I/DD Waivers in New Hampshire

All states: Medicaid disability services map

New Hampshire I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in New Hampshire?

The Bureau of Developmental Services (BDS), part of the NH Department of Health and Human Services (DHHS), runs the state's I/DD waivers for the Medicaid program. Day to day, people reach services through ten regional Area Agencies, which handle intake and eligibility. Case management, called service coordination, is done by service coordination agencies the person chooses.

• Bureau of Developmental Services (BDS): the DHHS unit that operates the Developmental Disabilities (DD) and In Home Supports (IHS) waivers. It also runs the Acquired Brain Disorder (ABD) waiver through the same network.
• Area Agencies: ten nonprofit corporations, one for each region (Regions I to X), that BDS redesignates on a five-year cycle. Each one takes applications, decides eligibility for developmental services and keeps a registry of the service needs people expect over the next five years, under rule He-M 500. Area Agencies are also the only financial management service (FMS) entities for self-directed services.
• Service coordination: a waiver service provided by a service coordination agency the person picks. Rule He-M 503.08 bars a service coordinator from working for an agency that also provides the person's direct services. BDS can grant a one-year exemption when no other qualified agency is willing, the person agrees, and the agency keeps the two functions in separate departments and locations.
• Conflict-free case management: DHHS reports that New Hampshire reached full compliance with federal rules on conflict-free case management and provider direct billing, work that ran from 2016 to 2023.

We did not find a current official list of the ten Area Agencies with contact details. Families can ask BDS at 603-271-5034 which Area Agency serves their town.

What Medicaid waivers serve people with I/DD in New Hampshire?

New Hampshire has two 1915(c) waivers for people with I/DD: the Developmental Disabilities (DD) Waiver and the In Home Supports (IHS) Waiver for children. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. Both waivers serve people with autism, intellectual disability or another developmental disability who meet the level of care for an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), the institutional option these waivers replace.

• Developmental Disabilities (DD) Waiver (1915(c), control number NH.0053.R08.00): serves people of any age who are found eligible by an Area Agency, mainly adults who have left school. CMS approved its renewal on July 21, 2026, for September 1, 2026 through August 31, 2031. Services include residential habilitation (agency residences, family residences and the family home), supported independent living, community participation services (day services), supported employment, respite, service coordination, community integration, crisis response, assistive technology, environmental and vehicle modifications, individual goods and services, non-medical transportation, personal emergency response, specialty services, wellness coaching and removable prosthodontics. Rule He-M 517 covers its services, and services are offered based on available funds. DHHS reported an average cost of about $73,739 per person per year in February 2025.
• In Home Supports (IHS) Waiver for Children with Developmental Disabilities (1915(c), control number NH.0397.R05.00): serves children and young people from birth through age 21 who live at home with family and have not graduated or left school. The current waiver period runs 2026 to 2030, effective January 1, 2026, under rule He-M 524. Services include in-home residential habilitation (including personal care), respite, service coordination, community integration, consultations, assistive technology, environmental and vehicle modifications, individual goods and services, non-medical transportation, personal emergency response and wellness coaching. DHHS describes it as family directed, with an average cost of about $14,820 per year.

Related program: the Acquired Brain Disorder (ABD) Waiver (NH.4177.R06.00) is run by BDS through the same Area Agencies and providers, so many I/DD agencies serve it too. It is for adults 22 and older with a brain disorder acquired before age 60 who meet nursing facility level of care, so it is not counted here as an I/DD waiver.

Waiver services cannot be paid to the parent of a person under 18 or to a spouse, with a narrow exception for spouses in the ABD waiver. In the IHS waiver, parents can be paid for in-home residential habilitation only under extraordinary conditions.

Does New Hampshire pay for I/DD services through managed care?

No. State law, RSA 126-A:5, XIX(i), says the DD, In Home Supports, ABD and Choices for Independence waivers shall not be moved into the Medicaid managed care program. Enrolled providers bill NH Medicaid directly, fee-for-service, through the state's Medicaid Management Information System (MMIS).

