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New Hampshire home care payment guide
Last updated: 13 September 2026
Paying for help at home in New Hampshire usually takes more than one program. The main long-term public path is Medicaid’s Choices for Independence program, often called CFI. Medicare can help with qualifying skilled home health, but it does not pay for ongoing personal care when that is the only help needed. Veterans may have separate VA options, and local aging services can sometimes fill smaller gaps.
Bottom Line
For ongoing help with bathing, dressing, toileting, transfers, meals, supervision, or other daily tasks, call New Hampshire’s Aging and Disability Resource Centers at 1-866-634-9412 and ask about Choices for Independence (CFI). Start the Medicaid financial application through NH EASY at the same time. For short-term skilled nursing or therapy, ask the doctor about Medicare home health.
There is no single New Hampshire home-care grant for everyone. Families may combine Medicaid, Medicare, VA help, caregiver services, insurance, and private pay.
Urgent Help if Home Is Not Safe
Call 911 for a medical emergency, serious fall, trouble breathing, stroke signs, or another immediate danger. If there is no emergency but the older adult cannot safely be left alone today, call the Aging and Disability Resource Center at 1-866-634-9412. For other urgent local needs such as food, housing, transportation, or utility help, dial 211 or use 211 New Hampshire.
Start Here
- Write down the care need. Note skilled nursing or therapy, personal care, dementia supervision, respite, and household help.
- Call the state front door. New Hampshire’s Aging and Disability Resource Centers, formerly ServiceLink, can explain CFI, caregiver services, Medicare counseling, and local help. Call 1-866-634-9412.
- Open other payment paths. Apply for Medicaid if it may fit, ask about Medicare home health for skilled care, and contact the VA for a Veteran.
For a broader benefits map, see New Hampshire senior assistance.
Home Care Payment Paths at a Glance
| Need | Possible payer | Best first step | Main limit |
|---|---|---|---|
| Ongoing personal care at home | New Hampshire Medicaid CFI | ADRC + NH EASY | Financial and nursing-facility-level clinical rules apply |
| Short-term skilled nursing or therapy | Medicare home health | Doctor or discharge planner | Not a long-term custodial care benefit |
| Veteran needs personal care | VA home-based services | VA social worker | Clinical need and local availability matter |
| Unpaid caregiver needs a break | Caregiver support or respite | ADRC | Funds and service capacity are limited |
| Not eligible for public help | Insurance + private pay | Review policy and price care | Benefits, waiting periods, and hourly costs vary |
First, Separate Home Care From Home Health
Home care usually means nonmedical help with daily life, such as bathing, dressing, toileting, eating, transfers, meals, light cleaning, errands, reminders, or supervision. Home health means skilled medical care such as nursing or therapy.
Medicare may pay for qualifying home health. It usually will not pay for months or years of personal care when that is the only need. See GFS guidance on home care for seniors.
New Hampshire Medicaid: Choices for Independence
For many New Hampshire adults who need long-term help at home and have limited income and resources, the main public program is Choices for Independence (CFI). It is a Medicaid home and community-based services waiver. CMS lists the CFI waiver as approved through June 30, 2027. A July 2026 CFI update also confirms a recently approved waiver amendment.
Current New Hampshire CFI program rules require an adult to meet Medicaid financial rules and the state’s nursing-facility-level clinical standard, need at least one CFI service, and choose community care instead of institutional care.
The clinical standard is more than simply needing help at home. Skilled medical personnel assess qualifying nursing, restorative, medication, and functional needs. One route is needing help with two or more activities of daily living, such as eating, toileting, transferring, bathing, dressing, or continence.
What CFI can pay for
Depending on the approved care plan, CFI can include in-home and personal care, homemaker help, home health aide services, respite, meals, nonmedical transportation, adult day services, skilled nursing, emergency response systems, equipment, community transition help, participant-directed services, and case management.
Services and units must be authorized. CFI is not an unrestricted cash benefit and generally cannot duplicate care already covered by Medicaid, Medicare, another insurer, or another service.
How the CFI application works
CFI has a financial review and a clinical review. Start through NH EASY or call DHHS at 1-844-275-3447. The GFS NH EASY portal guide can help you prepare.
