Self-Direction and FMS in New Hampshire

All states: self-direction map

New Hampshire self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in New Hampshire offer self-direction?

New Hampshire offers self-direction in four 1915(c) Medicaid waivers and in a State Plan personal care attendant benefit. The state calls self-direction Participant Directed and Managed Services (PDMS). PDMS is a way of delivering services inside each waiver, not a separate program. In all four waivers the participant has both employer authority and budget authority.

• Choices for Independence (CFI) Waiver, PDMS: serves adults 65 and older and adults 18 to 64 with physical or other disabilities who meet nursing facility level of care. It is run by the Bureau of Adult and Aging Services (BAAS, formerly the Bureau of Elderly and Adult Services) at the New Hampshire Department of Health and Human Services (DHHS). The participant has employer authority and budget authority. Under rule He-E 801, PDMS can be used for any CFI waiver service except residential care facility services, and a participant can mix PDMS with agency-directed services.
• Developmental Disabilities (DD) Waiver, PDMS: serves people of all ages with intellectual or developmental disabilities, including autism, who meet the level of care for an intermediate care facility. It is run by the DHHS Bureau of Developmental Services (BDS) and delivered through ten designated Area Agencies. The participant has employer authority and budget authority. PDMS is available statewide.
• Acquired Brain Disorder (ABD) Waiver, PDMS: serves adults 22 and older with an acquired brain disorder who meet nursing facility level of care. It is run by BDS and delivered through the Area Agencies. The participant has employer authority and budget authority.
• In Home Supports (IHS) Waiver for Children with Developmental Disabilities, PDMS: serves children and young people from birth to 21 with autism or intellectual or developmental disabilities who live at home with family. It is run by BDS and delivered through the Area Agencies. The family has employer authority and budget authority, and can also choose to hand both to the Area Agency.
• Medicaid State Plan Personal Care Attendant (PCA) Services: serves adults 18 and older who are their own guardian, use a wheelchair for mobility on a long-term basis, are able to self-direct, and need at least 2 hours of PCA services a day. It is run by New Hampshire Medicaid, through managed care plans for most members, and enrolled PCA service providers. The recipient selects, directs, supervises and manages the attendant. We did not find a statement on whether the recipient has budget authority.

Employer authority means the participant recruits, hires, schedules and supervises the workers. Budget authority means the participant also manages a set amount of money for services. DHHS has no single web page for self-direction. The rules sit in the waiver applications, state rules, and guidance such as the BDS guidance on PDMS (January 2023), which covers the DD, ABD and IHS waivers. We could not confirm which individual services in each waiver carry employer or budget authority, so ask the bureau that runs the waiver if you need a service-by-service answer.

Who handles financial management services (FMS) in New Hampshire?

It depends on the waiver. For the DD, ABD and IHS waivers, the ten state-designated Area Agencies are the only organizations allowed to provide financial management services. For the CFI waiver, any qualified organization enrolled as a New Hampshire Medicaid provider can do it, and GT Independence is one that serves CFI. In every waiver the participant can choose between two models, and that choice decides who the legal employer is.

New Hampshire offers both common FMS models. In the Fiscal/Employer Agent model, the participant (or a person the participant names) is the employer, and the FMS organization acts as the employer's agent for payroll and taxes. In the Agency with Choice model, which the DD waiver calls Agency of Choice, the FMS organization and the participant share the employer role. The participant acts as the managing employer who directs the worker day to day.

• DD, ABD and IHS waivers: an Area Agency is one of ten regional nonprofit agencies the state designates to deliver developmental services. The Area Agencies are the only entities allowed to furnish FMS in these three waivers, and FMS is paid as a Medicaid administrative activity, not as a waiver service. Under Fiscal/Employer Agent the participant or a chosen representative is the employer. Under Agency of Choice the Area Agency and the participant are joint employers.
• IHS waiver only: there is a third option, Agency with Choice with agency management, where the family hands its budget and employer authority to the Area Agency.
• CFI waiver: the CFI waiver lets any willing and qualified entity furnish FMS once it is enrolled with New Hampshire Medicaid. Here FMS is a waiver service, billed monthly. GT Independence says it serves CFI participants. The state publishes no current list of enrolled FMS providers, so we did not find who else is enrolled. Ask BAAS at 603-271-9203.
• CFI employer: the state's FAQ on PDMS and FMS says the participant picks a model when enrolling with the FMS provider and can switch later on request. The participant or a person they designate is the employer of record under Fiscal/Employer Agent. Under Agency with Choice the FMS provider is the employer of record and the participant manages the worker's performance.
• State Plan PCA services: there is no separate FMS entity. The attendant is an employee of, or under contract with, the enrolled personal care service provider, while the recipient selects and manages the attendant.

In CFI the participant sets each worker's pay inside the budget. The FMS provider supplies a list of maximum rates for each service, and a higher rate needs prior approval from the bureau chief. The CFI FMS provider also buys workers' compensation coverage and runs criminal record checks.

Who can be a paid caregiver under self-direction in New Hampshire?

Relatives can be paid in New Hampshire's waivers, but the limits differ by program and are not all clear. In CFI, the state says spouses and authorized representatives can become paid providers under PDMS, while guardians and people who hold a durable power of attorney cannot. In the IHS waiver a parent can be paid only under extraordinary conditions. In State Plan PCA services, family members cannot be paid at all.

