Paid Family Caregiver Programs in New Hampshire

Written & Reviewed by

Analic Mata-Murray

Managing Editor

Yolanda Taylor

Senior Healthcare Editor

Last updated: 6 April 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, usually through the Choices for Independence (CFI) waiver and New Hampshire’s approved self-directed personal assistance option. In the right setup, an adult child can often be paid, and a spouse may also be paid in some cases.

Emergency help now

1. If the older adult is in immediate danger, call 911 now.
2. Call ServiceLink 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 or 603-271-9700.

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 self-direction rules that 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 service model, usually participant-directed and managed services (PDMS) and financial management services (FMS) or New Hampshire’s approved 1915(j) Self-Directed Personal Assistance Services.

Adult children are usually the easiest family members to fit into this system. Spouse pay is possible too, but it is not automatic. New Hampshire’s approved self-directed PAS pages say the state allows legally liable relatives to be paid, and the CFI rule defines a legally responsible relative as the participant’s spouse. In plain English: spouse pay can happen in New Hampshire, but only inside the approved Medicaid self-directed setup, not as a simple open-ended paycheck.

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, and for this guide the main group is seniors age 65 and older.
• The person must meet nursing-facility level of care, based on a medical assessment by the state’s long-term-care process.
• 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 such as personal care, respite, home health aide help, or adult family care.

If you are married, do not assume your spouse must “spend down” everything first. In a February 2024 DHHS Q&A on HCBS eligibility, New Hampshire said HCBS waiver applicants such as CFI are not subject to the nursing-facility spousal resource assessment, and separate resources held only by the non-applicant spouse are not counted for the waiver. These rules are technical, so get case-specific advice before moving money.

Best programs, protections, portals, or options in New Hampshire

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, medical equipment, home modifications, home-delivered meals, and more, as shown in the state CFI booklet.

How to apply. The state’s CFI case management sheet says the first step is the Medicaid application, often called Form 800, through NH EASY, a DHHS district office, or ServiceLink. 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.

Self-Directed Personal Assistance Services and PDMS: the key path if you want a family member paid

What it is. New Hampshire added Self-Directed Personal Assistance Services effective 12 May 2023, and the approved state plan pages say the state chose to serve an unlimited number of participants and to allow legally liable relatives to be paid. The earlier CFI policy release also added PDMS and FMS so CFI participants could have more control over workers. Who can use it. People using Medicaid personal care services or CFI can use self-direction if they can manage it themselves or appoint a representative.

How it helps. This is the New Hampshire route that most often makes family pay possible. Adult children and other relatives can often be hired. A spouse may also be paid because the approved self-directed PAS rules allow legally liable relatives, and New Hampshire’s CFI rule defines the spouse as the legally responsible relative. The same rule says PDMS covers a menu of CFI services, but not residential care facility services.

How much does it pay? New Hampshire does not publish one guaranteed family-caregiver wage. The latest public NH MMIS CFI fee schedule I could verify lists agency-directed and consumer-directed personal care at $8.00 per 15 minutes and respite at $8.00 per 15 minutes. But that is Medicaid billing, not always the worker’s paycheck. The separate manual-priced PDMS codes show why take-home pay varies by budget, service, and any special-rate approval. How to apply. Tell ServiceLink or the case manager right away that you want self-direction and a family worker. Under the PDMS/FMS provider notice, the case manager refers the participant to an FMS provider. What to gather first. Have the family caregiver’s name, contact information, schedule, 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’s CFI rules include adult family care, a more formal family-home care model. The senior lives in a certified residence of an unrelated person or the participant’s relative. Who can use it. This fits families when it is no longer safe for the senior to live alone, but a nursing home still feels like too much. How it helps. It can turn a relative’s home into a regulated care setting 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 residence rules say the provider must be at least 21 and have a high school diploma or GED, and the home has to meet state requirements. What to gather first. Be ready to discuss where the senior would live, who would provide the daily care, and whether the home could meet the state’s adult family care standards. This is not the easiest option, but for some New Hampshire families it is the best real option.

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 the Manchester VA caregiver support page or the national VA caregiver support page. 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. The NH Family Caregiver Support Program is run through ServiceLink and uses limited funds for respite and supplemental help. Who can use it. It can help unpaid family caregivers of a person age 60 or older who needs help with at least two activities of daily living, and it can also help caregivers of a person with dementia regardless of age. How it helps. It usually does not pay wages, but it may give a burned-out caregiver time off, small supports, and better guidance while the family works on Medicaid or other long-term plans.