The state uses an on-site, face-to-face clinical assessment. Keep medical records and the doctor’s office involved if more information is requested.
Helpful tip: Before the assessment, list what the person cannot do safely alone. Include falls, transfers, toileting, bathing, dressing, eating, nighttime needs, medications, wandering, and hands-on family help.
Important 2026 CFI Financial Rules
Older New Hampshire materials may show lower resource figures. Use the current rules and law for a 2026 CFI case.
| Rule | 2026 point | What to know |
|---|---|---|
| Income cap | $2,982 per month | The nursing-facility cap is 300% of the federal SSI maximum. The 2026 individual SSI maximum is $994. |
| Single applicant resources | $7,500 effective limit | A newer disregard raises the effective limit for adult HCBS waiver applicants; countable-resource rules still matter. |
| Married applicant | Spouse treatment differs | Current NH law generally counts resources in the applicant’s name, not the nonapplicant spouse’s resources. |
| Over the income cap | Do not assume “no” | New Hampshire has a medically needy route that DHHS must calculate for the individual case. |
New Hampshire’s current Medicaid rules set the income cap at 300% of the maximum federal Supplemental Security Income benefit. Social Security lists the 2026 SSI amount as $994, so 300% is $2,982.
For resources, current rules apply a disregard up to a $7,500 standard for CFI and other named long-term-care groups. State law gives a single adult HCBS waiver applicant an effective $7,500 resource limit and provides different treatment for married applicants. See the NH resource law.
Do not give away or retitle assets simply to qualify. New Hampshire asset-transfer rules can review transfers within 60 months before application. Transfers for less than fair market value can cause a period of ineligibility. Get qualified advice before changing ownership of a home, trust, annuity, large gift, or joint account.
Can a Family Member Be Paid?
Sometimes. CFI participant-directed services can give a participant more control over authorized workers, with a financial management services provider.
Family payment is not automatic. Current CFI rules treat a spouse as a legally responsible relative and do not cover a CFI service provided by that legally responsible relative. Other relatives have different requirements.
This area is changing. A June 2026 BAAS update says state law directs DHHS to seek federal approval to expand caregiver supports in CFI and another waiver. Until an approved change takes effect, get the worker’s eligibility confirmed in writing before care starts.
See GFS guidance on paid family caregivers.
Medicare: Useful for Skilled Home Health, Not Long-Term Custodial Care
Medicare can help when a person needs skilled care at home after an illness, injury, surgery, or change in condition. Medicare’s home health rules can cover qualifying part-time or intermittent nursing, therapy, medical social services, and limited aide care tied to skilled services.
The person must meet Medicare’s medical rules, including needing skilled services and being homebound. A health care provider must assess and order the care, and a Medicare-certified home health agency must provide it.
Medicare does not cover 24-hour home care, meal delivery, unrelated homemaker work, or personal care when that is the only care needed. A person may therefore qualify for a nurse or therapist but still need another payer for daily personal care.
For broader Medicaid basics, use the GFS Medicaid senior guide.
Veterans: Check Both VA Services and Pension Help
Veterans should check two separate paths. First, the VA may provide actual in-home services. The VA’s Homemaker and Home Health Aide program can help eligible enrolled Veterans with daily activities. The VA says the Veteran must meet clinical criteria, be eligible for community care, and have the service available locally. A copay may apply depending on service-connected status.
Second, some Veterans or survivors who already qualify for VA pension may receive a higher monthly payment through Aid and Attendance if they need another person’s help with daily activities or meet another qualifying condition. This is an added pension payment, not a promise that the VA will send a caregiver.
Ask a VA social worker about home and community services and ask an accredited benefits helper about pension eligibility. The GFS guide to New Hampshire veteran benefits can help you prepare for those calls.
Caregiver Support and Local Services Can Reduce the Paid-Care Gap
New Hampshire’s Family Caregiver Support Program may connect unpaid caregivers with information, counseling, training, respite, and limited supplemental supports. Funding and availability can vary, so start through the ADRC.
The aging network can also help locate meals, transportation, adult day services, benefits counseling, and other supports that may reduce private-pay hours. Use the GFS directory of New Hampshire aging agencies.
If the family is stuck between programs, 211 New Hampshire can search local nonprofit and community resources. It is a backup referral route, not a substitute for the CFI application.
