Personal Care Services New Hampshire Medicaid: What's Covered Under the CFI Waiver

What Personal Care Services Actually Include

Personal care services under New Hampshire Medicaid mean hands-on, non-medical assistance with Activities of Daily Living — the basic physical tasks your parent can no longer safely perform alone. This isn't housekeeping or companionship (though those are separate waiver benefits). Personal care is the daily, physical help that keeps someone functional in their own home.

The Choices for Independence (CFI) Medicaid waiver covers personal care assistance with:

• Bathing — help getting in and out of the tub or shower, washing, drying
• Dressing — selecting appropriate clothing, putting on and removing garments
• Toileting — getting to the bathroom, managing clothing, personal hygiene
• Eating — help with feeding, cutting food, managing nutritional intake
• Transferring — moving between bed and chair, standing from a seated position, getting in and out of a vehicle
• Continence care — managing incontinence supplies, skin care to prevent breakdown

A personal care attendant — either an agency-employed aide or a self-directed family caregiver — provides these services in your parent's home on a regular schedule established by the care plan.

How to Get Authorized

Personal care services don't start with a phone call to an agency. They start with a clinical determination that your parent requires them. The authorization process runs through three gates:

Gate 1: Clinical assessment. Your parent must meet the nursing facility level of care (NFLOC) standard, which requires documented dependency in at least two ADLs. A registered nurse from the Bureau of Elderly and Adult Services (BEAS) conducts the Medical Eligibility Assessment (MEA) — an in-home visit lasting approximately 45 minutes — to evaluate your parent's functional capacity.

Gate 2: Financial eligibility. Simultaneously, a Family Services Specialist reviews your parent's income and assets. For the CFI waiver: gross monthly income under $2,982, countable assets under $8,500 (after the He-W 856.07 resource disregard of $6,000 above the $2,500 base). The primary home is exempt up to $752,000 in equity.

Gate 3: Care plan authorization. Once both clinical and financial eligibility are confirmed, a Case Management Agency develops a comprehensive Plan of Care. This plan specifies exactly which personal care services your parent receives, how many hours per week, and which provider delivers them.

The entire process — from initial contact with ServiceLink (1-866-634-9412) through care plan activation — typically takes 45 to 90 days.

The Difference Between Personal Care and Home Health

Families often confuse Medicaid personal care services with Medicare home health care. They're fundamentally different programs serving different needs.

Medicare home health covers short-term, intermittent skilled nursing care and therapy (physical, occupational, speech) for patients certified as homebound by a physician. A nurse visits two or three times per week for wound care, medication management, or rehabilitation exercises. Medicare does not cover ongoing help with bathing, dressing, or meals if that's the only care needed.

Medicaid personal care through the CFI waiver covers long-term, ongoing custodial assistance with ADLs. A personal care attendant comes daily — or multiple times daily — for as long as your parent's care plan authorizes. There's no homebound requirement and no time limit as long as eligibility continues.

Many families use both simultaneously. A parent recovering from hip surgery might receive Medicare home health for physical therapy while also receiving Medicaid personal care for bathing and dressing assistance. The programs serve different needs and don't conflict.

Hours and Scheduling

The number of personal care hours your parent receives isn't standardized — it's determined by the individualized care plan. A parent with moderate ADL limitations might receive 15 to 20 hours per week. A parent with severe functional decline or cognitive impairment might receive 40 or more hours.

The care plan is reviewed and updated at least annually during the redetermination process. But you can request a care plan modification at any time if your parent's needs change. A fall, a hospitalization, or a noticeable cognitive decline are all reasons to contact the Case Management Agency and request a reassessment.

Scheduling is arranged between the family, the care provider, and the Care Coordinator. Most families structure personal care visits around the times of day when ADL assistance is most needed — typically morning (bathing, dressing, breakfast) and evening (dinner, toileting, bed preparation).

What Happens During a Staffing Shortage

New Hampshire's home care workforce has been under documented strain. The federal Fitzmorris v. Weaver lawsuit specifically addressed situations where families had authorized care hours that no agency could staff. Low Medicaid reimbursement rates make it difficult for agencies to recruit and retain aides when competing with retail and hospitality wages.

If your parent's authorized hours go consistently unfilled, you have options:

• Request a provider change through your Case Management Agency
• Shift to self-directed care and hire a family member, friend, or neighbor as the paid attendant (up to $20/hour through the waiver's fiscal management system)
• File a formal complaint with DHHS referencing the authorized care plan and the undelivered hours

The self-directed care route is particularly practical during staffing shortages because it draws from a labor pool — your parent's own network — that agencies can't access.

The Aging in Place in New Hampshire guide walks through the full personal care authorization process, includes the 14-day functional care log for documenting ADL needs before the MEA, and covers the self-directed care enrollment sequence for families who want to hire their own attendant.

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