Paid Family Caregiver Programs in New Hampshire

Last updated: May 6, 2026

Bottom line: New Hampshire does not have a simple state cash program that pays every family member who helps an older adult. For most seniors, the real paid-family-caregiver path is Medicaid long-term care, usually through Choices for Independence (CFI), participant direction, and related self-directed personal assistance rules. In the right setup, an adult child may be paid. A spouse may also be possible in some cases, but it is not automatic and must fit the approved service plan, budget, and worker rules.

If you need help beyond caregiver pay, the New Hampshire senior benefits guide can help you compare food, health, housing, tax, and local aging resources in one place.

Where to start

Emergency help now

1. If the older adult is in immediate danger, call 911 now.
2. Call ServiceLink/ADRC at 1-866-634-9412 and say you need urgent long-term-care or home-care help.
3. Start the Medicaid application today through NH EASY, or call DHHS at 1-844-ASK-DHHS (1-844-275-3447) or 603-271-9700.

Contents

What this help actually looks like in New Hampshire

Many families search for a “New Hampshire program that pays me to care for my mother.” That search can be misleading. New Hampshire’s main senior-caregiver pay route is not a broad state stipend. It is Medicaid long-term care, mainly through Choices for Independence, plus service models that may let the older adult choose and manage workers.

That means two things usually have to happen. First, the older adult must qualify for Medicaid and meet a nursing-facility level of care. Second, the family has to use the right worker model. For CFI, that may mean participant-directed and managed services (PDMS) with financial management services (FMS). For some personal care, it may also mean New Hampshire’s approved Self-Directed PAS approval.

Adult children are usually the easiest family members to fit into this system. Spouse pay is more sensitive. The approved self-directed personal assistance pages allow legally liable relatives to be paid, and New Hampshire’s CFI rule defines a legally responsible relative as the participant’s spouse. In plain English: spouse pay may be possible in the right Medicaid self-directed setup, but you should ask the case manager and FMS provider before assuming it will be approved.

Quick facts

Who qualifies

• The older adult usually must be a New Hampshire Medicaid applicant or recipient.
• For CFI, adults must be at least 18. This guide focuses on seniors age 65 and older and their family caregivers.
• The person must meet nursing-facility level of care. Under New Hampshire rules, that can include a need for 24-hour care for certain nursing, rehab, medication, or help with two or more activities of daily living.
• If the family wants self-direction, the senior must be able to direct services or appoint a representative to do that.
• The care needs must fit covered tasks. These may include personal care, respite, home health aide help, homemaker help, adult family care, or other services in the approved plan.

If you are married, do not assume your spouse must “spend down” everything first. New Hampshire Medicaid long-term-care rules can be technical, and waiver cases may be treated differently from nursing-home cases. Get case-specific advice before moving money or changing accounts.

Main New Hampshire options

Choices for Independence (CFI): New Hampshire’s main Medicaid route

What it is. CFI is New Hampshire’s main home-and-community-based Medicaid program for older adults and adults with disabilities who would otherwise need nursing-facility care. Who can use it. The person must be Medicaid-eligible and meet nursing-facility level of care. How it helps. CFI can cover in-home personal care, respite, home health aide help, homemaker services, medical equipment, home modifications, home-delivered meals, adult day services, and more when those services are approved in the care plan.

How to apply. The state’s CFI case sheet says the first step is the Medicaid application, often called Form 800, through NH EASY, a DHHS district office, or ServiceLink/ADRC. The same sheet says processing can take up to 45 days once the application and supporting documents are submitted. What to gather first. Have ID, proof of income, bank and asset records, insurance cards, trust papers if any, and a full medication list ready.

Participant direction and self-directed PAS: the key path if you want a family member paid

What it is. New Hampshire has two related paths that matter for family pay. CFI has participant-directed and managed services, often called PDMS. New Hampshire also has a Medicaid 1915(j) Self-Directed Personal Assistance Services option that took effect on May 12, 2023. The state’s PDMS/FMS FAQ explains that an FMS provider helps with worker and budget tasks.