• CFI: the waiver says the state pays legally responsible persons for personal care and similar services when the individual is directing services under participant direction and chooses that arrangement, or when extraordinary care or a lack of other providers applies. The state FAQ says spouses and authorized representatives can become providers under PDMS, and that durable powers of attorney and guardians cannot. Rule He-E 801 also bars the legal guardian or power of attorney agent from providing personal care services.
• IHS: the IHS waiver lets a parent or legal guardian be paid for In Home Residential Habilitation only when the child has high dependency, complex medical needs or serious behavioral needs, and the parent cannot find qualified providers or cannot keep paid work because of the child's care needs.
• DD: the DD waiver says that when relatives or legal guardians are paid for direct support, they are contracted or employed as providers of the provider agency. We did not find a readable answer on whether legally responsible individuals, such as a spouse or the parent of a minor, can be paid. Ask BDS at 603-271-5034.
• ABD: we did not find the paid family rules for the ABD waiver. Ask BDS or the participant's Area Agency.
• State Plan PCA services: the attendant may not be a family member of the recipient. That covers a spouse, parent, stepparent or sibling, and a grandparent, aunt or uncle who lives in the same household.

A separate state law, RSA 161-I:3-a, lets DHHS authorize payment to a legally responsible family member, guardian or power of attorney holder for medically necessary personal care at home, when need, a lack of other providers and cost savings justify it. We did not find a weekly hour cap for self-directed workers in any of these programs. In CFI, overtime can be requested for short-term changes in need.

Does EVV apply to self-directed workers in New Hampshire?

Partly. Electronic visit verification (EVV) applies to self-directed services in the CFI waiver and to State Plan personal care when they are delivered in the home. No DD, ABD or IHS waiver service is on the state's EVV services list, so EVV does not currently apply to self-direction in those three waivers. Claims are not yet denied for missing EVV.

• Which services: the state's EVV services list (May 2026) includes CFI PDMS personal care, home health aide, skilled nursing and respite, a separate CFI row for consumer directed personal care, and State Plan personal care.
• Whose system: visits are recorded in the state's free AuthentiCare system (Fiserv), or in a third-party EVV system that sends its data to AuthentiCare. The state's EVV FAQ says fiscal intermediaries get the same training as other providers and describes no separate EVV path for FMS.
• Live-in caregivers: a live-in caregiver who is paid as live-in is exempt. Personal care billed by the hour or by the unit still needs EVV, even when the caregiver lives with the member.
• Does payment depend on it: not yet. As of the September 17, 2026 provider meeting, the edit that would deny claims without EVV had not started, and DHHS has promised at least 30 days of notice before it does.
• DD, ABD and IHS waivers: the DD and IHS waiver applications say personal care and respite are subject to EVV, that no approved system was in place by the federal deadline, and that the state has been paying the federal penalty. In the DD waiver, payment to the worker or agency depends on the individual or guardian signing to verify that the service was delivered.

Two points could not be confirmed. We did not find a statement on whether CFI self-directed workers record visits directly in AuthentiCare or in an FMS provider's own app that feeds it. We also did not find a date for bringing DD, ABD and IHS waiver services under EVV. For CFI questions ask BAAS, and for the other waivers ask BDS.

What is changing next for self-direction in New Hampshire?

We did not find a published upcoming change to self-direction in New Hampshire as of our last check. Two waivers are in the middle of renewal, and neither has published changes to PDMS. The two most recent renewals kept the current setup.

• ABD waiver renewal: the current approval runs through October 31, 2026. DHHS took public comment on a draft renewal for 2026 to 2031 in spring 2026 and said it expected to finish in the fall. We could not confirm that the renewal has been approved, so check the BDS waiver page for its status.
• CFI waiver renewal: the current approval runs through June 30, 2027. DHHS has started work on a renewal for 2027 to 2032 with informal listening sessions. No draft changes to participant direction have been published yet. Updates are posted on the CFI renewal page.
• CFI class action notice: the same page carries a notice of a proposed class action settlement, Fitzmorris v. Commissioner, that may affect current and former CFI participants. We did not review its terms and do not know whether it touches participant direction.
• EVV: DHHS has said claim denials for missing EVV will start only after at least 30 days of notice. No start date has been published.

Already in effect: the DD waiver renewal was approved on July 21, 2026 and took effect September 1, 2026 for five years. It keeps PDMS, both employer models and Area Agency FMS. The IHS waiver renewal took effect January 1, 2026. A CFI amendment on rate methodology and medical eligibility took effect July 1, 2026, and DHHS said it does not reduce services.

New Hampshire self-direction sources

• NH DHHS: Choices for Independence waiver application (amended, effective July 1, 2026)
• NH DHHS: Developmental Disabilities waiver application
• NH DHHS: In Home Supports waiver application (2026 to 2030)
• NH DHHS Bureau of Developmental Services: PDMS guidance (January 2023)
• NH DHHS: FAQ on PDMS and FMS in Choices for Independence
• New Hampshire administrative rules: He-E 800 (includes He-E 801, Choices for Independence)
• NH DHHS: EVV services list (May 2026)
• NH DHHS: EVV general FAQs
• NH DHHS: Choices for Independence Waiver Renewal and Amendments 2022-2032

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• New Hampshire EVV requirements

Page history

• October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.