New Hampshire Choices for Independence Medicaid Waiver (formerly Home and Community-Based Care Program for the Elderly and Chronically Ill Waiver)

Last updated: March 02, 2024

 

Overview of New Hampshire’s Choices for Independence Waiver

The New Hampshire Choices for Independence Waiver, abbreviated as CFI, is a statewide Medicaid program for seniors and adults with disabilities who are at risk of institutionalization (nursing home admission). Intended as a nursing home diversion program, various long-term services and supports (LTSS) are available to assist persons in continuing to live at home and in the community. These include adult day care, home and vehicle modifications, personal care services, skilled nursing, personal emergency response systems, and respite care. Transitional services are also available for persons currently residing in nursing home facilities who are able and willing to live in the community with CFI services.

Program participants can reside in their home, a loved one’s home, an adult family home (adult foster care home), or a residential care facility (assisted living facility).

The services offered under the CFI Waiver may be provided by licensed agency providers or program participants have the option to self-direct most of their benefits. The participant-directed option includes the ability to hire a friend or relative, such as an adult child or spouse, to provide care. A Financial Management Services Agency handles the financial aspects of employment responsibilities, such as tax withholding, background checks, and caregiver payments.

New Hampshire’s Choices for Independence Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. It was previously called the Home and Community-Based Care Program for the Elderly and Chronically Ill Waiver. CFI is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. The number of participant enrollment slots are limited, and when these slots are full, a waitlist for program participation forms.

 What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

 

Benefits of New Hampshire’s Choices for Independence Waiver

Follows is a list of home and community based services available via CFI. An individualized service plan indicates the exact benefits a program participant receives. The benefits that can be self-directed are marked with an asterisk.

– Adult Day Health Care*
– Adult Family Care*
– Community Transition Services* – i.e., security deposit, utility set-up fees, essential home appliances / furnishings
– Financial Management Services – for persons self-directing their own care
– Home Health Aides*
– Homemaker Services* – i.e., preparation of meals, laundry, light housecleaning, essential shopping
– Home Meal Delivery*
– Home Modifications* – for safety and accessibility (i.e., wheelchair ramps, grab bars, widening of doorways, outdoor fencing for persons with wandering issues)
– Non-Medical Transportation*
– Personal Care Assistance* – i.e., bathing, dressing, eating, mobility, toiletry
– Personal Emergency Response Systems*
– Residential Care Facility Services / Assisted Living Services
– Respite Care* – in-home and out-of-home care to relieve a primary caregiver
– Skilled Nursing Care*
– Specialized Medical Equipment / Supplies*
– Supported Employment*
– Supportive Housing Services*
– Vehicle Modifications* – for safety and accessibility

While program participants can reside in adult family homes and residential care facilities (assisted living residences) and receive CFI Waiver services, the cost of room and board is not paid for by this program.

 New Hampshire seniors who utilize a wheelchair might also want to consider the Personal Care Attendant Services Program. This Medicaid program does not require an applicant need a Nursing Facility Level of Care, nor does it maintain a waiting list for services.

 

Eligibility Requirements for New Hampshire’s Choices for Independence Waiver

Applicants for CFI must be New Hampshire residents who are seniors (65+ years old) or between the ages of 18 and 64 and disabled. Persons who are disabled can continue to receive Waiver services as an aged individual upon turning 65. Additional eligibility criteria is as follows.

 The American Council on Aging provides a quick and easy New Hampshire Medicaid Eligibility Test for seniors

 

Financial Criteria: Income, Assets & Home Ownership

Income
The individual applicant income limit is $2,829 / month. This figure is equivalent to 300% of the Federal Benefit Rate (FBR) for 2024. When both spouses of a married couple are applicants, there is a couple income limit of $5,658 / month. When only one spouse is an applicant, the individual income limit of $2,829 / month applies and the income of the non-applicant spouse is disregarded. However, in some cases, income can be allocated to the non-applicant spouse from the applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance (MMNA).

In New Hampshire, there is a Minimum Income Allowance, which the state calls a “Maximum Income Standard”. Effective 7/1/23 – 6/30/24, it is $2,465 / month. This allows the applicant spouse to transfer up to $2,465 / month to their non-applicant spouse in order to bring the non-applicant’s total monthly income up to $2,465. The state also sets a Maximum Income Allowance, which in 2024, is $3,854 / month. While this potentially allows a non-applicant spouse a higher income allowance, any additional amount they can receive is dependent on their shelter and utility costs. However, a Spousal Income Allowance can never push a non-applicant’s total monthly income over $3,854.

Assets
In 2024, the asset limit is $2,500 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $5,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can have $2,500 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.

In 2024, the CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of the couple’s assets, up to this amount.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Medicaid Spend Down Calculator.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Medicaid in NH considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a child under 21 years old living in the home.
– The applicant has a disabled or blind child of any age living in the home.

While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home here.

 

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the CFI Waiver, functional need is assessed by a registered nurse utilizing the Medical Eligibility Assessment (MEA) instrument. Limitations in the ability to independently complete Activities of Daily Living (ADLs), such as bathing, dressing, eating, toileting, transferring, and continence, are considered. Persons who require assistance with two or more ADLs are considered needing a NFLOC. While persons with Alzheimer’s disease or a related dementia commonly need assistance with their ADLs due to cognitive decline, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

 Learn more about long-term care Medicaid in New Hampshire here.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for NH Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

New Hampshire has a Medically Needy Program for Medicaid applicants who have high medical expenses relative to their income. Also known as a spend-down program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s Medically Needy Income Limit (called a Protected Income Level). The amount that must be “spent down” can be thought of as a deductible. Once one’s “deductible” has been met, the Choices for Independence Waiver will pay for care services and supports.

When persons have assets over the limit, trusts are an option. Irrevocable Funeral Trusts (IFTs) are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts (MAPTs), which must be implemented well in advance of the need for care, are trusts that protect assets from Medicaid and Medicaid’s Estate Recovery Program. Another planning technique, although rarely used anymore and limited to married persons with a significant amount of excess assets is a Medicaid Divorce. There are additional Medicaid planning strategies available when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in New Hampshire to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.

 

How to Apply for New Hampshire’s Choices for Independence Waiver

Before You Apply

Prior to submitting an application for CFI, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.

Since New Hampshire’s Choices for Independence Waiver is not an entitlement program, there may be a waitlist for program participation. This Waiver is approved for a maximum of approximately 5,185 beneficiaries per year. In the case of a waitlist, it is thought that an applicant’s access to a participant slot is based on date of application.

 

Application Process

Persons can apply for the CFI Waiver online at NH Easy, over the phone at ServiceLink at 866-634-9412, or in-person at one’s district DHHS office. Furthermore, an Application for Assistance (Form 800) can be downloaded here.

An assessment for functional need will be scheduled after the application has been submitted.

Additional information about the CFI Waiver, although not necessarily intended for a consumer audience, can be found here. Additionally, persons can contact an Options Counselor at ServiceLink at 866-634-9412 or the DHHS Customer Services Center at 844-275-3447.

The Bureau of Elderly and Adult Services (BEAS) within the New Hampshire Department of Health and Human Services (DHHS) administers the Choices for Independence Waiver.

 

Approval Process & Timing

The New Hampshire Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waitlist may exist, approved applicants may spend many months waiting to receive benefits.

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