How to Get Paid as a Family Caregiver in New Hampshire

To get paid as a family caregiver in New Hampshire, look to NH Medicaid's Choices for Independence (CFI) waiver, a VA caregiver program, or a private contract. CFI's Participant Directed and Managed Services (PDMS) option lets a participant select their own service providers, but the state rule bars CFI from paying for any service provided by the participant's spouse.1 For veteran families, VA's family caregiver program accepts a spouse as a Family Caregiver.2

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to an approved Primary Family Caregiver of an eligible veteran, and VA has stated the stipend is a nontaxable benefit.3 VA Aid and Attendance sets a 2026 ceiling of $34,488 a year for a veteran with one dependent; VA pays the difference between the veteran's countable income and that ceiling, not the full amount to every recipient.4

The Short Version

If the care recipient is a veteran, VA programs are the strongest route. PCAFC pays an approved Primary Family Caregiver, who can be a spouse or other family member, a monthly stipend. Aid and Attendance adds monthly payments to a VA pension the veteran or surviving spouse already qualifies for.3

If the care recipient qualifies for NH Medicaid's CFI waiver, its PDMS option lets them choose who provides their services, with one firm limit: CFI will not pay a spouse.1 Confirm through the ADRC line at 1-866-634-9412 that the family member you have in mind can be hired before any arrangement is made.

If neither VA benefits nor Medicaid applies, a private personal services contract is the fallback. Write it before care begins, at a fair-market rate, and keep records of the care provided.

Ways to Get Paid as a Family Caregiver in New Hampshire

Choices for Independence (CFI) Waiver

The Choices for Independence waiver is New Hampshire's Medicaid home- and community-based program for adults 65 or older and adults 18-64 with physical or other disabilities who meet a nursing facility level of care. It covers personal care, respite, adult day services, home health aide, homemaker, and participant directed and managed services, among other supports.1

Eligibility takes two separate decisions. The Bureau of Family Assistance (BFA) decides financial eligibility, using income and resource rules specific to the Medicaid Long Term Care Program. The Bureau of Adult & Aging Services (BAAS), which runs CFI, administers the clinical assessment.1

Under PDMS, the participant can direct and manage any CFI waiver service except residential care facility services and select their own service providers. A Financial Management Services (FMS) provider hires the workers the participant chooses, runs payroll, and withholds federal, state, and local taxes. CFI does not cover any service provided by the participant's spouse.1

NFCSP Through NH's Area Agencies on Aging

The National Family Caregiver Support Program is federally funded under Title III-E of the Older Americans Act and delivered by area agencies on aging or the entities they contract with. It provides information about services, help gaining access to them, counseling, support groups and caregiver training, respite care, and limited supplemental services. For family caregivers of older adults, respite care and supplemental services are available only when the older person is frail: unable to perform at least two activities of daily living without substantial human assistance, or, because of a cognitive or other mental impairment, needing substantial supervision because they behave in a way that poses a serious health or safety hazard.5

Eligible caregivers include adult family members or other informal caregivers of people 60 or older, caregivers of people of any age with Alzheimer's disease and related disorders, relatives age 55 or older (not parents) caring for children under 18, and relatives age 55 or older, including parents, caring for adults ages 18-59 with disabilities. An older relative caregiver must live with the child or adult with a disability and be their primary caregiver. A relative raising a child must also be the primary caregiver because the parents are unable or unwilling to serve, and must have a legal relationship to the child, such as legal custody, adoption, or guardianship, or be raising the child informally.5

To connect with local caregiver services, call New Hampshire's ADRC line at 1-866-634-9412 or use the Eldercare Locator.1

The Five Pathways

Pathway 1: CFI Participant Directed and Managed Services

For adults who qualify for the CFI waiver, PDMS lets the participant choose who provides their care. A spouse cannot be one of the paid workers under CFI.1 The enrollment sequence:

Pathway 2: VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to a designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran, or someone who lives full time with the veteran (or will if VA designates them).2

VA lists four requirements, and all must be true: the veteran has a VA disability rating (individual or combined) of 70% or higher, was discharged from the U.S. military or has a date of medical discharge, needs at least 6 months of continuous, in-person personal care services, and is enrolled in VA health care.3 Those four are a first screen, not a decision. The regulation, 38 CFR 71.20(a), adds conditions VA assesses during the joint application: participation must be in the veteran's best interest, the same personal care must not be simultaneously and regularly provided by another person or entity, the veteran must receive care at home, and the veteran must receive ongoing care from a primary care team.3

The monthly stipend starts from the OPM General Schedule grade 4, step 1 annual salary for the veteran's geographic locality, divided by 12. That monthly base is then multiplied by a factor, and 38 CFR 71.40(c)(4)(i) sets four of them across two schedules:2

• Current program (the veteran meets 38 CFR 71.20(a)): the factor is 0.625, or 1.00 if VA determines the veteran is unable to self-sustain in the community.2
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the factor comes from the sum of the veteran's 2019 clinical ratings instead, at 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12. No unable-to-self-sustain determination is required on this route, so a legacy household whose ratings sum to 21 or higher reaches the full 1.00 factor on the ratings alone.2
• Both: a veteran who meets the current-program and the legacy criteria receives whichever of the two amounts is higher.2

