New Hampshire State Guide for Medicaid Waivers/HCBS Care Coverage Made Simple
Learn how New Hampshire’s Medicaid waivers support in-home dementia care and HCBS services, offering peace of mind and better daily living at home.
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Tendly Home Key Takeaways
Here’s a quick overview of how New Hampshire’s Medicaid waivers provide support for at-home dementia care and HCBS services:
- 🏡 New Hampshire’s Medicaid waivers allow eligible residents to receive care at home, helping individuals with dementia stay in familiar environments while reducing the need for institutionalization.
- 🧠 Dementia care services are covered under specific Home and Community-Based Services (HCBS) waivers, supporting memory care, behavioral support, and daily living assistance at home.
- 📝 Applicants must meet medical and financial eligibility requirements, including a functional need for nursing facility-level care and income/assets below state-set thresholds.
- 🧑⚕️ Services available through waivers include personal care aides, respite services, adult day health, and care coordination, customized to promote independence and quality of life.
- 📞 Guidance and application support are available through state caseworkers and Area Agencies, ensuring families navigate the process smoothly to access vital in-home support.
Navigating complex care options for a loved one can feel overwhelmingespecially when you're balancing emotional stress with financial uncertainty. Whether you're caring for an aging parent, a child with developmental disabilities, or someone recovering from a serious illness, you're likely asking the same question many families across New Hampshire face: How can we access quality care without completely draining our savings?
That’s where New Hampshire’s Medicaid Waivers and Home and Community-Based Services (HCBS) come in. These programs are designed to help residents receive the support they needwithout being confined to an institution or nursing home. From in-home caregiving support to behavioral therapies and assistive technology, these waivers open the door to a more self-directed, dignified quality of life.
In this guide, we’ll explore the ins and outs of New Hampshire’s Medicaid Waiver programs, who they’re for, how to apply, and what benefits they offer. Let’s break it down in a way that’s clear, compassionate, and truly useful.
At its core, Medicaid is a state and federally funded program offering health coverage to low-income residents, including seniors, individuals with disabilities, and families with children. Unlike traditional Medicaid services, Medicaid waivers and HCBS programs go a step further—they "waive" certain federal rules so individuals can receive long-term care services at home or in community settings rather than institutions.
New Hampshire currently offers several key Medicaid waiver programs under its broader HCBC offerings:
- Choices for Independence (CFI)
- Developmental Disabilities Waiver (DD Waiver)
- Acquired Brain Disorder (ABD) Waiver
- In-Home Supports Waiver (for children)
- Community Mental Health Services Waiver
Each of these programs targets specific populations, allowing the state to tailor services based on the unique needs of elderly adults, individuals with intellectual and developmental disabilities, children with complex medical conditions, or people living with traumatic brain injuries.
HCBS programs are especially critical in a rural and aging state like New Hampshire. Roughly 18% of the Granite State's population is over 65, many living in remote areas with limited access to in-facility care. HCBS mitigates this challenge by extending support into individuals’ homes, preserving family routines, autonomy, and dignity.
The state rolls out these Medicaid waivers through its Bureau of Elderly and Adult Services (BEAS) and the Bureau of Developmental Services (BDS), among other local agencies. These waivers also emphasize “person-centered planning” — a collaborative process where the recipient and their support team determine the best care path based on individual preferences, strengths, goals, and family dynamics.
Eligibility is based on medical need and financial guidelines, varying by program. Many services are provided under managed care, meaning providers must be approved by the state and services are coordinated for cost-effectiveness and better outcomes.
Understanding these waivers isn’t just policy talk—it’s about real lives, real decisions, and real relief for New Hampshire families in need.
The Choices for Independence (CFI) Waiver is New Hampshire’s primary HCBS option for adults over 18 who have functional limitations or are over age 65 and at risk of nursing home placement. For caregivers and aging individuals who dream of aging in place, CFI can be a crucial resource.
