New Hampshire's Choices for Independence (CFI) waiver rule bars paying a spouse, but the person receiving care can choose other workers through Participant Directed and Managed Services (PDMS). Whether another family member, such as an adult child, can be paid through CFI in New Hampshire is not addressed by name in the CFI rule (He-E 801) or the personal care statute (RSA 161-I), and neither lists adult children among the people it excludes. CFI does not cover personal care from the participant's legal guardian, power-of-attorney agent or personal care services representative.

In This Guide

How PDMS Hiring and Payroll Work

The Choices for Independence waiver is New Hampshire's Medicaid home- and community-based program for people 65 and older and for adults 18 to 64 with physical or other disabilities who meet a nursing facility level of care. It covers personal care, respite, adult day services, homemaker services, adult family care and participant directed and managed services, among others. To join New Hampshire's CFI waiver, a person must meet Medicaid's financial and categorical requirements and the clinical requirements for nursing facility care.

Under the adopted rule, PDMS lets a CFI participant direct and manage any CFI waiver service except residential care facility services. The participant designs the services, selects service providers, and decides how authorized funding is spent based on the comprehensive care plan.

The payroll side sits with a financial management services (FMS) provider. In New Hampshire CFI, the FMS provider hires the workers the participant chose, processes payroll and pays employees, and withholds all federal, state and local taxes. The participant serves as co-employer alongside the FMS provider. PDMS also lets the participant, or the participant's legal representative, define the training, experience or education a provider needs, unless state or federal licensing or certification rules require otherwise.

Which Family Members Can Be Paid Through CFI in New Hampshire?

The answer turns on two texts: the CFI rule, He-E 801, and the personal care services statute, RSA 161-I, which applies to people eligible for the waiver for the elderly and chronically ill.

Relationship to the CFI participant What He-E 801 and RSA 161-I say
Spouse No. He-E 801.12(a) excludes a service provided by a legally responsible relative, defined in He-E 801.02(ac) as the spouse
Adult child Not named. Neither text lists adult children among the people it excludes
Legal guardian No for personal care (He-E 801.24(c)(3))
Power-of-attorney agent No for personal care (He-E 801.24(c)(3))
Personal care services representative No for personal care (He-E 801.24(c)(3))
Relative who lives with the participant Not stated. Neither text excludes a relative for living with the participant

Spouses

He-E 801.12(a) says no service shall be covered through the CFI waiver if it is provided by a legally responsible relative, and He-E 801.02(ac) defines that relative as the participant's spouse. RSA 161-I likewise excludes a spouse from being a personal care services provider, except as authorized under RSA 161-I:3-a. That exception is narrow. RSA 161-I:3-a lets New Hampshire's Department of Health and Human Services authorize reimbursement to a legally responsible relative, guardian or power-of-attorney holder who cares for an eligible consumer "with special health care needs residing at home," the wording the statute uses for its child category, and the statute does not say the exception reaches a CFI participant. It also bars any such authorization until a plan and rules are reviewed and approved by the legislature's oversight committee on health and human services.

That is what the adopted rule says. If an ADRC counselor or case manager tells you a spouse can be a PDMS worker, ask for that answer in writing before care starts. Our guide to getting paid to care for your spouse in New Hampshire covers the VA routes that can pay a spouse.

Guardians, Powers of Attorney and Representatives

He-E 801.24(c)(3) says CFI personal care services are not covered when provided by the participant's personal care services representative, the participant's agent acting under a power of attorney, or the participant's legal guardian. This matters most for adult children. If you hold your parent's power of attorney or guardianship, or you are their designated representative, New Hampshire's CFI rule (He-E 801.24(c)(3)) does not cover personal care you provide.

Adult Children and Other Relatives

Neither He-E 801 nor RSA 161-I names adult children, and the exclusions they list (a spouse, a parent of a minor child, a guardian, a power-of-attorney agent and a personal care services representative) do not reach an adult child as such. Because the rule doesn't say yes in so many words either, ask the ADRC or the case manager directly: "Can I be hired as my parent's PDMS worker if I am not their guardian, POA agent or representative?"

New Hampshire's separate Medicaid personal care attendant (PCA) service works differently. Its rule, He-W 552, says the attendant must not be a member of the recipient's family, a term that includes a spouse, parent, step-parent, sister or brother. Our guide to New Hampshire Medicaid PCA services covers who that program serves.

If You Live With the Person You Care For

New Hampshire's CFI rule and RSA 161-I don't exclude a relative because the relative lives with the participant. He-E 801.12(a) does exclude any service that addresses needs already being met by another paid or unpaid service, so care a household member already gives for free can shape what the care plan pays for.

CFI also has a separate service for shared homes. In New Hampshire's CFI waiver, adult family care is personal care, homemaking and other services for a participant who lives in a certified residence of an unrelated person or of the participant's relative, organized and managed by an adult family care oversight agency. Ask the oversight agency how a relative's household is certified and paid.