How it helps. This is the New Hampshire route that most often makes family pay possible. A family worker may need to meet worker requirements, register or clear checks, follow the care plan, and be paid through an agency or FMS provider. The CFI rule says PDMS lets participants direct a menu of CFI services, except residential care facility services. It also says the participant can serve as co-employer with an FMS provider.

How much does it pay? New Hampshire does not publish one guaranteed family-caregiver wage. The public NH MMIS schedule checked for this guide lists some CFI personal care and respite billing at $8.00 per 15 minutes. That is Medicaid billing, not a promise of the worker’s take-home pay. Pay can vary by the approved budget, service code, employer setup, taxes, and any special-rate approval.

How to apply. Tell ServiceLink/ADRC or the case manager right away that you want self-direction and a family worker. Ask which model applies to the case: CFI PDMS, self-directed personal assistance, agency-directed care, or another route. What to gather first. Have the family caregiver’s name, contact information, schedule, worker history, and any power of attorney or representative papers ready.

Adult Family Care under CFI: when the senior will live in the caregiver’s home

What it is. New Hampshire CFI includes adult family care, a more formal family-home care model. The senior lives in a certified residence of an unrelated person or a relative, and an oversight agency is involved. Who can use it. This may fit when it is no longer safe for the senior to live alone, but a nursing home is not the only choice. How it helps. It can turn a home setting into a regulated care option instead of trying to patch together scattered hourly visits.

How to apply. Ask the CFI case manager whether adult family care fits the care plan. The adult family care rules say an adult family care residence may serve one or two residents and must meet state requirements. What to gather first. Be ready to discuss where the senior would live, who would provide daily care, and whether the home can meet state standards.

Manchester VA caregiver programs: important if the older adult is a veteran

What it is. VA Manchester caregiver support helps veteran families find local and federal caregiver options. Who can use it. Families caring for a veteran enrolled in VA health care should ask about it, even if Medicaid is also in the picture. How it helps. VA programs may provide training, counseling, respite, care coordination, and in some cases a stipend or added coverage depending on the veteran’s situation and the program used.

How to apply. Start with Manchester VA or the national VA caregiver support information. The VA Caregiver Support Line listed by Manchester VA is 855-260-3274. What to gather first. Have the veteran’s VA enrollment details, service history, diagnosis list, and current care needs ready.

New Hampshire Family Caregiver Support Program: real help, but usually not wages

What it is. New Hampshire’s caregiver support services are coordinated through ServiceLink/ADRC and the Bureau of Adult and Aging Services. Who can use it. It may help family members and others who provide day-to-day care without pay, including caregivers of older adults, people with disabilities, grandparents raising grandchildren, and people caring for someone with Alzheimer’s disease or dementia. How it helps. It usually does not pay wages, but it may offer information, counseling, training, support groups, respite, and limited short-term help.

How to apply. Call ServiceLink/ADRC. What to gather first. Be ready to explain the older adult’s daily needs, the caregiver’s unpaid role, and whether dementia, supervision, or safety problems are part of the situation.

How to apply or use it without wasting time

1. Call ServiceLink/ADRC first. Ask for CFI screening, Medicaid long-term-care help, and self-direction information.
2. File the Medicaid application right away. Use NH EASY or go to a DHHS district office.
3. Prepare for the nurse assessment. The nurse may ask about daily functioning, medications, falls, transfers, bathing, toileting, meals, and safety.
4. Say early that you want a family caregiver paid. Ask whether the case can use self-directed PAS, PDMS, and FMS.
5. Bring the hard parts into the open. Do not just say “she needs help.” Say how often she needs bathing help, toileting help, transfers, cueing, nighttime supervision, wandering prevention, or medication reminders.
6. Follow up fast. If no one contacts you after the Medicaid interview about the nurse assessment, call ServiceLink/ADRC and ask what is missing.

