Choosing a Home Care Agency in New Hampshire: Licensing, CFI Providers, and What to Ask

The Two Types of Agencies You're Choosing Between

When families arrange home care in New Hampshire, they're often choosing from two distinct systems simultaneously without realizing it. Understanding which system applies to your parent's situation is the first step.

Private-duty home care agencies provide services paid out of pocket or through long-term care insurance. No eligibility requirements, no waitlists, and services can start within 24 to 48 hours. Costs run $35 to $50 per hour depending on the level of care and your location in the state.

CFI waiver providers deliver services funded through New Hampshire Medicaid's Choices for Independence program. If your parent is enrolled in the CFI waiver, the state assigns their case to a Case Management Agency (CMA) that coordinates all authorized services. But the critical detail many families miss: your parent has the legal right to choose their CMA and their home care providers. You're not locked into whoever the state initially assigns.

How Licensing Works in New Hampshire

The Health Facilities Administration (HFA) under the Department of Health and Human Services licenses, inspects, and monitors home care agencies in New Hampshire. Three license categories cover the home care landscape:

Home Health Care Providers (He-P 809) — licensed to provide skilled nursing, therapy, and medical services in the home. Annual licensing fee: $250.

Personal Care Providers (He-P 822) — licensed to provide non-medical personal care assistance (bathing, dressing, meal preparation, light housekeeping). Licensing fee: $25 for agencies serving fewer than 10 clients, $100 for 10 or more.

Individual Home Care Service Providers — solo caregivers licensed at $25 annually.

Before hiring any agency, verify their current license status with HFA. An agency operating without proper licensing has no regulatory oversight, no inspection history, and no accountability mechanism if something goes wrong.

What to Ask Before You Sign

The questions that actually reveal agency quality aren't the ones on their marketing brochures. Work through this list during your initial conversation:

"What is your current caregiver-to-client ratio, and how do you handle call-outs?" New Hampshire is in the middle of a documented home care staffing shortage — the federal class-action lawsuit Fitzmorris v. Weaver specifically addressed the state's failure to deliver authorized care hours due to low reimbursement rates and labor scarcity. An agency that can't clearly explain their backup staffing plan will eventually leave your parent without coverage on a day you can't fill in.

"Do your caregivers have specific training in my parent's condition?" General home care competency and dementia-specific training are different skill sets. If your parent has Alzheimer's, Parkinson's, or another condition with behavioral components, ask about specialized training certifications and how many of their current caregivers hold them.

"What does your complaint and incident reporting process look like?" Every licensed agency is required to have one. If the person you're speaking with can't describe it clearly, that's a signal about their operational maturity.

"Can I see your most recent HFA inspection results?" Licensed agencies undergo periodic inspections. Asking to see results — and watching whether the agency provides them readily or deflects — tells you something about transparency.

"Do you accept the CFI waiver, and what services are you currently authorized to provide under it?" Not all licensed agencies accept Medicaid reimbursement. If your parent is on the CFI waiver, confirm that the agency is an enrolled Medicaid provider and that they can deliver the specific services authorized in your parent's care plan.

Choosing a Case Management Agency

For CFI waiver participants, the Case Management Agency plays a distinct role from the direct care provider. The CMA conducts the initial home assessment, develops the comprehensive care plan, coordinates services across providers, and manages annual redeterminations.

When evaluating a CMA, the critical question is caseload. A care coordinator managing 40 clients will be more responsive than one juggling 80. Ask directly: "How many active cases does the coordinator assigned to my parent carry?"

You can change your CMA at any time by contacting DHHS. You don't need to give a reason, and the transition shouldn't interrupt ongoing services.

The Complaint Hotline

If you observe neglect, abuse, or substandard care from a licensed home health agency, file a complaint through the HFA Home Health Hotline at 1-800-621-6232. The HFA investigates complaints against all licensed facilities and can take enforcement action including fines and license revocation.

For complaints about residential care facilities (assisted living, supported residential health care), contact the Office of the Long-Term Care Ombudsman at (603) 271-4375.

Putting It Together

Start with ServiceLink (1-866-634-9412) — they maintain current directories of licensed agencies by county and can help you understand which providers are accepting new clients in your parent's area. For CFI waiver participants, your assigned care coordinator should present multiple provider options, not just one.

The Aging in Place in New Hampshire guide includes a provider evaluation checklist covering licensing verification, staffing capacity, dementia training, and complaint history — designed to standardize agency comparisons so you're evaluating everyone against the same criteria.

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