Can a Family Member Be a PCA Under New Hampshire Medicaid? (2026)

Under New Hampshire Medicaid's personal care attendant (PCA) services, a spouse, parent, step-parent, sister or brother can't be the paid attendant, because the rule bars family members.1 The rule, He-W 552, also limits the benefit to adults who are their own legal guardian, use a wheelchair and can direct their own attendant, so it does not fit a parent who has a guardian or can't make those choices.1

In This Guide

• Can a Family Member Be the Paid PCA Under New Hampshire Medicaid?
• Who Qualifies for New Hampshire Medicaid PCA Services?
• How PCA Hours Are Set
• If a Family Member Can't Be the PCA Under New Hampshire Medicaid: CFI Is the Usual Route
• What a PCA Job Typically Pays
• How to Start
• Frequently Asked Questions
• Learn More

Can a Family Member Be the Paid PCA Under New Hampshire Medicaid?

Mostly no. Under He-W 552, the state's Medicaid rule for personal care attendant services, every attendant must be employed by or under contract with an enrolled New Hampshire Medicaid provider and must not be a member of the recipient's family.1

New Hampshire's He-W 552 defines a family member as someone related to the recipient within the second degree of kinship, "including" two groups: a spouse, parent, step-parent, sister or brother, wherever they live; and a grandparent, aunt or uncle who lives in the same household.1

The adult-child question is genuinely open. He-W 552's general family test is "within the second degree of kinship," but the list that follows does not name a son or daughter, so New Hampshire's PCA rule neither names nor clearly excludes an adult child.1 If you are an adult child hoping to be hired, get the provider's answer in writing before you count on the income.

New Hampshire's bar is wider than the federal one. The rule cites 42 CFR 440.167, which requires personal care to come from someone who is not a member of the person's family, but defines a family member for that section as a legally responsible relative. He-W 552's list reaches parents, siblings and some live-in relatives as well.1

Who Qualifies for New Hampshire Medicaid PCA Services?

A Medicaid recipient qualifies for PCA services only when they meet all eight He-W 552 criteria. The recipient:1

1. Is at least 18 years old.
2. Is their own legal guardian.
3. Is chronically wheelchair-mobile.
4. Is approved by the PCA provider to take part in an independent living program.
5. Can participate fully in activities of daily living, such as eating, bathing, dressing, toileting and transferring.
6. Can self-direct: make informed choices about their PCA services, and select, direct, supervise and manage the attendant under a plan of care.
7. Lives outside an institution but needs at least 2 hours a day of medically oriented PCA services.
8. Has a documented need for the services.

The guardian and self-direction criteria decide most family questions before the attendant rule does: a New Hampshire adult with a court-appointed guardian, or one who can't make informed choices about an attendant, does not qualify for He-W 552 PCA services.1

How PCA Hours Are Set

Hours come from documentation, not a fixed allotment. Under New Hampshire's He-W 552, the recipient's physician documents how many hours of PCA services are needed per day or week.1

Under He-W 552, the recipient also signs a statement that New Hampshire PCA services are meant to assist, not replace or supplant, help already available from family members and other natural supports. The He-W 552 statement must also explain why the legally responsible relative can't provide the care needed, for example physical limitations or a work schedule.1

Under He-W 552, the PCA provider's registered nurse then writes a plan of care that sets the type, frequency and number of hours. New Hampshire's PCA rule sets a minimum of 2 hours a day and states no maximum.1

If a Family Member Can't Be the PCA Under New Hampshire Medicaid: CFI Is the Usual Route

For an older adult who needs help at home, New Hampshire's Medicaid home care program is the Choices for Independence (CFI) waiver. New Hampshire's CFI waiver serves people 65 or older, and adults 18 to 64 with physical or other disabilities, who are financially eligible for Medicaid and meet a nursing facility level of care.2

CFI has its own family rules, set by He-E 801:3

• Spouse: He-E 801, New Hampshire's adopted CFI rule, does not cover a service provided by a legally responsible relative, which it defines as the participant's spouse.
• Adult child: not named in He-E 801, and outside the exclusions it lists.
• Guardian, power-of-attorney agent or personal care services representative: CFI does not cover personal care that person provides, even if they are also an adult child.
• Choosing workers: CFI's participant-directed option lets the participant select service providers.

Our guide to New Hampshire Medicaid HCBS waivers covers CFI eligibility in full.

What a PCA Job Typically Pays

Typical pay: about $18.64 an hour (estimate based on home care aide wages in New Hampshire, U.S. Bureau of Labor Statistics, May 2025).4 That figure reflects what employers pay home health and personal care aides, so pay through a particular PCA provider may differ. Because the attendant works for an enrolled Medicaid provider, ask that provider for its wage before you apply.1

How to Start

1. Confirm Medicaid. New Hampshire PCA services under He-W 552 are for Medicaid recipients. New Hampshire's Department of Health and Human Services decides Medicaid eligibility, and you can apply through NH EASY or call the DHHS Customer Service Center at 1-844-275-3447.5 Our guide on how to apply for New Hampshire Medicaid walks through it.
2. Get the physician's documentation of the services needed and the hours per day or week.1
3. Contact an enrolled PCA provider. Under He-W 552, the New Hampshire PCA provider approves the recipient for its independent living program, and the provider's registered nurse writes the plan of care.1
4. Ask about the attendant in writing: "Can my adult son or daughter be hired as my PCA under He-W 552.02(e)?" if that is your situation.

Learn More

Find personalized help working out whether New Hampshire Medicaid can pay a family caregiver 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.