented acquired brain disorder.
- Meets ICF/IID level of care.
- Family caregivers may be paid in some cases depending on the service authorized.
State-funded options
New Hampshire’s ServiceLink network connects older adults and adults with disabilities to state and federal programs. State-funded supports may bridge the gap for those waiting on Medicaid eligibility.
A ServiceLink Aging and Disability Resource Center assesses needs and refers participants to services such as homemaker, personal care, or respite. Some programs allow paying a family caregiver through a contracted provider.
State-funded programs generally follow Medicaid-style rules and exclude spouses and legal guardians from paid caregiver roles.
Who qualifies
- New Hampshire residents age 60 or older (programs for younger adults vary).
- Households meeting state income guidelines, often tied to the federal poverty level.
- Residents in regions where program funding is available.
Veterans’ programs
New Hampshire veterans and surviving spouses can fund in-home family caregiving through VA benefits. Aid & Attendance and Veteran Directed Care are the two main federal pathways.
Aid & Attendance Pension
A&A adds to a qualifying veteran’s or surviving spouse’s monthly VA pension to help cover care needs. The payment goes to the veteran, who can use it to pay a family caregiver.
- Eligibility: wartime service, limited income and assets, and a need for help with activities of daily living.
- Adult children and other relatives can be paid; a spouse cannot be paid directly because household income is combined.
- Applications go through the VA Pension Management Center.
Veteran Directed Care (VDC)
VDC may be offered through the Manchester VA Medical Center and partner sites. The veteran manages a flexible monthly budget to hire caregivers, including family.
- Open to veterans needing nursing-facility level of care in the VA system.
- Spouses may be paid caregivers under VDC.
- A financial management service handles payroll and reporting.
Long-term care insurance
Qualifying long-term care insurance can pay a New Hampshire family caregiver for in-home services. Confirm payment rules with the insurer before relying on this option.
What to check in the policy
- Policy covers in-home personal care, not just facility-based care.
- Benefits are paid as cash or indemnity to the policyholder, who can pay the caregiver directly.
When a policy only pays licensed agencies, the family caregiver can be hired by a New Hampshire-licensed home care agency that bills the insurer and pays the caregiver through payroll.
How to apply in New Hampshire (step-by-step)
- Identify the most likely path: Choices for Independence (CFI) Waiver, ABD Waiver, VA benefits, or LTC insurance.
- Gather documents: photo ID, Social Security details, proof of New Hampshire residency, income and asset records, medical history, and veteran service records if applicable.
- Contact the right agency:
- CFI Waiver: contact your local ServiceLink Aging and Disability Resource Center (866-634-9412) to start the application.
- ABD Waiver: contact the Bureau of Developmental Services through DHHS.
- VA paths: speak with a VA social worker at the Manchester VA Medical Center about Aid & Attendance or VDC.
- LTC insurance: call the insurer to confirm caregiver payment rules.
- Complete the level-of-care and financial eligibility assessments through DHHS.
- Choose Participant-Directed and Managed Services (PDMS) or an enrolled agency, select your family caregiver, and complete required training and background checks.
- Begin services, submit time sheets or electronic visit verification records, and keep care notes for periodic reviews.
New Hampshire paid caregiver FAQs
What is the Choices for Independence Waiver?
Choices for Independence (CFI) is New Hampshire’s primary Medicaid HCBS waiver for older adults and adults with disabilities. It funds personal care, homemaker, respite, and other in-home supports.
Can I be paid to care for my parent in New Hampshire?
Yes. Adult children are commonly paid through the CFI Waiver’s Participant-Directed and Managed Services (PDMS) option, as well as through VA programs and qualifying LTC insurance.
Can a spouse be paid as a caregiver in New Hampshire?
Spouses are generally excluded from CFI paid-caregiver roles. Veteran Directed Care can pay spouses when the veteran qualifies.
Is there a waitlist for CFI in New Hampshire?
Waitlists are possible because CFI has a capped number of slots. Contact ServiceLink early to start the application and identify interim supports.
How long does CFI approval take?
After the level-of-care and financial assessments, services usually begin within several weeks once the participant selects a provider or self-directed option and completes the required paperwork.
