Getting paid to care for a family member in New Hampshire

Adults 18 or older on the Choices for Independence (CFI) waiver, which means they meet Medicaid's financial and categorical requirements and need nursing facility level of care, such as 24-hour care for medical monitoring and nursing care or help with 2 or more activities of daily living, and they choose CFI services instead of a nursing facility. PDMS lets the participant direct and manage CFI waiver services, choose providers, and decide how the authorized budget is spent.

Under PDMS you are co-employer of your workers along with a Financial Management Services provider, which handles payments.

Source: New Hampshire Code of Administrative Rules, He-E 801 Choices for Independence Program (New Hampshire General Court)Checked Nov 2, 2026

Yes. Yes. Relatives may be paid for providing waiver services whenever they are qualified to provide them. Homemaker and personal care services can be provided without a license if the provider only assists family members.

The second sentence is from the state's FAQ on PDMS and FMS.

Source: Application for 1915(c) HCBS Waiver NH.0060.R08.02, Choices for Independence, as of July 1, 2026, Appendix C-2-e (New Hampshire Department of Health and Human Services; approved by the Centers for Medicare & Medicaid Services)Checked Nov 2, 2026

Depends. Depends. New Hampshire's own sources disagree. The approved Choices for Independence waiver (as of July 1, 2026) says the state pays legally responsible persons, such as a spouse, for personal care and similar services when the participant directs services through participant direction and has chosen this arrangement, and otherwise only for extraordinary care on a state-approved assessment tool or when other providers cannot be found because of geographic, cultural or other limits. The state's CFI rule says no CFI service is covered when it is provided by the participant's spouse.

The rule is New Hampshire Code of Administrative Rules He-E 801.12(a)(6), effective 1-29-22: no CFI service is covered if it 'Is provided by a legally responsible relative', which He-E 801.02(ac) defines as 'the participant's spouse'. The Bureau of Elderly and Adult Services FAQ regarding FMS and PDMS (April 2022) says 'Spouses and authorized representatives can become providers under PDMS.'

Source: Application for 1915(c) HCBS Waiver NH.0060.R08.02, Choices for Independence, as of July 1, 2026, Appendix C-2-d (New Hampshire Department of Health and Human Services; approved by the Centers for Medicare & Medicaid Services)Checked Nov 2, 2026

Depends. Depends. New Hampshire's own sources disagree. The approved Choices for Independence waiver (as of July 1, 2026) says relatives and legal guardians may be paid for waiver services whenever they are qualified, contracted or employed as CFI providers of a provider agency. The state's PDMS FAQ says guardians cannot become providers under PDMS.

The Bureau of Elderly and Adult Services FAQ regarding FMS and PDMS (April 2022) says 'Durable Powers of attorney and guardians cannot become providers under PDMS.' The CFI rule He-E 801.24(c)(3), effective 1-29-22, says personal care services are not covered when provided by the participant's legal guardian.

Source: Application for 1915(c) HCBS Waiver NH.0060.R08.02, Choices for Independence, as of July 1, 2026, Appendix C-2-e (New Hampshire Department of Health and Human Services; approved by the Centers for Medicare & Medicaid Services)Checked Nov 2, 2026