This waiver targets individuals who require a nursing facility level of care but prefer to receive services in their own residence or a community-based setting. Services typically include:
- Personal care and homemaker assistance
- Adult day health services
- Respite care for family caregivers
- Home-delivered meals
- Medical transportation
- Environmental modifications (ramps, grab bars)
- Personal Emergency Response Systems
To qualify for the CFI waiver, applicants must meet New Hampshire’s income and asset limits for Medicaid and be assessed as needing nursing facility-level care. As of 2024, the monthly income limit for an individual is roughly $2,742, and asset limits are capped at $2,000, though these numbers are subject to annual adjustments.
The emotional benefits of this waiver are hard to overstate. For example, consider the case of Margaret, a 79-year-old widow in Manchester with declining mobility. Through the CFI waiver, she receives in-home support multiple times a week and gets to remain in the home where she raised her family. Her daughter, Sarah, also receives respite care, giving her time to manage work and her own family obligations without burning out.
Enrolling in CFI involves a multi-step process: application through the NH Department of Health and Human Services (DHHS), medical evaluation for level-of-care requirements, and financial eligibility screening. The program has limited slots and sometimes entails a waitlist, so applying early—even preemptively—is advised.
Ultimately, the CFI waiver gives peace of mind—not only to aging individuals but to the family members who worry about them daily. It ensures that people can maintain independence, receive competent care, and remain connected to their communities.
For families navigating intellectual or developmental disabilities (IDD), New Hampshire’s developmental service waivers offer a customized lifeline at every life stage. There are two primary waivers in this category:
- Developmental Disabilities (DD) Waiver for adults and children with IDD.
- In-Home Supports (IHS) Waiver tailored specifically for children under 21.
These waivers aim to provide support for individuals to live and thrive in the community rather than reside in a facility. Think of it as building a framework for independence, with services like:
- Community participation programs
- Life skills training
- Behavioral therapies
- Job coaching and supported employment
- Residential habilitation and shared living models
- Specialized medical equipment
- Family caregiver stipends and respite service
Eligibility is based on a documented developmental disability that results in substantial functional limitations in at least three areas such as self-care, mobility, communication, or self-direction. These needs are assessed through the Bureau of Developmental Services and designated Area Agencies across New Hampshire.
One inspiring example is 10-year-old Alex from Nashua, who was born with autism and intellectual delays. Before receiving waiver services, his parents struggled with out-of-pocket therapy costs and limited educational support. With the IHS waiver, Alex now receives ABA therapy, occupational therapy, and participates in a weekend camp that nurtures social skills while giving the family a much-needed break.
Parents often don’t realize early enough that they can apply for these services well before a transition, such as a child aging out of school-based programs or approaching adulthood. Planning ahead ensures continuity of support through life milestones—including post-secondary education, employment, and housing.
Another critical advantage of these waivers is self-direction. That means families can often choose their service providers and even pay family caregivers, creating a flexible, family-tailored support system.
Developmental service waivers are about more than managing a condition—they’re about enabling a fuller, richer life. And in New Hampshire, that possibility is within reach for many families.
While the promise of home- and community-based care is encouraging, navigating the application process can be daunting. The good news? With a little preparation and the right contacts, you can take confident steps toward applying for the support your family needs.
The application process generally consists of three components:
- Medical Eligibility Assessment
You’ll need to demonstrate that the individual requires the level of care typically provided in a nursing facility or equivalent. This may involve evaluations by medical professionals, functional assessments, and documentation of diagnoses.
- Financial Eligibility Review
Medicaid in New Hampshire has strict income and asset limits, which vary by program. As a rule of thumb, individual applicants must typically have no more than $2,000 in countable assets. However, certain assets, like a primary residence or car, may be excluded depending on the waiver.
- Coordination Through Area Agencies or Service Providers
Most waiver programs are locally administered. For example, developmental disability services are accessed through one of ten regional Area Agencies in the state. These groups can guide assessments, help develop service plans, and assign case managers.
The New Hampshire DHHS manages most waiver applications through their website and local field offices. It’s often helpful to start by calling the ServiceLink Aging and Disability Resource Center (1-866-634-9412). They offer free, confidential counseling and can direct you to the appropriate agency for your needs.
