New Hampshire Choices for Independence Waiver: Home Care Through Medicaid

What the CFI Waiver Covers

Choices for Independence is New Hampshire's Medicaid home and community-based services waiver. It pays for care that would otherwise require a nursing home: personal care attendants, adult day programs, home-delivered meals, environmental modifications like wheelchair ramps, and case management. The goal is to let your parent stay home instead of moving to a facility.

The program is administered by DHHS through the Bureau of Elderly and Adult Services, with care coordinated by designated Area Agencies on Aging across the state. A care manager assesses your parent's needs, builds a service plan, and arranges providers.

CFI covers services Medicare doesn't — things like help with bathing, dressing, and meal preparation on an ongoing basis. Medicare's home health benefit requires a skilled care need and is time-limited. CFI fills the gap for people whose primary needs are long-term personal assistance.

Eligibility: Different Rules Than Medicare Savings Programs

This is where families get confused. The Medicare Savings Programs (QMB, SLMB, SLMB135) use relatively generous income and asset limits — $1,350 per month and $9,950 in assets for a single person in 2026. CFI operates under Long-Term Services and Supports Medicaid rules, which are much tighter.

CFI income limit (2026): $2,982 per month gross income for a single applicant — categorically needy standard. This is actually higher than the MSP ceiling, but the asset limit is where it gets restrictive.

CFI asset limit: $2,500 for an individual. Compare that to $9,950 for MSP. A senior with $5,000 in savings qualifies for QMB but would need to spend down to $2,500 before CFI approval.

Spousal protections exist. If your parent is married and the other spouse remains at home, the community spouse can keep a resource allowance between $32,532 and $162,660, plus a monthly maintenance needs allowance up to $4,066.50. These protections don't apply to MSP — they're specific to long-term care Medicaid, including CFI.

How MSP and CFI Interact

Your parent can hold both an MSP and CFI benefits simultaneously. In fact, having both is common. The MSP covers Medicare premiums and cost-sharing. CFI covers home-based personal care and support services. They serve different purposes and neither disqualifies the other.

Here's the practical sequence most families follow:

1. Apply for an MSP first — the higher asset limit ($9,950) means faster approval, and the income calculation with the $20 disregard often puts people under the QMB ceiling.
2. Once MSP is in place, the Part B premium comes off your parent's expenses, improving their financial picture for any subsequent application.
3. If home care needs emerge, apply for CFI through the Bureau of Elderly and Adult Services. CFI eligibility is assessed under its own, stricter LTSS financial rules.

One critical difference: MSP-only benefits are protected from estate recovery under federal law. CFI services received at age 55 or older can be subject to estate recovery — New Hampshire can seek reimbursement from the estate after the recipient dies. This is a major consideration for families where the parent owns a home.

Applying for CFI

The entry point is ServiceLink, New Hampshire's aging and disability resource center network. Call your regional ServiceLink office and request a functional assessment. A care manager will evaluate whether your parent meets the "nursing facility level of care" clinical threshold — the medical standard that determines whether someone qualifies for facility care, which CFI then allows them to receive at home instead.

The application is separate from an MSP application, though both go through DHHS. You'll need financial documentation such as bank statements and income verification, plus medical records supporting the need for ongoing personal assistance.

Wait times for CFI can vary. Ask ServiceLink about current wait times in your parent's region.

For families navigating both programs, the New Hampshire Medicare Savings Programs Guide covers the MSP application side with document checklists and timeline trackers, so you can tackle that piece while the CFI assessment moves forward.

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