New Hampshire Medicaid HCBS Waivers: The CFI Waiver

For older adults, New Hampshire Medicaid pays for care at home and in the community through the Choices for Independence (CFI) waiver.1 CFI is New Hampshire's Medicaid Home and Community-Based Services (HCBS) waiver for seniors 65 and older, along with adults ages 18 to 64 who have a physical or other disability, who are financially eligible for Medicaid and meet a nursing-facility level of care but want to get their care at home or in the community instead.1

New Hampshire Medicaid HCBS waivers can feel complicated at first, but the rules are manageable once you see them one at a time, and that is how this guide walks through them.

In This Guide

• What Are New Hampshire Medicaid HCBS Waivers?
• Choices for Independence: New Hampshire's CFI Waiver Up Close
• Who Qualifies for New Hampshire's CFI Waiver?
• What New Hampshire Medicaid HCBS Waivers Cover
• Enrollment and Slots: What to Know Before You Apply
• How to Apply for the CFI Waiver in New Hampshire

What Are New Hampshire Medicaid HCBS Waivers?

Home and Community-Based Services (HCBS) is the Medicaid umbrella for long-term care delivered outside an institution, in your own home, a family member's home, a residential care setting, or another community setting, rather than in a nursing home. Federal Medicaid law lets states run these programs through a section 1915(c) HCBS waiver, which is the authority New Hampshire uses for its Choices for Independence program.1

The word "waiver" points to how these programs are built. To offer care in the community instead of an institution, a state asks the federal government to waive certain standard Medicaid rules, and in exchange the state agrees to serve people who would otherwise qualify for institutional care. That trade has one consequence worth understanding up front: because a 1915(c) waiver is tied to a nursing-facility level of care, federal law requires the state to run a level-of-care evaluation as part of deciding whether you are eligible, on top of the usual financial review.3

So when people ask whether New Hampshire Medicaid HCBS waivers can pay for a parent to stay at home, the answer runs through one program, and the rest of this guide is about that program in detail.

Choices for Independence: New Hampshire's CFI Waiver Up Close

Choices for Independence is New Hampshire's Medicaid HCBS waiver for seniors and adults with chronic illnesses. The New Hampshire Department of Health and Human Services (DHHS), as the single state Medicaid agency, administers it through its Bureau of Adult and Aging Services (BAAS).1

CFI is for people who are financially eligible for Medicaid and medically qualify for the level of care provided in nursing facilities, and it pays for services at home or in the community, including residential care facility services.1

On the federal side, CFI is a section 1915(c) waiver that also operates with concurrent 1915(b)(1) and 1915(b)(4) authority, and the Centers for Medicare & Medicaid Services (CMS) lists it as waiver 0060.R08.00.1 The current waiver period runs from 2022 to 2027, since CMS requires states to renew these waivers every five years. In 2026, DHHS took public comment on a CFI amendment that updates how the state sets rates and how it determines medical eligibility, and DHHS says the amendment does not change the nursing facility level-of-care criteria, reduce the services available to eligible participants, or add cost-sharing.1 For a family, the practical takeaway is simpler: CFI is the door to Medicaid-paid home and community care in New Hampshire, and DHHS runs it through BAAS.1

Who Qualifies for New Hampshire's CFI Waiver?

Eligibility for CFI comes down to two separate tests, and you have to clear both. One is medical, and one is financial.

The medical test is a nursing-facility level of care. DHHS states the participation test as a set: you must be at least 18, be eligible for Medicaid, and meet nursing facility level of care.3 Because CFI is a federal 1915(c) waiver, the evaluation has to find two things together: that you need the level of care a nursing facility provides, and that without waiver services you would otherwise be in such a facility. It isn't a one-time check either, since federal rules require a reevaluation at least once a year.3 If you are found likely to need that level of care, you have a federal right to be told about the alternatives available under the waiver and to choose between institutional care and home and community-based services.3 In plain terms, the waiver is for people whose needs are serious enough that a nursing home would otherwise be on the table, not for someone who needs only light help around the house.

The financial test uses New Hampshire's Medicaid long-term-care rules. For 2026, the monthly income cap for a single applicant is $2,982, effective January 1, 2026 (up from $2,901 in 2025). That figure is three times the 2026 federal Supplemental Security Income (SSI) benefit rate of $994, and New Hampshire's own rule sets the nursing facility cap at 300% of the maximum SSI benefit.2 Income over the cap isn't an automatic bar. Under New Hampshire's medically needy rules, a CFI applicant whose gross income is above $2,982 can still be income eligible when net income is at or below the state's protected income level (PIL), and a separate medically needy test applies if net income is higher still.2 There is also a resource, or asset, test that applies alongside the income limit.3 New Hampshire's base countable-resource limit is $2,500 for one individual and $4,000 for two, but $2,500 is not the most a CFI applicant may hold: for applicants 18 or older seeking CFI or nursing facility services, everything between the base standard and $7,500 is disregarded.4 Which assets New Hampshire exempts is a separate set of rules, covered in our New Hampshire Medicaid eligibility guide.