A legacy participant's stipend also cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, for as long as the veteran remains at the address on record with VA. The legacy schedule runs for eight years beginning October 1, 2020 and lapses October 1, 2028.2

VA has stated the stipend is a nontaxable benefit, and the caregiver must be enrolled in direct deposit through the VA customer engagement portal to receive it.3 Primary caregivers may also get CHAMPVA health care benefits if they don't already qualify under another health care plan, plus mental health counseling and at least 30 days of respite care per year.2 Contact the Manchester VA Medical Center's Caregiver Support Coordinator for current NH locality figures, for which factor applies to your household, and for enrollment guidance. If the veteran has been in PCAFC since before October 1, 2020, say so, because the legacy schedule may pay more.

Pathway 3: VA Veteran-Directed Care (VDC)

VA Veteran-Directed Care is a VA program run with the Administration for Community Living. Veterans in the program are given a budget for services that is managed by the veteran or the veteran's representative, and with the help of a counselor they hire their own workers, which VA says might include their own family member or neighbor. An Aging and Disability Network Agency arranges fiscal management services and provides ongoing counseling and support.6

VA's description names a family member or neighbor; if you are the veteran's spouse, ask VA directly whether you can be the paid worker before counting on it. All enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and it is available; services may vary by location. Talk with your VA social worker to find out whether VDC is available to you in New Hampshire.6

Pathway 4: VA Aid and Attendance

VA Aid and Attendance adds monthly payments to a VA pension for qualified veterans and survivors who need another person's help with daily activities such as bathing, feeding, and dressing. The veteran or survivor must already qualify for a VA pension.3

2026 Aid and Attendance Maximum Annual Pension Rates (effective December 1, 2025 through November 30, 2026). Pension is paid monthly: VA subtracts countable income from the annual rate, divides by 12, and rounds down to the whole dollar.4

• Veteran with no dependents: up to $29,093 a year4
• Veteran with one dependent: up to $34,488 a year
• Surviving spouse (no dependents): up to $18,697 a year

The net worth limit is $163,699. VA pension is subject to a 36-month look-back on asset transfers under 38 CFR 3.276 for transfers made on or after October 18, 2018.4

The veteran receives the pension. Families can direct those funds toward a family caregiver through a personal arrangement or a personal services contract.

Pathway 5: Private Personal Services Contract

For families outside both VA and NH Medicaid systems, a personal services contract documents and compensates caregiving work. Requirements:

• Written and signed before care begins
• Specific about services, schedule, and rate
• Priced at or below what local home care agencies charge for the same services
• Supported by ongoing service logs

If the care recipient might later apply for NH Medicaid long-term care, ask a New Hampshire elder-law attorney how the state will treat payments to a family caregiver before any money changes hands. A written contract at a fair-market rate, signed before care begins, creates a paper trail.

Spouses are generally not recommended as parties to a personal services contract for Medicaid planning purposes, because inter-spousal transfers receive different treatment under Medicaid rules.

Choosing How to Get Paid as a Family Caregiver in New Hampshire

Veteran household: If the veteran has a 70% or higher rating, needs at least six months of continuous personal care, and meets VA's other conditions, start with PCAFC. The stipend is nontaxable, spouses qualify, and the primary caregiver may get CHAMPVA health care benefits if not already covered by another plan. Layer Aid and Attendance pension on top if the veteran qualifies for both. Ask the Manchester VAMC Caregiver Support Coordinator about Veteran-Directed Care as a flexible supplement.3

Non-veteran Medicaid household: Call the ADRC line at 1-866-634-9412 to start a CFI application and confirm that the family member you have in mind, other than a spouse, can be hired under PDMS.1

Private-pay household: A personal services contract is the right structure for families outside both systems. Involve a NH elder-law attorney if the care recipient might later apply for NH Medicaid.

IRS Notice 2014-7 and Taxes

If NH Medicaid personal care programs authorize payments to a live-in family caregiver, those payments may qualify for the IRS Notice 2014-7 difficulty-of-care income exclusion. When the caregiver and care recipient share a household and the payments come from a qualifying Medicaid program, the income may be excludable from federal gross income. Families should verify with a tax professional whether the specific NH program and living arrangement qualify.

VA has stated the monthly PCAFC stipend is a nontaxable benefit.3

Personal services contract income is ordinary taxable income.

Common Misconceptions

"NH Medicaid will pay a spouse to be the caregiver." It will not under CFI. He-E 801.12(a) bars coverage of any service provided by a legally responsible relative, and He-E 801.02(ac) defines that as the participant's spouse.1

"Medicare pays for ongoing personal care." Medicare does not cover long-term personal care or custodial care. It covers short-stay post-hospital skilled nursing and home health for homebound patients with a skilled need. NH Medicaid and VA programs are the routes for ongoing ADL support.

"A verbal arrangement is enough." If Medicaid long-term care may come later, a written contract signed before care begins and priced at a fair-market rate documents that payments were for care. Have a New Hampshire elder-law attorney review it.

Learn More

Find personalized help choosing the right New Hampshire paid-caregiver pathway 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.