New Hampshire · waiver service
Choices for Independence (CFI) Waiver in New Hampshire
Choices for Independence is New Hampshire's Medicaid home and community based services waiver for adults who need nursing-home level care but want to stay at home. Under its participant-directed and managed services (PDMS) option, the participant picks their own workers and acts as co-employer with a financial management services (FMS) agency, which runs payroll. That lets a relative such as an adult child be hired and paid, but state rules bar payment to a spouse.
Also called: CFI · CFI waiver · Choices for Independence · HCBS-CFI · NH CFI program · participant directed and managed services · PDMS
Who do you care for?
Quick facts
- Pay
- Not published
- Adult children & other relatives
- Yes
- Spouse
- Not right now
- Parent of a minor child
- CFI only serves adults 18 and older.
- Waitlist
- possible
Who qualifies for Choices for Independence (CFI) Waiver
- Age 18 or older (He-E 801.03).
- Financially and categorically eligible for New Hampshire Medicaid, including the long-term care income and asset rules.
- Clinically eligible for nursing facility care: needs 24-hour care for medical monitoring, restorative or rehab care, certain medication administration, or help with 2 or more activities of daily living such as bathing, dressing, eating, toileting or transferring.
- Needs at least one CFI waiver service and gets at least one waiver service every month.
- Chooses home and community services instead of a nursing home, by signing the application.
Who can be paid as the caregiver
- Adult children & other relatives Yes
- under PDMS the participant selects their own providers, and the FMS agency hires the workers the participant chooses, so adult children and other relatives can be hired; agency personal care cannot be given by the participant's legal guardian, power-of-attorney agent or designated PCS representative.
- Spouse Not right now
- He-E 801.12 says no CFI service is covered if it is provided by a legally responsible relative, and He-E 801.02 defines that as the participant's spouse.
- Parent of a minor child
- CFI only serves adults 18 and older.
- Living together
- the rules do not require the paid relative to live with the participant.
Who employs the caregiver: Either. With PDMS, the participant (or their legal representative) is co-employer with an FMS agency that hires the chosen workers, checks backgrounds, runs payroll and pays taxes. Without PDMS, personal care comes from licensed home health or home care agency staff.
Spouse rules differ by program — see spouse pay in New Hampshire.
How much Choices for Independence (CFI) Waiver pays
Not published. New Hampshire does not publish a set hourly wage for family workers under CFI. Payment to CFI providers is made at rates the Department of Health and Human Services sets under RSA 161:4, VI(a). Under PDMS, the participant and case manager build a budget with itemized costs, and the FMS agency pays the worker from that budget and withholds taxes. Ask the FMS agency what hourly wage your budget supports.
Hours and budget: A state nurse does a face-to-face clinical assessment and builds an identified needs list. The case manager writes a comprehensive care plan and asks the state to authorize specific services, units and frequencies. Under PDMS the budget lists each service, how often it is given and its cost. The total cost of home services is compared to the average Medicaid cost of nursing facility care (He-E 801.09).
Compare with other New Hampshire programs on the New Hampshire caregiver pay page, or across states in pay rates by state.
Is there a waitlist?
CFI is a 1915(c) waiver, not an entitlement, so enrollment is limited to the number of slots CMS approves. A current waitlist count is not published on the pages reviewed.
How to apply for Choices for Independence (CFI) Waiver
- Call ServiceLink (the Aging and Disability Resource Center) to meet with an options counselor about CFI.
- File the Application for Assistance (Form 800) for Medicaid through NH Easy online, through ServiceLink, or at a DHHS district office.
- A registered nurse for the Bureau of Elderly and Adult Services visits you for the clinical assessment while the Bureau of Family Assistance checks finances.
- Once approved, choose a case management agency, then tell your case manager you want participant-directed and managed services and name the relative you want to hire.
- Enroll with the FMS agency, which completes hiring paperwork and background checks before your relative starts paid work.
- ServiceLink Aging and Disability Resource Center · 866-634-9412 · official site
- NH DHHS Bureau of Elderly and Adult Services – Choices for Independence · not published on pages reviewed · official site
- NH Easy (apply for Medicaid online) · not published on pages reviewed · official site
Find out in 2 minutes
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Choices for Independence (CFI) Waiver questions
Can I get paid to care for my husband or wife under CFI?
No. New Hampshire's CFI rules say a service is not covered when it is given by a legally responsible relative, and the rules define that as the participant's spouse. A spouse can still help unpaid and can be part of planning.
Can an adult son or daughter be paid under CFI?
Yes, through participant-directed and managed services (PDMS). The participant chooses the worker and the financial management services agency hires them, runs payroll and pays taxes. The worker must pass the required background checks.
Can my relative be paid if they hold my power of attorney?
For agency personal care, no. He-E 801.24 says personal care is not covered when given by the participant's legal guardian, the agent under a power of attorney, or the designated PCS representative. Ask your case manager how this applies to your PDMS plan.
How much does a family caregiver earn under CFI?
New Hampshire does not publish a set wage. The pay comes out of the participant's PDMS budget, which is built from the services and hours in the care plan. The FMS agency can tell you the hourly rate your budget allows.
Is there a waiting list for CFI?
There can be. CFI is a waiver with a limited number of slots approved by the federal government, so a waitlist can form when slots are full. Ask ServiceLink about current availability when you apply.
Do I have to be in a nursing home to qualify?
No. You have to need the level of care a nursing home gives, such as help with two or more daily activities, but CFI is for people who choose to get that care at home or in the community instead.
Sources: gc.nh.gov · dhhs.nh.gov · dhhs.nh.gov · medicaidplanningassistance.org · Updated 2026-10-08. Program rules change — always confirm with the program.
Where most New Hampshire caregivers are
Counties with the most residents aged 65 and older. The rules are the same everywhere in New Hampshire — pick yours for the local picture.
Across the line
States that border New Hampshire
Each state writes its own rules, and they differ more than people expect — a spouse who can be paid on one side of the line often cannot be on the other.