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Last updated: 27 September 2026
New Hampshire has real ways for some family caregivers to be paid, but there is no single state paycheck for everyone caring for an older relative. The main routes are Medicaid self-direction, the Choices for Independence program, and, for some veterans, VA caregiver benefits. The rule for a spouse is different from the rule for an adult child, so the exact program matters.
Bottom Line
An adult child may be paid through New Hampshire Medicaid when the older adult qualifies for the right service and uses an approved self-directed worker arrangement. For Choices for Independence (CFI), participant-directed and managed services can let a participant choose workers, while a financial management service handles payroll. A spouse is different: current CFI rules exclude CFI services provided by the participant’s spouse. However, New Hampshire’s separate Medicaid 1915(j) self-directed personal assistance option expressly permits paid legally liable relatives. If you are asking about spouse pay, say “1915(j) self-directed personal assistance services” rather than assuming CFI allows it.
For most families, the best first call is New Hampshire’s Aging and Disability Resource Center system, often still called ServiceLink, at 1-866-634-9412. Ask for help comparing CFI, personal care, and self-directed options.
If Care Is Unsafe Today
If the older adult is in immediate danger, call 911. If the caregiver cannot safely continue, call the statewide Aging and Disability Resource Center line and explain that the home-care situation is urgent. For food, housing, utility, or other crisis help while care is being arranged, use the GFS guide to New Hampshire emergency help.
Start Here
- Call the ADRC/ServiceLink line. Use the official ServiceLink information and call 1-866-634-9412. Say you need paid-family-caregiver options.
- Start Medicaid if needed. Apply through NH EASY or ask a DHHS district office for help. The GFS guide to New Hampshire benefits portals can help you prepare for the online process.
- Name the relationship. Tell the worker whether the proposed caregiver is an adult child, spouse, sibling, friend, or another person. That relationship can change which Medicaid route is allowed.
| Your situation | Best first route | What to ask |
|---|---|---|
| Adult child wants to be paid | CFI with participant direction may fit | “Can I use PDMS and hire my adult child?” |
| Spouse wants to be paid | Ask about 1915(j) self-directed PAS | “Does the separate 1915(j) option fit this case?” |
| Senior needs daily hands-on help | CFI screening and Medicaid application | “Does the person meet nursing-facility level of care?” |
| Caregiver needs a break, not wages | Family caregiver support and respite | “Is respite or supplemental help available now?” |
| Older adult is a veteran | VA caregiver support plus Medicaid review | “Should we apply for PCAFC?” |
What Has Changed
The current federal listing shows New Hampshire’s CFI waiver with an approval dated July 1, 2026 and an expiration date of June 30, 2027. The update also separates two rules that are easy to confuse: the current New Hampshire CFI rule excludes CFI services provided by a legally responsible relative, defined as the participant’s spouse, while the separate Medicaid 1915(j) self-directed personal assistance option allows legally liable relatives to be paid when its requirements are met.
This guide also removes the old statewide billing-rate example. A Medicaid billing rate is not the same thing as the family worker’s paycheck, and New Hampshire does not publish one guaranteed wage for every paid family caregiver.
How New Hampshire Pays Family Caregivers
There are two different Medicaid ideas to keep straight. Choices for Independence is New Hampshire’s Medicaid home- and community-based waiver for adults who meet financial rules and a nursing-facility level of care. The current CFI waiver listing confirms that the program includes personal care, homemaker help, respite, financial management services, participant-directed and managed services, adult family care, and other supports.
New Hampshire also has a separate 1915(j) Self-Directed Personal Assistance Services state-plan option. The federal 1915(j) approval has been effective since May 12, 2023. This option matters because its approved state-plan language allows participants to hire legally liable relatives as paid personal-assistance providers.
Both are Medicaid routes, but they are not interchangeable. A family should not be told simply that “Medicaid pays spouses” or “CFI pays spouses.” The exact authority, approved service plan, worker relationship, and payment setup control the answer.