Checklist of documents or proof

• Photo ID and proof of New Hampshire address
• Social Security, Medicare, and Medicaid numbers if available
• Social Security award letters, pension statements, and wage proof
• Bank statements and other asset records
• Trust papers, burial plans, or life-insurance paperwork if requested
• Medication list and recent doctor, hospital, or therapy records
• Power of attorney, guardianship, or representative papers
• A short written list of falls, wandering, unsafe events, and daily care tasks
• The family caregiver’s legal name, address, phone number, and possible work schedule

Reality checks

• No simple state stipend exists for every family caregiver in New Hampshire.
• For seniors, Medicaid is usually required for paid family caregiving.
• Approval depends on both money rules and care-needs rules.
• Spouse pay may be possible, but only in the right approved setup.
• Support programs outside Medicaid usually help with respite, not wages.
• Worker shortages can slow services even after approval.
• Medicaid billing rates do not always equal a worker’s paycheck.

Common mistakes to avoid

• Waiting to ask about self-direction until after services start
• Assuming the Medicaid billing rate is the worker’s paycheck
• Sending in the application without proof documents
• Minimizing dementia, supervision, or nighttime safety needs
• Missing appeal deadlines printed on the DHHS notice
• Changing bank accounts or moving assets without advice
• Paying a family caregiver privately without a written agreement

Best options by need

What to do if denied, delayed, blocked, or waitlisted

First, find out what part was denied: financial eligibility, clinical eligibility, or the family-worker setup. Do not accept a vague answer. Ask for the written notice and read the date on it. New Hampshire CFI waiver materials explain that you generally have 30 calendar days to appeal, and if services are being cut or ended, filing within 15 days can matter if you want services to continue while the appeal is pending.

• For general appeal rights and contacts, the DHHS rights and responsibilities form lists appeal information. You can also call the Administrative Appeals Unit.
• If the case is stalled, use the Long Term Care contact list. It lists the LTC Medical Eligibility Unit at 603-271-9088 and the secure email longtermcare@dhhs.nh.gov for verifications and questions.
• If the problem is not enough workers, ask whether self-direction, a different provider, or a special-rate request makes sense.
• If the denial is about care level, submit stronger doctor notes, hospital records, therapy records, and a caregiver log that shows exactly what happens each day.
• If you are age 60 or older and need legal help with an appeal, NH Legal Assistance lists the Justice in Aging Project at 1-888-353-9944.

Plan B / backup options

• Use the Family Caregiver Support Program for respite while Medicaid is pending.
• If the senior is a veteran, use VA caregiver support at the same time.
• Ask CFI or ServiceLink/ADRC about adult day, meals, transportation, and home safety supports.
• If bills are building up, check utility bill help, food programs for seniors, and housing and rent help while the care plan is being worked out.
• For broader local help, charities helping seniors may be worth checking, but they usually cannot replace Medicaid-paid long-term care.
• If family will be paid privately, use a written caregiver agreement before money changes hands. This helps with taxes and future Medicaid reviews.
• If the family may need Medicaid planning, speak with a qualified elder-law attorney before transferring assets.

You can also use our senior help tools to compare next steps for bills, care needs, housing, and local support.

Local resources if verified and useful

Special notes for dementia, language access, and family helpers

If English is not your first language, ask ServiceLink/ADRC or DHHS for language help. If dementia or poor health makes self-direction hard, the self-directed rules may let the participant appoint a representative. During the nurse assessment, do not focus only on physical weakness. Explain cueing, redirecting, wandering risk, unsafe cooking, medication mistakes, and nighttime confusion.

If the older adult owns a home, also check property tax relief in New Hampshire. If Medicare premiums are hard to pay, our guide to Medicare Savings Programs explains another path that may lower health costs.

Phone scripts you can use

Calling ServiceLink/ADRC about CFI

“Hello, I care for an older adult in New Hampshire who needs help with bathing, toileting, meals, medication reminders, and safety. I want to ask about CFI, Medicaid long-term care, and whether a family caregiver can be paid through self-direction. What should we do first?”

