Choices for Independence: Get Paid To Care For A Family Member In New Hampshire

Yes. New Hampshire is one of the relatively few states that allows a spouse to be paid as a caregiver through its self-directed Medicaid waiver. Under the CFI waiver's Participant Directed and Managed Services (PDMS) option, the participant is the employer and can hire a spouse to provide the unskilled, custodial care they are approved for, such as help with bathing, dressing, and other activities of daily living. This is a meaningful advantage over many other states, where spouses are specifically excluded. There is an important limit, though: a person who is the participant's legal guardian or who holds durable power of attorney cannot be the paid caregiver, even if they are the spouse. Skilled or medical tasks must still be performed by a licensed professional. Because the exact rules can turn on your specific situation, confirm your spouse's eligibility with your case manager or the Bureau of Elderly and Adult Services at 1-800-351-1888.

Family caregivers hired through New Hampshire's CFI waiver generally earn in the range of about $15 to $22 per hour in 2025-2026, with many arrangements paying up to roughly $20 per hour. The precise rate is tied to New Hampshire Medicaid's reimbursement rate for the service (usually personal care) and to the participant's authorized budget, so it can vary by service type and change over time as the state updates its rates. Across a month, a caregiver can earn up to roughly $3,000 depending on the number of hours approved in the care plan. Caregivers who self-direct through Participant Directed and Managed Services are typically W-2 employees, which means the Financial Management Services (FMS) agency withholds federal and state taxes, Social Security, and Medicare from each paycheck. For the current exact rate that applies to your plan, ask your case manager or the FMS agency you choose.

There is no single fixed timeline, but families should generally plan for a process of a couple of months or more from first contact to the first paycheck. The main steps are: applying for New Hampshire Medicaid long-term care and the CFI waiver, completing the clinical assessment that confirms you need a nursing facility level of care, getting assigned a case manager who builds your care plan, and then onboarding through a Financial Management Services agency once you choose to self-direct. If you are not already on Medicaid, the financial eligibility determination can add time. Because CFI is not an entitlement, there can also be a waitlist when funded slots are full, which can add further delay. You can speed things up by gathering documents in advance - proof of New Hampshire residency, identification, Social Security number, and income and asset records - and by telling the ADRC (1-866-634-9412) up front that you want to self-direct and hire a family member.

One of the advantages of self-direction under CFI is that a family caregiver does not need to be a Certified Nursing Assistant, Home Health Aide, or other licensed professional to provide the unskilled, custodial care the participant is approved for. The participant (or their representative), as the employer, trains the caregiver on the specific tasks they need help with. The main formal requirement is that the caregiver clears the criminal background and registry checks arranged by the Financial Management Services (FMS) agency, which also pays for fingerprinting if it is needed for a criminal records check. The caregiver also completes standard employment paperwork, such as I-9 and W-4 forms, through the FMS agency. Keep in mind that skilled or medical services - things like nursing care - are not part of self-direction and must be delivered by an appropriately licensed provider, so the no-certification rule applies to personal care and similar custodial help, not to clinical tasks.

Participant Directed and Managed Services, or PDMS, is the self-direction option inside the CFI waiver. It lets a participant direct and manage most of their waiver services instead of receiving them only through a traditional agency. Under PDMS the participant designs how services are delivered, selects the people who provide them, decides how the authorized budget is spent based on the needs in their comprehensive care plan, and oversees the work on an ongoing basis. This is the mechanism that makes it possible to hire and pay a family member, including in many cases a spouse or adult child. Participants can mix and match: they might choose to self-direct personal care while continuing to receive another service, like home health aide, through an agency. PDMS covers the menu of CFI waiver services except residential care facility services. A case manager helps set up the plan and enters authorizations, and a Financial Management Services agency handles the employer-side paperwork so the participant does not have to run payroll themselves.

The Financial Management Services (FMS) agency is the entity that handles the employer paperwork for participants who self-direct under PDMS, so families do not have to manage payroll and tax filings on their own. The FMS agency assists with managing and disbursing the funds in the participant-directed budget, performs fiscal accounting and budget management, and provides skills training to the participant who acts as co-employer of their direct support worker. In practical terms, that means the FMS agency processes payroll and issues payment to the caregiver, withholds and files taxes, and makes sure the required criminal background and registry checks are completed before the caregiver starts - including paying for any fingerprinting needed for a criminal records check. The FMS agency does not choose the caregiver, set the schedule, or supervise the care - those decisions stay with the participant. Your case manager coordinates with the FMS agency for each caregiver you hire, entering the authorizations in the state system.

Both play a role, but the participant stays in control of who provides day-to-day care under self-direction. A case management agency assigns you a case manager who is responsible for the ongoing assessment, person-centered planning, coordination, and monitoring of the services in your comprehensive care plan. The case manager helps identify what services you need and how many hours, and enters the service authorizations in NH EASY, the state system. But when you choose Participant Directed and Managed Services, you (or your authorized representative) are the employer of your caregiver - you decide who to hire, you train them on your needs, you set the schedule, and you can end the arrangement if it is not working. The Financial Management Services agency handles the payroll and background-check paperwork behind the scenes. So the case manager coordinates and monitors the overall plan, while you direct the hands-on care and the person who delivers it.

There can be. Choices for Independence is a Medicaid waiver, not an entitlement program, which means meeting the eligibility requirements does not automatically guarantee immediate enrollment. New Hampshire funds a set number of CFI slots - roughly 5,951 beneficiaries per year - and when those funded slots are full, a waitlist can form for program participation. If you qualify clinically and financially but a slot is not immediately available, you may be placed on the waitlist until one opens. Because timing varies, it is worth starting the process as early as possible and staying in close contact with your case manager or the Aging and Disability Resource Center at 1-866-634-9412 so you know where you stand. In the meantime, ask about other New Hampshire supports you may qualify for while you wait, since eligibility and availability can change and there may be other programs that help family caregivers.