Compare the Main Payment Routes
| Route | Who it may help | Family worker rule | Reality check |
|---|---|---|---|
| CFI with PDMS | Medicaid-eligible adults who meet CFI care-level rules | A chosen worker such as an adult child may be hired if approved; spouse-provided CFI services are excluded by current rule | The care plan, budget, worker rules, and available providers still apply |
| 1915(j) self-directed PAS | People eligible for New Hampshire State Plan personal care who choose self-direction | The approved state plan permits paid legally liable relatives | This is a separate personal-assistance route, not a blanket exception inside CFI |
| VA PCAFC | Qualifying veterans and designated family caregivers | A qualifying Primary Family Caregiver may receive a monthly stipend | VA decides eligibility after its own application and evaluation |
| Family caregiver support | Eligible unpaid caregivers | Usually support and respite, not wages | Funding and services can be limited |
Choices for Independence: The Main Home-Care Route
CFI is often the first program families should ask about when an older adult needs enough help that nursing-home care could otherwise become necessary. The official CFI case sheet says an adult must be financially eligible for Medicaid and clinically eligible at nursing-facility level of care. It also lists participant-directed and managed services as one CFI support.
Under the current CFI administrative rules, participant-directed and managed services, often called PDMS, let the participant help design services, select providers, and oversee the approved services. Financial management services, often called FMS, manage the participant-directed budget, employment paperwork, background checks, payroll, tax withholding, and payments to approved workers.
Adult child: New Hampshire’s CFI rule defines a “legally responsible relative” as the participant’s spouse. That means an adult child is not excluded by that spouse rule. An adult child may still need to meet worker qualifications, pass required checks, complete paperwork, and work only the hours or services authorized in the plan.
Spouse: The same current CFI rule says a CFI service is not covered when it is provided by a legally responsible relative. Because that term is defined as the spouse, families should not rely on CFI itself as the spouse-pay route.
If disability, mobility, or daily-care needs are part of the problem, the GFS guide to disability help in New Hampshire can help you organize related home-care, equipment, transportation, and benefits questions.
Spouse Pay: Ask About 1915(j) Self-Directed PAS
New Hampshire’s 1915(j) Self-Directed Personal Assistance Services option is the clearest official path for asking whether a spouse can be paid for personal assistance. The state’s 1915(j) public notice says the change was intended to allow payment for personal assistance rendered by a legally liable relative when the Department reasonably finds that the caregiver can provide the services. The approved federal state-plan document also checks the option allowing legally liable relatives to serve as paid providers.
This does not mean every spouse will be approved. The person receiving care still has to meet the Medicaid and personal-care rules that apply to this state-plan benefit. The services must be in the approved plan and budget, and the caregiver has to meet the program’s provider requirements. Ask DHHS to confirm the exact enrollment and worker steps before care begins.
A useful phrase is: “I understand CFI excludes spouse-provided services. Please tell me whether the 1915(j) self-directed personal assistance option can apply to us.”
Family Caregiver Support: Help Without a Paycheck
Not every useful caregiver program pays wages. New Hampshire’s caregiver support system can help eligible unpaid family caregivers with information, counseling, education, referrals, and limited respite or supplemental services. The state’s caregiver support page is the official starting point, and the program’s operations guide describes limited respite funds for eligible unpaid caregivers.
This can be valuable while a Medicaid case is pending or when the older adult does not qualify for paid-caregiver Medicaid services. Ask what respite is available now, whether there is a wait, and whether the caregiver needs an assessment. The GFS guide to respite care for seniors can help you compare other break-care options.
Veteran Caregiver Programs
If the older adult is a veteran, check VA caregiver support even if you are also applying for Medicaid. VA Manchester caregiver support connects New Hampshire families with local and national caregiver services. The VA Caregiver Support Line is 855-260-3274.
The PCAFC program can provide a monthly stipend and other supports to an approved Primary Family Caregiver when the veteran and caregiver meet VA requirements. Families can use the official VA Form 10-10CG page to apply online or get the current form. This is a federal VA benefit, not a New Hampshire Medicaid payment.
For a broader benefits check before a VA appointment, see the GFS guide to New Hampshire veteran benefits.
How to Start Without Wasting Time
- Write down the care tasks. List bathing, dressing, toileting, transfers, eating, cueing, dementia supervision, medication reminders, meal preparation, and nighttime safety needs.
- Call ADRC/ServiceLink. Say that the older adult needs long-term care at home and that you want to compare CFI, PDMS, and self-directed personal assistance.
- Apply for Medicaid. Use NH EASY or a DHHS district office. Keep the application confirmation and copies of every document.
