Area Agencies on Aging in New Hampshire

Structure of Area Agencies on Aging (AAAs) in New Hampshire

New Hampshire operates a highly centralized aging services system, with just one statewide Area Agency on Aging (AAA) managing Older Americans Act (OAA) programs for the entire state. Unlike most states, which have multiple regional AAAs, New Hampshire takes a state-led approach, where services are coordinated by a single organization under the oversight of the New Hampshire Department of Health and Human Services (DHHS).

The AAA functions are managed by ServiceLink Aging & Disability Resource Centers (ADRCs), which serve as the primary access points for aging services across the state. These centers provide case management, long-term care counseling, Medicaid assistance, and home-based service coordination for older adults and individuals with disabilities.

Key Aspects of New Hampshire’s AAA Structure

1. Only One AAA Covers the Entire State:
   • New Hampshire has one single AAA, rather than multiple regional agencies.
   • The AAA operates through ServiceLink Resource Centers, which act as local offices throughout the state.
   • This structure is similar to Delaware, Rhode Island, and Alaska, which also have only one AAA for the entire state.
2. State-Run System Under New Hampshire DHHS:
   • Unlike most states where AAAs operate independently, New Hampshire’s AAA is run directly by the New Hampshire Department of Health and Human Services (DHHS).
   • The state government manages funding, contracts with local service providers, and ensures compliance with federal programs.
   • This differs from states like Texas, California, and Florida, where AAAs function as independent regional entities under state oversight.
3. ServiceLink Aging & Disability Resource Centers (ADRCs) Serve as Local Access Points:
   • ServiceLink Resource Centers (ADRCs) provide direct support to seniors and people with disabilities.
   • These centers help residents navigate long-term care, Medicaid eligibility, in-home care options, transportation, and nutrition services.
   • This model is similar to Wisconsin and Missouri, where Aging & Disability Resource Centers (ADRCs) are integrated into the AAA network.
4. Direct State Management of Programs:
   • In most states, AAAs contract services to local agencies, but in New Hampshire, the state plays a direct role in service administration.
   • New Hampshire contracts some services (like home-delivered meals and transportation) to local organizations but retains more control over program coordination than many other states.
   • This is similar to Hawaii and Nevada, which also have centralized aging service administration.
5. Emphasis on Home and Community-Based Services (HCBS):
   • The state prioritizes aging in place, meaning that home-based care and community services are preferred over nursing home placement.
   • The New Hampshire Choices for Independence (CFI) Medicaid Waiver helps seniors receive in-home care rather than institutional care.
   • This is similar to states like Minnesota, Oregon, and Vermont, which also emphasize community-based aging services over institutional care.
6. Services Provided by the AAA and ServiceLink ADRCs Include:
   • Home-delivered and congregate meals (Meals on Wheels)
   • Caregiver support and respite care
   • Long-term care counseling
   • Medicare and Medicaid assistance (SHIP program)
   • Transportation services
   • Case management for older adults and individuals with disabilities
   • Legal assistance for seniors
   • Employment and volunteer opportunities for older adults
7. Medicaid & Long-Term Care Integration:
   • New Hampshire’s Choices for Independence (CFI) Waiver allows seniors to receive Medicaid-funded home care rather than entering a nursing home.
   • This program is similar to Vermont’s Choices for Care program, which also promotes aging in place through Medicaid-funded home support.
   • However, New Hampshire’s program is smaller in scale compared to states like Minnesota and Oregon, which have more extensive Medicaid aging services.

Comparison with Other States

Similarities:

• State-Run Aging System:
  • New Hampshire’s single AAA managed by DHHS is similar to:
    • Delaware (State-run AAA under DHSS)
    • Rhode Island (One AAA for the state)
    • Alaska (State-run AAA for all aging services)
• ServiceLink Resource Centers as ADRCs:
  • The use of ServiceLink ADRCs for local service access is similar to:
    • Wisconsin (AAAs and ADRCs function together)
    • Missouri (ADRCs help seniors navigate services)
• Emphasis on Aging in Place:
  • New Hampshire prioritizes home and community-based services (HCBS) over nursing homes, similar to:
    • Minnesota
    • Oregon
    • Vermont
• Medicaid Waivers for Home Care:
  • The Choices for Independence (CFI) Medicaid Waiver supports home care, similar to:
    • Vermont’s Choices for Care
    • Maine’s Medicaid Aging Programs

Differences:

• Only One AAA, Not Multiple Regional Agencies:
  • Most states divide AAAs by region, but New Hampshire has only one for the entire state.
  • This is different from states like California (33 AAAs), Texas (28 AAAs), and New York (59 AAAs).
• More State Control Over Aging Programs:
  • Unlike most states where AAAs operate independently, New Hampshire’s AAA is state-run.
  • States like Florida, Texas, and Indiana have independent AAAs that manage services separately from the state government.
• ServiceLink ADRCs Play a Central Role:
  • Instead of multiple AAAs handling services, ServiceLink ADRCs serve as the main access points for senior programs.
  • Most states do not rely on ADRCs as heavily—they use AAAs as the primary service coordinators instead.
• Limited Local Control Over Programs:
  • In states like Pennsylvania and Georgia, AAAs operate at a local level, adapting programs to community needs.
  • In New Hampshire, the state government makes most program decisions, which reduces local flexibility.
• Smaller Scale Medicaid Aging Programs Compared to Some States:
  • While New Hampshire’s CFI Medicaid Waiver supports home care, it is not as large or comprehensive as programs in:
    • Minnesota (Extensive home care funding)
    • Oregon (National leader in aging-in-place programs)

Conclusion

New Hampshire’s aging services system is highly centralized, with a single AAA operating under the Department of Health and Human Services (DHHS). Instead of multiple AAAs, ServiceLink Aging & Disability Resource Centers (ADRCs) serve as local access points, helping seniors with long-term care planning, Medicaid services, nutrition programs, and transportation assistance.

Compared to most states, New Hampshire’s model offers greater state control and streamlined administration, reducing regional disparities. However, this limits local flexibility and relies heavily on state decision-making. The ServiceLink ADRC system provides an integrated approach, ensuring easy access to aging and disability services in a way that is more centralized than in most other states.

While New Hampshire emphasizes home and community-based services (HCBS) like Vermont and Minnesota, it has fewer resources compared to larger states. Despite this, the state-run system ensures consistent service delivery across the entire state, making it efficient but less locally adaptable compared to states with independent AAAs.

List of Area Agencies on Aging in New Hampshire