Waiting lists can be a reality, especially for high-demand services. However, emergency cases—such as sudden caregiver loss or hospitalization—may be expedited. It’s essential to communicate clearly any urgent needs.
Tip: Keep detailed records of all communications and paperwork, and make copies of everything you submit. Involve your loved one in the process where possible—it reinforces the “person-centered” approach that these waivers strive to support.
Remember, this process isn't just bureaucracy—it’s your gateway to meaningful, life-changing assistance. Patience, persistence, and preparation can make all the difference.
Caring for a loved one is one of life’s most selfless and challenging journeys. But you don’t have to do it alone. New Hampshire’s Medicaid Waivers and HCBS programs exist to help families like yours access the care, support, and dignity every individual deserves—no matter their age, ability, or income level.
From elderly residents striving to age in place, to children with special needs building a foundation for their future, these waivers offer both financial relief and emotional peace of mind. They allow caregivers to rest a little easier, knowing their loved one is safe, valued, and supported.
It all starts with information and action. Reach out to local agencies, ask questions, and take those first steps—whether you're years away from needing care or currently in crisis. Apply early, plan ahead, and stay hopeful.
In a state as community-oriented and resilient as New Hampshire, help is never as far away as it seems. Your journey to better care, for you and your loved ones, begins today.
Frequently Asked Questions
To be eligible for a Medicaid waiver in New Hampshire, individuals must typically meet income and asset limits and require a level of care usually provided in an institutional setting, like a nursing home or developmental center. Eligibility may also be based on age, disability, or specific medical conditions. Each waiver has its own criteria, so it's essential to review the requirements for the specific program you're interested in. Residents must also be legally residing in New Hampshire and be enrolled in New Hampshire Medicaid.
Home and Community-Based Services (HCBS) waivers in New Hampshire can cover a wide range of supports, including personal care assistance, respite care, adult day services, home modifications, and case management. The type and amount of services provided depend on individual needs and the specific waiver program. These services are designed to help individuals remain in their community or home setting instead of moving to institutional care.
To apply for a Medicaid waiver in New Hampshire, start by contacting the Bureau of Elderly and Adult Services (BEAS) or your local area agency based on your service needs. They will help assess your eligibility and guide you through the application process. You'll need to provide medical and financial documentation. It’s important to start early, as waitlists may apply and some programs have limited enrollment slots.
Yes, many New Hampshire Medicaid waivers have waitlists due to limited program capacity and funding. The length of the waitlist can vary depending on the waiver and the individual's level of need. Some clients may receive priority based on health or safety risks. It’s advisable to apply as soon as possible and maintain regular contact with your caseworker to track your application status.
Medicaid waivers in New Hampshire are designed to offer services beyond what's typically covered under standard Medicaid. While regular Medicaid covers basic healthcare like doctor visits and hospital stays, waivers provide extra support such as in-home care, assistive technology, and caregiver support. The goal of waivers is to allow individuals with complex needs to live safely in the community rather than in institutional care.
Dr. Alan Lee is a board-certified geriatrician specializing in neurodegenerative conditions including Alzheimer’s disease, Parkinson’s, and Lewy Body dementia. With more than two decades in clinical practice and research, Dr. Lee is a trusted authority in personalized care planning for aging adults. He serves as a medical reviewer for several national caregiving organizations and frequently lectures on aging in place and ethical dementia care.
Emily Sanders is a Dementia Practitioner and educator who trains in-home caregivers and family members in person-centered dementia care. With a background in occupational therapy and caregiver training, Emily creates practical tools and care plans that improve everyday life for people living with Alzheimer’s and related conditions. She is passionate about preserving identity, dignity, and connection in home-based settings.
Maria Torres is a social worker with a focus on elder care, family systems, and caregiver mental health. She has worked in both hospice and community health settings and currently supports family caregivers navigating long-term care decisions. Maria brings an empathetic lens to her writing and advocates for proactive planning, emotional resilience, and equitable access to home care resources.