- Prepare for the clinical review. Describe what happens on a bad day, not only what the person can do on a good day. Explain falls, wandering, unsafe cooking, missed medicines, and help needed overnight.
- Ask about the worker before services start. Name the exact caregiver and relationship. Ask whether the person can be hired under the proposed service model and what employment forms or checks are required.
- Get the pay rules in writing. Ask what service will be authorized, what budget applies, who is the employer, who issues payment, and what rate limits apply. Do not assume a Medicaid billing amount equals take-home pay.
If home care no longer seems safe even with added services, the GFS guide to assisted living in New Hampshire can help you compare other care settings.
Documents and Information to Gather
| Item | Examples | Why it matters |
|---|---|---|
| Identity and residence | Photo ID, New Hampshire address, Social Security number | Needed for Medicaid and case records |
| Income and resources | Social Security, pension, bank and insurance records | Long-term-care Medicaid has financial rules |
| Care needs | Medication list, diagnoses, falls, ADL help, dementia behaviors | Supports the clinical assessment and care plan |
| Legal papers | Power of attorney, guardianship, authorized representative forms | Shows who may act for the older adult |
| Caregiver details | Legal name, relationship, address, proposed schedule | Helps the program check worker eligibility and payroll setup |
Reality Checks
- No universal caregiver stipend exists. Payment depends on the older adult’s eligibility, the service model, the care plan, and the worker arrangement.
- CFI and 1915(j) are different. CFI may work well for an adult child, while spouse payment should be checked under the separate 1915(j) personal-assistance option.
- Medicaid approval is not the same as worker approval. The caregiver may still need forms, checks, training, payroll enrollment, and an authorized schedule.
- Worker availability can still be a problem. Even after eligibility is approved, local provider capacity and setup can delay care.
- Do not move money just to qualify. Long-term-care Medicaid has detailed financial rules. Ask DHHS or qualified legal help before transferring assets or changing ownership.
Common Mistakes to Avoid
- Calling every type of help a grant or assuming family care automatically creates a paycheck.
- Asking only “Can my spouse get paid?” without naming the specific 1915(j) option.
- Waiting until after the care plan is final to ask for participant direction.
- Using a provider reimbursement rate as if it were the caregiver’s wage.
- Understating dementia, supervision, falls, toileting, transfers, or nighttime care during the assessment.
- Ignoring mail from DHHS. A request for proof or a denial notice can have a deadline.
- Paying a family member informally without checking Medicaid, employment, and tax rules.
Denied, Delayed, or Hours Cut
First find out what was denied: Medicaid financial eligibility, CFI clinical eligibility, a specific service, a number of hours, or the proposed family worker. Ask for the reason and legal basis in writing.
Current CFI rule text gives a participant 30 calendar days to appeal certain CFI denials or service decisions. A shorter timing rule can affect whether existing services continue while a reduction or termination is appealed. Because the notice controls your case, do not wait. Contact the Administrative Appeals Unit as soon as you receive an adverse notice and ask what deadline applies to both the appeal and continued services.
A 2024 DHHS CFI appeal memo also explains that some participants remain eligible for CFI services while a redetermination appeal is pending. Keep the envelope, notice, medical records, care notes, and names of people you spoke with.
If you need help understanding another benefit at the same time, the GFS New Hampshire senior guide can help you organize food, health, housing, tax, and local support questions.
Backup Options if Paid Caregiver Services Do Not Fit
If the older adult is not eligible for the Medicaid route you wanted, ask the ADRC about respite, homemaker help, meals, transportation, adult day services, and other community supports. If the family is struggling with Medicare premiums, the GFS guide to New Hampshire Medicare Savings may free part of the household budget for care needs.
If the older adult’s needs have changed quickly, ask for a new assessment or updated care plan rather than assuming the earlier decision still fits. If the main problem is that no worker is available, ask whether self-direction, a different enrolled provider, respite, or another approved service can safely fill the gap.
Useful New Hampshire Contacts
- ADRC/ServiceLink: 1-866-634-9412 for long-term-care options, CFI, caregiver support, and local referrals. The GFS guide to New Hampshire aging agencies explains how the statewide ADRC system works.
- DHHS Customer Service: 1-844-ASK-DHHS (1-844-275-3447) for benefit and application questions.