Calling DHHS about the Medicaid application

“Hello, I am helping my parent apply for long-term-care Medicaid and Choices for Independence. Can you tell me what documents are missing, whether the interview is complete, and what the next step is for the medical assessment?”

Calling the case manager about a family worker

“We want to know if a family member can be hired for approved care tasks. Please review whether this case can use PDMS, FMS, self-directed personal assistance, or another approved model. We do not want to start the wrong worker setup.”

Calling after a denial or cut

“I received a notice that care was denied, cut, or delayed. I need to know the exact reason, the appeal deadline, and whether services can continue during the appeal if I file quickly. Can you also tell me where to send more medical records?”

Resumen en español

New Hampshire no tiene un programa simple que le pague a cualquier familiar por cuidar a un adulto mayor. Para la mayoría de los seniors, la ruta real es Medicaid, especialmente Choices for Independence (CFI) y las reglas de cuidado autodirigido.

Un hijo adulto muchas veces puede recibir pago si el adulto mayor califica para Medicaid, cumple con el nivel de cuidado de un nursing home y usa el modelo correcto de autodirección. En algunos casos, un esposo o esposa también puede recibir pago, pero no es automático. Hay que preguntar al case manager si el plan, el presupuesto y las reglas permiten pagar a ese familiar.

La mejor primera llamada es a ServiceLink/ADRC al 1-866-634-9412. Diga: “Quiero aplicar para CFI y preguntar si un familiar puede recibir pago por el cuidado.” Si necesita empezar la solicitud de Medicaid, use NH EASY o llame a DHHS al 1-844-275-3447.

FAQ

Can an adult child get paid to care for a parent in New Hampshire?

Yes, often. For seniors, the main route is Medicaid through CFI, participant direction, or self-directed personal assistance. The parent must usually qualify for Medicaid, meet nursing-facility level of care, and have an approved service plan and budget. The adult child must be hired through the approved setup.

Can a spouse get paid in New Hampshire?

Sometimes. New Hampshire’s approved self-directed personal assistance option allows legally liable relatives to be paid, and the CFI rule defines a legally responsible relative as the participant’s spouse. But spouse pay is not automatic in every model. Ask the case manager and FMS provider to review the rule for your case.

Does the senior need Medicaid?

For the main paid-family-caregiver path, yes. If the senior is not on Medicaid, call ServiceLink/ADRC because it can help with the application and point to respite, caregiver support, and local programs. Veterans should also check VA options.

How much do family caregivers get paid?

There is no one statewide guaranteed wage for family caregivers in New Hampshire. A public CFI fee schedule checked for this guide lists some personal care and respite billing at $8.00 per 15 minutes, but the worker’s actual take-home pay depends on the approved budget, employer setup, taxes, and any special-rate approval.

How do I know if the senior meets nursing-facility level of care?

The state uses a medical assessment. The nurse looks at eating, bathing, dressing, toileting, transfers, medications, and safety. For dementia cases, explain cueing, wandering, unsafe cooking, falls, and nighttime confusion. Those details matter.

How long does approval take?

The New Hampshire CFI case management sheet says processing can take up to 45 days after the application and supporting documents are submitted. Delays can happen if documents are missing, the interview is not complete, or the medical assessment has not been scheduled.

Is there a waitlist?

The approved self-directed personal assistance pages say New Hampshire chose to serve an unlimited number of participants in that option. For CFI, families should still ask ServiceLink/ADRC and the case manager about current local delays, provider shortages, and any waiting issues.

What if DHHS says no or cuts hours?

Read the written notice right away. In CFI cases, you usually have 30 calendar days to appeal, and 15 days can matter if you want services to continue while the appeal is pending. Call the Administrative Appeals Unit and ServiceLink/ADRC the same day if the notice is confusing.

What tax rules may apply if a family caregiver is paid?

Ask the agency or FMS provider whether the worker will be treated as an employee and what tax form will be issued. Also read the IRS page on IRS waiver payments. Tax treatment can vary, so get personal tax advice.