Once Medicaid is paying for nursing-facility care, you apply your available income toward the cost of that care but keep a Personal Needs Allowance (PNA) each month. When DHHS computes a nursing-facility resident's cost of care, it subtracts either a $93 personal needs allowance or, for a resident entitled to it, the VA's $90 Nursing Facility Pension, and state law requires the allowance to be adjusted every year for cost-of-living increases.2 That is above the federal floor: federal law requires states to leave an institutionalized individual at least $30 a month, and New Hampshire sets its amount above that minimum.5 The PNA also isn't the only money protected. Federal rules deduct other allowances too, such as a maintenance allowance for a spouse at home and incurred medical costs like health insurance premiums, so not everything above the PNA goes to the facility.5 If you will receive CFI services at home or in a residential setting rather than a nursing facility, ask DHHS how the post-eligibility rules apply to your income; the $93 figure is set for nursing-facility residents, so don't assume it is what you would keep.

What New Hampshire Medicaid HCBS Waivers Cover

The CFI service menu is broad. Per the federal waiver factsheet, the waiver provides:1

• Personal care, home health aide, and homemaker services
• Adult day services and respite for family caregivers
• Home-delivered meals and non-medical transportation
• Skilled nursing and specialized medical equipment services
• Removable prosthodontic services
• A Personal Emergency Response System (PERS), the button-and-monitor service that summons help if you fall or have an emergency at home
• Environmental accessibility services, such as home modifications for safety and access
• Adult family care, residential care facility services, and supportive housing services
• Participant-directed and managed services, plus financial management services that support self-direction
• Supported employment, community transition services, and in-home services

Because the list includes adult family care and residential care facility services, CFI can pay for care outside a private home, not only inside one.1 The services a given person actually receives are set through their care plan.

Directing your own care. Under CFI's Participant Directed and Managed Services (PDMS) option, the participant can direct and manage any CFI waiver service except residential care facility services, and selects their own service providers. A Financial Management Services (FMS) provider hires the workers the participant chooses, processes payroll, and withholds all federal, state, and local taxes.6 The PDMS budget is based on the needs the case manager identifies in the comprehensive care plan, including how often and how long each service is provided. New Hampshire's adopted rule bars CFI from paying a spouse (He-E 801.12(a), which excludes any service provided by a legally responsible relative, and He-E 801.02(ac), which defines that relative as the participant's spouse). It also bars paying the participant's legal guardian, power-of-attorney agent or personal care services representative for personal care (He-E 801.24(c)(3)).7 If you are hoping a relative can be the paid worker, our guide to CFI self-directed care for family caregivers in New Hampshire walks through who can and cannot be hired.

Separately from CFI, New Hampshire Medicaid pays for personal care attendant (PCA) services under rule He-W 552, but only for a narrow group: adults who are their own legal guardian, chronically wheelchair-mobile, and able to direct their own attendant, among other conditions. The attendant cannot be a member of the recipient's family.8

Enrollment and Slots: What to Know Before You Apply

One structural point matters before you apply. CFI is a waiver, not an open-ended entitlement, which means it has a limited number of enrollment slots. Under federal rules, the number of people a state says it will serve is a limit on the program's size unless CMS approves a larger number, and a state with that kind of limit may keep a list of people waiting to enroll.3 That is a normal feature of a 1915(c) waiver, and it is the trade the state made to offer community care in the first place.

What that means for you in practice is worth planning around. Meeting the medical and financial tests makes you eligible, but eligibility and an open slot are two different things, so it is worth asking DHHS about current availability at the same time you apply.3 If you are weighing this against a nursing-home stay, start the CFI conversation early rather than waiting until care is urgent.

How to Apply for the CFI Waiver in New Hampshire

You apply through New Hampshire DHHS. Under federal Medicaid rules, the state has to accept applications through several channels, so you can apply online, by phone, by mail, or in person, whichever fits your situation; check DHHS's own instructions for the channels it runs.9 Most long-term-care applicants apply on a basis other than the standard income test (MAGI), so DHHS may use an application designed for that route rather than the single streamlined form, and the federal ban on required in-person interviews covers only MAGI-based determinations, so it doesn't by its terms protect you.9

Federal rules also put a clock on the decision. Except in unusual circumstances, a determination may not exceed 45 days for most applicants, or 90 days for people who apply on the basis of disability, and a senior applying on the basis of age is on the 45-day standard.10 The unusual circumstances include, for example, an applicant or examining physician delaying a required step, or an administrative emergency beyond the agency's control. If the agency does run late, it must document the reasons in your case record, and it may not use the time standards as a waiting period or as a reason to deny you.10 Knowing the window helps you tell the difference between a normal wait and a delay worth following up on.

Learn More

Find personalized help understanding New Hampshire Medicaid HCBS waivers and the Choices for Independence program 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.