• Who pays claims: NH Medicaid pays enrolled providers directly. A provider can instead contract with an organized health care delivery system (OHCDS), which bills Medicaid on the provider's behalf (pass-through billing).
• Who coordinates services: Area Agencies handle intake and eligibility, and service coordination agencies chosen by the person plan and coordinate services.
• Other federal authority: CMS lists the DD waiver as operating with concurrent 1915(b)(1) and 1915(b)(4) authority, which are federal waiver options that can run alongside a 1915(c) waiver. We did not find a state description of how New Hampshire uses them. They do not put people into managed care plans.

Is there a waiting list for I/DD services in New Hampshire?

New Hampshire reports no one waiting. The DHHS Operating Statistics Dashboard, filed with the legislature's Fiscal Committee for its August 2026 meeting, showed 0 people on the DD, ABD and IHS waitlists in every month through June 2026. State law also sets a 90-day limit on how long a person can wait for funding.

• The 90-day rule: RSA 171-A:1-a requires no more than 90 days between completing a person's individual service agreement and the department allocating funds. For students leaving school, funding must be allocated 90 days before they exit.
• What the dashboard counts: the DD waitlist on the dashboard covers school leavers, newly eligible people and people who need more services.
• Registry of service needs: each Area Agency keeps a registry, in the department's database, of the services people are expected to need over the next five years. This is a planning list, separate from the waitlist count.

We did not find a published priority order for allocating funds. For a person's status, families can ask their Area Agency or BDS at 603-271-5034.

How do people apply for I/DD services in New Hampshire, and how are budgets set?

A person, or their guardian or authorized representative, applies in writing to the Area Agency for the region where they live. The Area Agency screens for a developmental disability that began before age 22 and must decide eligibility within 15 business days of a complete application. Waiver planning then uses the Supports Intensity Scale (SIS-A) and a health risk screen.

• Eligibility for developmental services: decided by the Area Agency under RSA 171-A after a comprehensive screening evaluation.
• Eligibility for a waiver: the person must also be Medicaid eligible and meet ICF/IID level of care. Within 5 business days of the person deciding to seek waiver services, the Area Agency submits the BDS functional screen through NH Easy, the state's online benefits system. Level of care is checked again every year.
• Supports Intensity Scale-Adult Version (SIS-A, 2023 edition): required for people 16 and older, given within 60 days of waiver eligibility, then every five years or after a significant change.
• Health Risk Screening Tool (HRST): done at eligibility and every year. People who need residential services also get personal safety assessments.
• Budgets: DHHS is building new rates tied to SIS-A need levels (see the last section). We did not find a published formula that turns an assessment into an individual budget today.

What day and residential services can I/DD providers offer in New Hampshire?

Providers can offer two day and employment services and several residential options. Day services are certified by DHHS and billed in 15-minute units, and residential habilitation is paid at a daily rate. The research did not find a published staff ratio for any day service.

Day and employment services

• Community participation services (DD and ABD waivers): New Hampshire's day service. It builds daily living, social, safety and community skills, and covers vocational exploration, volunteering and community activities, including transportation from home. It can be delivered at a central site or in the community. Unspecified community activities may not exceed 20% of a person's weekly hours. Programs must be certified by the DHHS Bureau of Health Facilities Administration under rule He-M 507. A provider serving 3 or more people who are not Area Agency eligible must also hold an adult day program license under RSA 151 and He-P 818. Billed in quarter hours. Rule He-M 507 does not set a staff ratio.
• Supported employment (DD and ABD waivers): help to get, improve or keep a job, including job development, on-the-job training, assistive technology referrals and transportation to work when combined with another employment service. Provided under rule He-M 518, and only when the same service is not funded by the NH Department of Education's vocational rehabilitation bureau. Billed in quarter hours.