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

How to apply or use it without wasting time

1. Call ServiceLink 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 state’s CFI booklet says the nurse may come to the home and asks about daily functioning, medications, and safety needs.
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. The CFI booklet says if you are not contacted within 10 business days of the Medicaid interview about the nurse appointment, call ServiceLink.

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

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 is possible, but only in the right approved setup.
• Support programs outside Medicaid usually help with respite, not wages.

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

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. The state’s CFI waiver materials explain the deadline this way: you generally have 30 calendar days to appeal, and if services are being cut or ended, filing within 15 days can keep them going while the appeal is pending.

• For general appeal rights and contacts, the DHHS rights and responsibilities form lists the Administrative Appeals Unit at 603-271-4292 and 1-800-852-3345 ext. 4292.
• 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 the case manager 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.

Plan B / backup options

• Use the Family Caregiver Support Program for respite while Medicaid is pending.
• If the senior is a veteran, use Manchester VA caregiver support at the same time.
• Ask CFI or ServiceLink about adult day, meals, transportation, and home safety supports.
• 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.

Local resources if verified and useful

Special notes for dementia, language access, and family helpers

If English is not your first language, New Hampshire’s CFI booklet says language interpreters are available through ServiceLink. If dementia or poor health makes self-direction hard, the approved self-directed PAS pages let the participant appoint a representative. And when the nurse assesses eligibility, do not focus only on physical weakness. New Hampshire’s own CFI comment responses discuss the need to consider cueing, redirecting, and cognitive safety needs, not just whether the person can technically move.

Frequently asked questions

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 plus self-direction. The parent must usually qualify for Medicaid, meet nursing-facility level of care, and have an approved service plan and budget. The adult child then has to be hired through the approved setup, not just informally helping at home.

Can a spouse get paid in New Hampshire?

Sometimes. This is one of the biggest points families miss. New Hampshire’s approved self-directed PAS option allows legally liable relatives to be paid, and the CFI rule defines the spouse as the legally responsible relative. But spouse pay is not automatic in every care model, so ask specifically whether your case can use the self-directed PAS rules.

Does the senior need Medicaid?

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

How much do family caregivers get paid?

There is no one statewide guaranteed wage for family caregivers in New Hampshire. The latest public fee schedule I could verify shows personal care at $8.00 per 15 minutes in Medicaid billing, but the worker’s actual take-home pay depends on the approved budget, whether the worker is hired through an agency or FMS, taxes, and any special-rate approval. Do not assume the billing rate equals the paycheck.

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

The state uses a medical assessment. The nurse looks at how the older adult functions with 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 it can take up to 45 days after the application materials and supporting documents are submitted. The state’s CFI booklet also says to call ServiceLink if no one contacts you within 10 business days of the Medicaid interview about the nurse assessment.

Is there a waitlist?

New Hampshire’s approved self-directed PAS state plan pages say the state elected to serve an unlimited number of participants in that option. On the senior CFI pages I reviewed, I did not find a public statewide waitlist page. In real life, families more often face delays from paperwork, assessments, and worker shortages than from a clearly posted statewide senior waitlist.

What if DHHS says no or cuts hours?

Read the notice right away. In CFI cases, move fast. The waiver materials explain that you usually have 30 calendar days to appeal, and 15 days can matter if you want services to continue while the appeal is pending. If the notice is confusing, call the Administrative Appeals Unit and ServiceLink the same day.

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 certain Medicaid waiver payments that may be excludable from income. That rule can matter when the caregiver lives in the same home as the person receiving care. Tax treatment can change from family to family, so get personal tax advice.

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 el programa 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 cónyuge también puede recibir pago. La mejor primera llamada es a ServiceLink al 1-866-634-9412. Si necesita ayuda urgente, empiece también la solicitud en NH EASY.

About This Guide

Editorial note: We wrote this guide for New Hampshire seniors, caregivers, and adult children who need practical steps, not generic national advice.

Verification: This guide was checked against official New Hampshire DHHS, ServiceLink, NH MMIS, Medicaid, VA, and IRS materials available through March 2026, with a final review on 6 April 2026.

Corrections: If you spot a broken link or a rule change, please report it to GrantsForSeniors.org through the site contact page so this guide can be updated.

Disclaimer: This article is for general education only. It is not legal, tax, or financial advice. Medicaid rules and program availability can change, and your exact eligibility depends on your own facts.