Guides → New Hampshire

Getting paid to care for a parent in New Hampshire

Updated 2026-08-10 · Every figure below is dated and sourced · Rules change — confirm with the agency
The short answer: New Hampshire's door is Choices for Independence (CFI) Waiver — Participant Directed and Managed Services (PDMS) option; plus Personal Care Attendant Services (PCAS), the consumer-directed Medicaid State Plan benefit run through Granite State Independent Living (GSIL), run by NH Department of Health and Human Services. Inside DHHS, the Division of Long Term Supports and Services sets the payment rates, and the bureau that actually runs the Choices for Independence waiver day to day is the Bureau of Elderly and Adult Services - which DHHS's website now calls the Bureau of Adult and Aging Services (BAAS). You can reach it at 603-271-9203 or BAAS@dhhs.nh.gov, 105 Pleasant Street, Concord, NH 03301. ServiceLink, the state's Aging and Disability Resource Center, is the front door for families and the number to call first. Granite State Independent Living (GSIL) is one of the agencies that recruits and employs personal care attendants for consumer-directed care.. Pay: What Medicaid pays and what you actually take home are two different numbers, and this is where families get misled most often (checked Aug 2026). The Medicaid BILLING rate is public. On the CFI waiver fee schedule, personal care (billing code T1019) pays $8.00 per 15 minutes - $32.00 an hour. Homemaker service is $7.80 per 15 minutes ($31.20/hr), home health aide is $8.38 per 15 minutes ($33.52/hr), and respite is $8.00 per 15 minutes. These come from DHHS's own CFI Rate Study delivered to the Legislature on June 28, 2024. The CFI waiver amendment that took effect July 1, 2026 rewrote how New Hampshire sets these rates, but DHHS said it expected "no immediate fiscal impacts" - so the rates themselves did not change on July 1, 2026. That $32/hr is what Medicaid pays the agency or the payroll agent. It is not your paycheck. If a home care agency employs you, the agency keeps a substantial share for overhead, taxes, supervision and unbilled time, and pays you a wage it sets. Granite State Independent Living advertises up to $22/hr for personal care attendants and $18/hr starting for personal care service providers (2026). Burd Home Health advertises up to $20/hr for CFI family caregivers. If your parent self-directs through Participant Directed and Managed Services, your parent sets your wage out of the approved budget - "subject to state limits" - and the fiscal agent pays employer payroll taxes out of that same budget, so the hourly number you agree to will be well under the billing rate. There is no state-set caregiver wage in New Hampshire. Before you count on a number, get it in writing from the agency that will employ you, or from the fiscal agent if your parent self-directs. Ignore the roughly $16.68/hr figure that circulates on caregiver websites - it does not match any current NH Medicaid CFI rate.

One or more details on this page could not be fully confirmed against official sources at publish time — confirm specifics with the agency below.

Who can be the paid caregiver

Adult children, siblings, other relatives and friends can be hired under both CFI (self-directed through PDMS, or as an employee of a home care agency that runs a family-caregiver program) and the state-plan personal care route. The caregiver must be 18 or older, legally able to work in the US, and pass a background check, which the fiscal agent or the agency arranges and pays for. The trap to know about: for personal care specifically, NH rule He-E 801.24(c)(3) says the service is not covered when it is provided by the person's personal care services representative, by their agent under a power of attorney, or by their legal guardian. RSA 161-I says much the same. The caregiving adult child is very often also the POA, so this catches a lot of families. But it is not a dead end, and you have two options - do not just sign your POA away. You can move the power of attorney to another family member before enrolling. Or you can ask DHHS to authorize the arrangement under RSA 161-I:3-a, the provision that exists specifically to let the department approve a legally responsible relative, guardian, or POA holder as the paid provider when the care is medically necessary for specific health needs and no suitable provider is available. The approved CFI waiver separately states that relatives and legal guardians may be paid for waiver services whenever they are qualified. Ask before you assume you are disqualified. The one bar with no way around it: whoever is designated as your parent's PCS representative - the person who oversees and directs the care on their behalf - cannot also be the paid worker. Those must be two different people.

The spouse question

It depends on which route you take, and the answer is more open than most guides say. Under the CFI waiver, the version CMS approved effective July 1, 2026 says plainly that New Hampshire "makes payment to legally responsible persons" - and for an adult, that means the spouse - when the person is directing their own services under Participant Direction (PDMS) and has chosen that arrangement. The waiver also allows paying a spouse when the person needs extraordinary care beyond what a husband or wife would ordinarily provide, or when no other provider can be found because of where they live or other barriers. So a spouse can be paid under CFI, and self-directing through PDMS is the ordinary way in - not a rare medical exception. The catch is that New Hampshire's own rules have not caught up. Administrative rule He-E 801.12(a)(6) still lists any service "provided by a legally responsible relative" as non-covered, and RSA 161-I bars a legally responsible relative from being the paid attendant except as authorized under RSA 161-I:3-a. The rule and the approved waiver do not read the same way. What that means in practice: a spouse's pay is not automatic. Ask the CFI case manager, in writing, to authorize it under participant direction, and get the answer in hand before anyone starts working unpaid. If the case manager says no, that is worth appealing or raising with the Bureau of Adult and Aging Services, because the approved waiver is on your side. Note: this page answers "care for my parent," so the adult-child path is the relevant one, and that path is clearly allowed.