How Many Hours Can a Family Member Be Paid Through CFI in New Hampshire?

Hours come from the care plan, not from who you are. The New Hampshire PDMS budget is based on the needs the case manager identifies in the comprehensive care plan, and it sets the frequency and duration of the required services. Neither He-E 801 nor RSA 161-I states an hours cap for personal care or PDMS. He-E 801 does limit CFI respite care to 30 24-hour days of care per state fiscal year.

What the Work Pays and How It's Taxed

Typical pay: about $18.64 an hour (estimate based on home care aide wages in New Hampshire, BLS, May 2025). It is the New Hampshire median wage for home health and personal care aides, not a CFI or PDMS rate, so your actual pay may differ.

New Hampshire describes CFI as a Section 1915(c) waiver. Under IRS Notice 2014-7, the IRS treats qualifying 1915(c) waiver payments to a care provider as difficulty-of-care payments excludable from gross income, but only for care in the provider's own home where the care recipient also lives. The IRS Notice 2014-7 exclusion does not apply when the provider has a separate home. See whether Medicaid waiver payments are taxable and who sends a paid family caregiver's W-2 or 1099, and check your situation with a tax professional.

How to Start and What to Ask

1
Step 1

Apply for CFI

New Hampshire's Department of Health and Human Services directs applicants to the nearest regional Aging & Disability Resource Center, at 1-866-634-9412, or to NH EASY online. Our New Hampshire Medicaid application guide walks through the forms.

2
Step 2

Ask for PDMS

Tell the case manager the participant wants to direct services and choose their own worker.

3
Step 3

Name your relationship

Say whether you are an adult child, spouse, guardian, POA agent, representative or other relative, and whether you live with the participant, and ask which rule applies to you.

4
Step 4

Get the FMS details before care starts

who the FMS provider is, how payroll and tax withholding work, and how many hours the care plan supports.

Frequently Asked Questions

Can a sibling or in-law be paid through CFI in New Hampshire?

Siblings and in-laws are not on the exclusion lists in New Hampshire's CFI rule (He-E 801) or personal care statute (RSA 161-I). The relatives those two texts exclude are a spouse and, under RSA 161-I, a parent of a minor child. A guardian, power-of-attorney agent or personal care services representative is excluded from CFI personal care whatever the family tie. Ask the case manager to confirm how the rule applies to your relationship.

Who decides whether a parent qualifies for CFI in New Hampshire?

Two New Hampshire DHHS bureaus decide it. The Bureau of Family Assistance determines financial eligibility, using income and resource criteria specific to the Medicaid Long Term Care Program. Medical eligibility is determined through an application and assessment process administered by the Bureau of Adult & Aging Services, the bureau that runs CFI. For 2026, the income cap New Hampshire DHHS uses for categorically needy CFI eligibility is $2,982 a month for a single applicant. Income above that cap is not an automatic bar, because New Hampshire has a medically needy route for CFI.

Who oversees a family member hired through PDMS in New Hampshire?

Under PDMS, the participant has a direct oversight role. New Hampshire's CFI rule lets a PDMS participant perform ongoing oversight of the services provided, alongside designing the services and selecting providers. The participant is co-employer with the FMS provider.

Does the National Family Caregiver Support Program pay family caregivers in New Hampshire?

The federal National Family Caregiver Support Program, authorized by Title III-E of the Older Americans Act, funds five types of services for family caregivers: information about available services; help gaining access to those services; counseling, support groups and caregiver training; respite care; and supplemental services on a limited basis. To be hired and paid as a CFI participant's worker, the route is PDMS, described above. See respite care in New Hampshire for respite options.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in New HampshireGet paid to care for a loved one in New Hampshire through the Medicaid CFI waiver's self-directed option, VA PCAFC, or a personal services contract. CaregiverGet Paid to Care for Your Spouse in New HampshireThe VA can pay a spouse caring for a qualifying veteran in New Hampshire, but NH's Medicaid CFI waiver rule bars paying a spouse. Here is what to do instead. CaregiverNew Hampshire Caregiver ProgramsNew Hampshire caregiver programs compared: which ones pay a family member, who the rules bar (spouse, guardian, POA), Alzheimer's respite and 2026 VA benefits. CaregiverNew Hampshire Medicaid Personal Care Attendant (PCA) ServicesNH Medicaid PCA rules (He-W 552) bar a spouse, parent, step-parent or sibling as the paid attendant, and only self-directing wheelchair users qualify. MedicaidNew Hampshire Medicaid HCBS Waivers: The CFI WaiverNew Hampshire Medicaid HCBS waivers pay for home care through the Choices for Independence (CFI) waiver. See who qualifies, what CFI covers, and how to apply. CaregiverAre Medicaid Waiver Payments Taxable?Are Medicaid waiver payments taxable? Usually not, if you live with the person you care for. What IRS Notice 2014-7 excludes, what it misses, how to report it.

Find personalized help working out whether you can be hired as a CFI worker in New Hampshire at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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