Long-Term Care Insurance and Private Pay
If the older adult already owns long-term care insurance, find the policy before buying care. Check the benefit trigger, waiting period, daily or monthly maximum, lifetime maximum, covered home-care services, and provider rules. GFS explains common terms in its long-term care insurance guide.
For private pay, compare the cost of the actual hours needed. Ask providers about hourly rates, minimum shifts, weekend rates, mileage, background checks, and backup workers. If hiring independently, confirm who handles payroll, taxes, insurance, scheduling, and replacements. See agency vs. independent care.
If safe home care would require near-constant staffing, compare other settings too. The GFS home care comparison can help.
How to Start Without Wasting Time
- Write a one-week care log. Track help with bathing, dressing, toileting, transfers, eating, medications, meals, wandering, falls, and nighttime supervision.
- Call ADRC first for long-term help. Ask for CFI screening, caregiver support, and local backup services.
- Submit the financial application early. Do not spend down blindly. Let DHHS tell you what documents it needs.
- Ask the doctor about skilled care. If nursing or therapy is medically needed, Medicare home health may run alongside the long-term-care planning process.
- Open the VA path immediately if relevant. VA health services and pension help are separate questions.
- Keep a call log. Record the date, office, worker’s name, what was requested, and the next deadline.
Documents and Information to Gather
| Item | Examples | Why it matters |
|---|---|---|
| Identity and coverage | Photo ID, Social Security number, Medicare and Medicaid cards | Confirms identity and existing coverage |
| Income | Social Security, pension, wages, VA income | Used in Medicaid financial review |
| Resources | Bank and investment statements, life insurance, trusts, annuities | Long-term-care Medicaid has resource rules |
| Medical and care needs | Medication list, diagnoses, discharge papers, care log | Supports the clinical assessment |
| Legal authority | Power of attorney, guardianship, authorized representative forms | Shows who may speak or sign for the applicant |
| Other payment sources | Long-term care policy, VA papers, other health insurance | Other coverage may have to pay first |
Reality Checks
- Approval is not instant staffing. CFI is active, but worker and provider capacity can vary.
- CFI is not unrestricted cash. Services must fit the approved care plan.
- Medicare is not long-term personal care insurance. Its home health benefit follows skilled-care rules.
- Family caregiver pay has limits. Confirm a relative’s eligibility before work starts.
- Medicaid may require a contribution. The state can calculate how much income a participant must contribute toward CFI services.
- Asset transfers can backfire. New Hampshire applies a 60-month look-back to certain transfers for long-term-care Medicaid.
- Estate recovery can matter. New Hampshire permits recovery of certain Medicaid assistance from the estate of a recipient who was 55 or older when assistance was received, subject to protections. Review the estate recovery limits before major property decisions.
Common Mistakes to Avoid
- Assuming Medicare will pay for ongoing bathing, dressing, supervision, or meal help.
- Waiting until savings are nearly gone before starting the CFI application.
- Using an old $2,500 resource figure without checking the newer $7,500 CFI rule.
- Giving away money, adding a child to an account, or transferring a home before understanding Medicaid transfer rules.
- Describing care needs too vaguely during the assessment instead of explaining what happens without help.
- Assuming a spouse or other relative can be paid without written program approval.
- Stopping after one denial without reading the appeal rights and deadline.
Denied, Delayed, or Overwhelmed
If CFI is denied, read the notice immediately. Current CFI appeal rules give an applicant 30 calendar days from the denial notice to appeal. A person can also reapply after a clinical denial or termination when circumstances or evidence change.
For an existing participant facing termination or reduced services, the rule also gives 30 days to appeal. Filing within 15 calendar days can preserve continued CFI payments under the continuation rule. Do not wait until day 30 when current services are at risk.
Ask the ADRC about missing paperwork, backup services, and the appeal route. Keep every notice, upload confirmation, medical-record request, and call note.
Backup Options While You Wait
While an application or assessment is pending, ask whether these options can safely reduce the gap:
- Medicare-covered skilled home health for a qualifying medical need.
- VA homemaker, respite, or other home services for an eligible Veteran.
- Caregiver respite or local aging services through the ADRC.