Waitlist reality

The state-plan personal care benefit is an entitlement - if your parent qualifies, there is no waitlist. CFI is different: it is a capped 1915(c) waiver. The version running July 1, 2026 through June 30, 2027 is approved for 5,951 people (the cap steps up each year of the waiver), and if it fills, a waitlist forms, generally in order of application date. Slot waitlists have historically been rare in New Hampshire. The harder problem is not getting a slot - it is getting the hours after you have one. A federal class action against NH DHHS is still live: filed January 11, 2021, certified as a class action November 28, 2023, the state's appeal rejected February 22, 2024, and allowed to proceed again by the federal court in April 2026. It alleges that people approved for CFI never receive some or all of the hours they were authorized, because there are not enough workers. Disability Rights Center-NH tracks it and takes calls at 603-228-0432. Hiring your own family member is one way around the worker shortage, but be realistic about how well-worn that path is. The approved waiver projects only about 280 people using participant direction this waiver year, out of 5,951 CFI participants - roughly one in twenty. You may end up explaining the option to your own case manager and pushing for it. Separately, budget up to about 3 months for the Medicaid financial eligibility decision itself.

Worth knowing: Key disqualifiers to state plainly. (1) For personal care, whoever holds your parent's power of attorney or guardianship generally cannot be the paid worker (He-E 801.24, RSA 161-I) - but before you hand your POA to a sibling, ask DHHS for an exception under RSA 161-I:3-a, which exists precisely to authorize a guardian or POA holder as the paid provider. The one bar with no exception is that the paid worker can never also serve as the PCS representative. (2) A spouse can be paid under CFI when your parent self-directs through PDMS, per the waiver CMS approved effective July 1, 2026 - but state rule He-E 801.12 still says otherwise, so get the authorization in writing before anyone works unpaid. (3) Your parent must be on NH Medicaid. For a single waiver applicant in 2026 that means $2,982/month in income (300% of the federal benefit rate, up from $2,901 in 2025) and $2,500 in countable assets, and for CFI they must need a nursing-home level of care. (4) There is no retroactive pay - care you give before enrollment is not reimbursed, so start the paperwork early. The consumer-directed personal care route additionally requires your parent to be able to direct their own care, which rules out most people with significant dementia; those families should aim for CFI with a representative, or the agency-employment route. Recent context: the CFI waiver was amended effective July 1, 2026 to change how rates are set (no immediate rate change), RSA 161-I:3-a was amended twice in 2023, and the class action over undelivered CFI hours is still live - rules and capacity are genuinely in flux. ServiceLink is the reliable starting call.

Other doors in New Hampshire

ProgramWhat to know
Personal Care Attendant Services (PCAS) via GSILMedicaid State Plan entitlement, no waitlist. Consumer-directed: parent hires/trains/fires their own attendant, including an adult child. Requires the parent to be able to self-direct care and need 2+ hours/day of help with 2+ ADLs. GSIL 603-228-9680.
Veteran-Directed Care (VDC)Available in NH through the Manchester VA Medical Center. Veteran gets a monthly budget and can hire any caregiver, including a spouse or adult child. Ask the Manchester VAMC social work/Caregiver Support team.
VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) and Aid & AttendancePCAFC pays a monthly stipend to caregivers of eligible veterans (spouses fine); Aid & Attendance adds up to roughly $2,800-$3,800/mo to a VA pension that can be spent on family care. Manchester VA Caregiver Support Coordinator.
Structured family caregiving (per-diem model)NH has no formal per-diem structured-family-caregiving Medicaid benefit like Georgia or Indiana. The closest equivalent is CFI agency 'family caregiver programs' where a home care agency employs the relative hourly.
National Family Caregiver Support ProgramThrough ServiceLink/area agencies: respite, counseling, training for the caregiver — support services, not wages.

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

  1. 1. Call ServiceLink, NH's Aging and Disability Resource Center, at 1-866-634-9412 (statewide, free). Ask for long-term care options counseling and a Choices for Independence (CFI) referral.
  2. 2. Apply for NH Medicaid financial eligibility online at NH EASY (nheasy.nh.gov) or with Form 800 at a DHHS district office. Questions: 1-844-ASK-DHHS (1-844-275-3447). Allow up to 3 months.
  3. 3. A nurse completes the medical/functional assessment to confirm your parent needs nursing-facility level of care (CFI) or at least 2 hours/day of personal care help (PCAS).
  4. 4. Once approved for CFI, choose how the family member gets paid: the Participant Directed and Managed Services option (parent is the employer, a financial management services agency runs payroll) or enroll with a home care agency that runs a family-caregiver program (e.g., Guardian Home Care 603-821-0929, Burd Home Health 603-836-0333) and hires you as staff.
  5. 5. For the PCAS route instead (parent 18+, can self-direct care), contact Granite State Independent Living at 603-228-9680 or 1-800-826-3700 and submit a Request for Services.
  6. 6. Complete background check and payroll paperwork with the fiscal agent or agency; paid hours start only after enrollment — care given before approval is not paid retroactively.

Where to start: ServiceLink Aging and Disability Resource Center — 1-866-634-9412, servicelink.nh.gov (statewide front door for CFI). For PCAS: Granite State Independent Living, 603-228-9680 / 1-800-826-3700, gsil.org

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.

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Sources & dates checked: Program rules and payment rates change. Everything here is educational — real eligibility is decided by the agencies, based on your family's details.