- VA Caregiver Support Line: 855-260-3274 for veteran caregiver support and PCAFC questions.
- Administrative Appeals Unit: 603-271-4292 for appeal-process questions after a DHHS notice.
A Short Tax Note for Paid Family Caregivers
Caregiver pay can have tax consequences, and the answer depends on the program and living arrangement. The IRS says certain Medicaid waiver payments for care provided in the caregiver’s home may be excludable from federal gross income under specific rules. Read the IRS page on Medicaid waiver payments and ask a qualified tax professional how the rule applies to your payment. Do not assume every CFI, 1915(j), or VA payment gets the same tax treatment.
Phone Scripts You Can Use
Calling ADRC/ServiceLink about an adult child
“I care for an older adult who needs help with daily activities. We want to check CFI and participant-directed services. Can an adult child be hired as the paid worker in this case, and what must we do first?”
Calling about spouse pay
“I understand CFI has a spouse restriction. Can you check whether New Hampshire’s 1915(j) self-directed personal assistance option applies to us and tell me who handles enrollment?”
Calling about a Medicaid application
“I applied for Medicaid long-term care. Can you tell me what proof is still missing, whether the clinical assessment has been requested, and what the next step is?”
Calling after a denial or cut
“I received a notice reducing or denying CFI services. Please tell me the appeal deadline, whether services can continue while I appeal, and how I request a hearing or reconsideration.”
Resumen en Español
En New Hampshire, algunos familiares pueden recibir pago por cuidar a una persona mayor, pero no existe un sueldo estatal automático para todos. Un hijo adulto puede ser contratado en ciertos casos de Medicaid con servicios dirigidos por el participante. Para empezar, llame a ADRC/ServiceLink al 1-866-634-9412 y pregunte por Choices for Independence (CFI), PDMS y servicios de asistencia personal autodirigidos.
La regla para un cónyuge es diferente. Las reglas actuales de CFI excluyen servicios de CFI prestados por el cónyuge. Sin embargo, la opción separada de Medicaid 1915(j) permite familiares legalmente responsables como proveedores pagados cuando se cumplen sus requisitos. Si usted quiere saber si un esposo o esposa puede recibir pago, pregunte específicamente por “1915(j) Self-Directed Personal Assistance Services”.
Guarde copias de solicitudes, cartas y documentos médicos. Si recibe una negación o una reducción de servicios, actúe rápido, lea la fecha límite en la carta y llame a la oficina de apelaciones para confirmar sus derechos.
Frequently Asked Questions
Can an adult child be paid to care for a parent in New Hampshire?
Yes, an adult child may be paid in an approved Medicaid self-directed arrangement such as CFI participant-directed and managed services. The older adult must meet program rules, and the child must meet worker, payroll, background-check, and care-plan requirements.
Can a spouse be paid through Choices for Independence?
Current New Hampshire CFI rules exclude CFI services provided by the participant’s legally responsible relative, and the rule defines that relative as the spouse. Ask DHHS instead whether the separate 1915(j) self-directed personal assistance option can apply, because that approved state-plan option permits paid legally liable relatives.
Does the older adult need Medicaid?
For CFI and New Hampshire’s 1915(j) self-directed personal assistance route, Medicaid eligibility is part of the process. VA caregiver benefits are separate and use VA eligibility rules instead of Medicaid rules.
How much does a family caregiver get paid?
New Hampshire does not publish one guaranteed paycheck for every family caregiver. Payment depends on the approved service, budget, employment model, authorized hours, and current program rate rules. Ask the case manager or financial management service for the written pay terms before work starts.
Where should I start if I want to be paid?
Call ADRC/ServiceLink at 1-866-634-9412 and explain the older adult’s care needs and your relationship to that person. If Medicaid is not already active, start the application through NH EASY and ask whether CFI, PDMS, or 1915(j) self-directed personal assistance is the right route.
What should I do if CFI is denied or reduced?
Read the notice immediately and ask what part was denied. Current CFI rule text gives 30 calendar days to appeal certain decisions, but a different timing rule can affect continuation of existing services. Contact the Administrative Appeals Unit promptly and follow the deadline written on your notice.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note: This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections: Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
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, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 27 September 2026 · Next review: 27 January 2027
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