Residential services

• Agency residences and family residences (DD and ABD waivers): residential habilitation with daily support for living skills, medication management, community inclusion and transportation. An agency residence is staffed by a provider agency. A family residence is run by a person or family who lives there under contract with a provider agency, New Hampshire's version of host homes or shared living. Homes are certified under rule He-M 1001 (current rule effective May 23, 2025), and a home serving 4 or more people must also be licensed under RSA 151 and He-P 814.
• Residential habilitation in the family home (DD waiver): for adults 18 and older living in their family's home, certified under He-M 521. Self-directed residential supports are certified under He-M 525.
• Supported independent living (DD waiver): support, not including room and board, for a person in their own home who is building skills to live on their own. He-M 1001 treats an independent living arrangement, with no daily ongoing supervision, as separate from a certified community residence. In the ABD waiver the similar service, community support, may not exceed 30 hours a week.
• In-home residential habilitation (IHS waiver): habilitation and personal care for a child or young adult living at home, often directed by the family through PDMS.

How are I/DD provider rates set and how do agencies enroll in New Hampshire?

New Hampshire pays from a state-set Medicaid fee schedule by procedure code. Residential habilitation is paid at a daily rate, and community participation, supported employment, respite and crisis response are paid in quarter hours. Agencies enroll as NH Medicaid providers through the MMIS provider portal and must also meet BDS requirements.

• Latest rate change: DHHS reported a 7% reimbursement increase for many key developmental services, adding $49.2 million in total funds ($24.6 million state general funds), in its February 2025 budget presentation.
• Rates being rebuilt: DHHS hired Myers and Stauffer, a consulting firm, to build cost-based rates centered on direct care wages and tied to SIS-A need levels. See the next section for the planned timing.
• Enrollment steps: enroll through the NH MMIS provider portal, request a BDS screening, meet the license or certification for each service (for example He-M 507 for day services or He-M 1001 for residences), and sign a Medicaid provider participation agreement. A provider can instead contract with an OHCDS for pass-through billing.
• EVV: electronic visit verification (EVV) does not yet apply to I/DD waiver services. The state's May 2026 EVV services list, used with the state's AuthentiCare system, includes Choices for Independence and State Plan services but no DD, IHS or ABD waiver services. The waivers say personal care and respite are subject to EVV and that the state has been paying the federal penalty for not yet requiring it.

What is changing next for I/DD services in New Hampshire?

The main change ahead is new rates. DHHS planned to phase in cost-based developmental services rates tied to SIS-A need levels, in steps through September 2027, subject to budget approval. These are plans, not confirmed decisions.

• New rates (planned): in February 2025 DHHS described three phases, planned for January 2026, January 2027 and September 2027. We did not find confirmation that the first phase took effect, or that the later phases are still on schedule. Providers should ask BDS for current rate notices.
• DD waiver renewal (in effect): the renewed DD waiver took effect September 1, 2026 and runs through August 31, 2031. We did not find a summary of what changed in the renewal.
• ABD waiver renewal (pending): CMS shows the current ABD waiver ending October 31, 2026. A 2026 to 2031 renewal went out for public comment in spring 2026, but we did not find CMS approval as of October 23, 2026.
• EVV for DD and IHS services: the state has not published a date for bringing personal care and respite in these waivers under EVV.

New Hampshire I/DD sources

• NH DHHS: Developmental Services (Bureau of Developmental Services)
• CMS: New Hampshire waiver fact sheet
• CMS: New Hampshire Developmental Disabilities Waiver (NH.0053.R08.00)
• NH Administrative Rules: He-M 500 (developmental services)
• NH Administrative Rules: He-M 1000 (community residences)
• NH RSA 126-A:5 (waivers excluded from Medicaid managed care)
• NH RSA 171-A:1-a (90-day funding limit)
• NH Fiscal Committee item FIS 26-152: DHHS Operating Statistics Dashboard (August 2026)
• NH DHHS budget presentation to House Finance Division III (February 10, 2025)
• NH DHHS: EVV services list (May 2026)

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• New Hampshire EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.