- Adult day services, meals, transportation, or personal emergency response.
- A smaller private-pay schedule focused on the highest-risk times.
- Hospital or rehabilitation discharge planning when a return home is not yet safe.
New Hampshire and Federal Resources
- Aging and Disability Resource Centers: 1-866-634-9412 for CFI navigation, caregiver support, local services, and Medicare counseling.
- NH DHHS Customer Service: 1-844-275-3447 for assistance applications and case questions.
- NH EASY: use the official state portal to apply, upload documents, and manage many benefit cases.
- Medicare: 1-800-633-4227 for Medicare coverage questions.
- VA: ask the Veteran’s VA care team or social worker about home and community services.
- 211 New Hampshire: dial 211 for non-emergency local health and human-service referrals.
Phone Scripts You Can Use
Calling the ADRC
“I am helping an adult in New Hampshire who needs ongoing personal care. I want to ask about CFI. How do we start the financial and clinical process, and what records should we gather?”
Calling NH DHHS
“I am applying for CFI. Can you confirm which financial documents are missing, the deadline, and where I should send them?”
Calling the doctor
“Could my family member qualify for Medicare home health because of a skilled nursing or therapy need? If so, what assessment and order are needed?”
Calling the VA
“This Veteran needs help with daily activities at home. Can a social worker review Homemaker and Home Health Aide care, respite, and where to ask about Aid and Attendance?”
Resumen en Español
La opción pública principal para cuidado personal de largo plazo en casa en New Hampshire es Medicaid Choices for Independence (CFI). Llame al Aging and Disability Resource Center al 1-866-634-9412 y pregunte por CFI. La solicitud financiera también puede comenzar por NH EASY.
Medicare puede pagar atención médica especializada en el hogar, como enfermería o terapia, cuando se cumplen sus reglas. No suele pagar cuidado personal de largo plazo cuando esa es la única necesidad.
En 2026, el límite de ingresos usado para la vía principal de CFI es $2,982 al mes para una persona. Para un solicitante individual de CFI, la regla actual crea un límite efectivo de recursos de $7,500. Las reglas para matrimonios, ingresos por encima del límite y transferencias son más complejas.
Una denegación inicial de CFI puede apelarse dentro de 30 días calendario. Si una persona ya recibe CFI y le reducen o terminan servicios, presentar la apelación dentro de 15 días puede ser importante para mantener pagos durante el proceso.
Frequently Asked Questions
Does New Hampshire Medicaid pay for home care?
Yes, for eligible people. CFI can cover approved home and community-based services for adults who meet Medicaid financial rules and New Hampshire’s nursing-facility-level clinical standard.
What are the 2026 CFI income and resource limits?
The 2026 CFI nursing-facility income cap is $2,982 per month for an individual. A single adult CFI applicant has an effective $7,500 resource limit. Medically needy and married-applicant rules can change the calculation.
Will Medicare pay for long-term home care?
Usually not when personal care is the only need. Medicare can cover qualifying part-time or intermittent skilled home health, but it does not cover 24-hour home care or long-term custodial care by itself.
Can my spouse be paid as my CFI caregiver?
Current CFI rules treat a spouse as a legally responsible relative and do not cover a CFI service provided by that relative. Confirm rules for other relatives in writing before care starts.
Where do I apply for CFI?
Call New Hampshire’s Aging and Disability Resource Centers at 1-866-634-9412 and start the Medicaid financial application through NH EASY or DHHS. CFI also requires a clinical assessment.
Does Medicaid estate recovery apply to CFI?
It can. Federal and New Hampshire rules allow estate recovery for certain Medicaid long-term-care assistance received after age 55, subject to protections. Ask DHHS or qualified elder-law counsel about a specific home or estate.
About This Guide
This guide uses official federal, state, local, and other high-trust nonprofit and community sources mentioned in the article.
Editorial note
This guide is produced based on our Editorial Standards using official and other high-trust sources, regularly updated and monitored, but not affiliated with any government agency and not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Please note that despite our careful verification process, errors may still occur. Email info@grantsforseniors.org with corrections and we will respond within 72 hours.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, and availability can change. Readers should confirm current details directly with the official program before acting.
Last updated: 13 September 2026 · Next review: 13 December 2026
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