Choices for Independence Waiver New Hampshire: How the CFI Program Works
Most families who start researching long-term care Medicaid in New Hampshire are hoping to find a way to keep a parent at home rather than move them to a nursing facility. The Choices for Independence (CFI) waiver is the state's answer to that — but it works very differently from nursing home Medicaid, and the differences matter before you build your care plan around it.
What the CFI Waiver Does
The CFI waiver is a Medicaid Home and Community-Based Services program under federal 1915(c) authority. It funds care services that allow eligible seniors to remain in their homes or in certain residential settings rather than move to a nursing facility.
Services covered include:
- Personal care assistance (help with bathing, dressing, eating, and other Activities of Daily Living)
- Homemaking and light housekeeping
- Home-delivered meals
- Skilled nursing visits
- Adult day health programs
- Assistive technology and minor home modifications (ramps, grab bars, widened doorways)
- Emergency response systems
- Respite care for family caregivers
- Transportation to medical appointments
- Care coordination through a licensed Case Management Agency
The CFI waiver does not cover room and board costs. If your parent lives in an assisted living facility and uses CFI services for personal care, the facility's rent — averaging $7,431 per month in New Hampshire — remains a separate, out-of-pocket expense. Many families discover this too late and find the combination unaffordable.
Eligibility Requirements
The financial and clinical eligibility rules for the CFI waiver are the same as for nursing home Medicaid:
- Income: under $2,982 per month (or eligible for the Medically Needy spend-down)
- Assets: under $7,500 in countable resources (using the state's effective threshold after the resource disregard)
- Clinical: must meet the Nursing Facility Level of Care standard — needing hands-on or stand-by assistance with at least two Activities of Daily Living
The clinical assessment is conducted by a registered nurse from the Bureau of Adult and Aging Services using the Medical Eligibility Assessment instrument. It is the same assessment used for nursing home eligibility.
One critical difference from nursing home Medicaid: the 2024 CFI waiver spousal rule. When one spouse applies for CFI — rather than nursing home placement — the BFA evaluates only assets in the applicant spouse's individual name. Joint assets in the community spouse's sole name are invisible to the eligibility calculation. This allows couples to retitle joint accounts into the community spouse's name before the CFI application, protecting much more of the couple's savings than the standard nursing home CSRA formula allows.
The Enrollment Cap and Waitlist Problem
Here is the core structural difference between CFI and nursing home Medicaid: nursing home Medicaid is an entitlement. The CFI waiver is not.
Meeting every eligibility criterion does not guarantee immediate CFI services. The waiver is capped at approximately 5,400 annual participants. When slots are full, applicants are placed on a waitlist. The length of the waitlist varies by region and changes over time.
For families in crisis — a parent who needs immediate home care following a hospital discharge — the waitlist can be a serious problem. If no CFI slot is available and the family cannot afford private-pay home care at $7,000–$8,000 per month, nursing home placement may be the only realistic option in the short term, even if home-based care is the family's preference.
This is why applying early — before a crisis — is so important for families where home-based care is the goal.
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How to Apply
The CFI waiver application process starts at ServiceLink, the state's Aging and Disability Resource Center network (1-866-634-9412). A ServiceLink options counselor:
- Conducts an initial financial screening
- Explains available programs
- Submits a referral for the clinical Medical Eligibility Assessment
- Provides the CFI program booklet (BAAS Form 3404) explaining the full program
The financial application (BFA Form 800) goes to the Bureau of Family Assistance. The clinical assessment is handled by the Bureau of Adult and Aging Services. Both tracks run simultaneously, but a CFI slot must also be available for services to begin.
Once approved, the family selects a licensed Case Management Agency from the state's approved list. The Case Manager coordinates with the family to develop a person-centered Comprehensive Care Plan and authorizes specific services.
CFI vs. Nursing Home Medicaid: The Decision Framework
| CFI Waiver | Nursing Home Medicaid | |
|---|---|---|
| Where care is delivered | Home, assisted living, or other community setting | Licensed nursing facility |
| Enrollment cap | Yes — approximately 5,400 participants | No — entitlement program |
| Waitlist possible | Yes | No |
| Room and board covered | No | Yes |
| Spousal asset assessment | Applicant's assets only (2024 rule change) | Joint assets pooled and split |
For families where home-based care is genuinely feasible, the CFI waiver is the better long-term outcome — both financially (the spousal asset protection is stronger) and clinically. For families dealing with immediate crisis placements or high acuity needs, nursing home Medicaid may be the only realistic path.
The New Hampshire Medicaid Long-Term Care & Asset Protection Guide covers the CFI application process in detail, including the 2024 spousal rule change, how to navigate waitlists, and how to evaluate assisted living options against nursing facility costs.
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