GuideHome health vs home care vs consumer-directed care in New Hampshire
What each kind of program is, who employs the caregiver and when a family member can be paid.
Home health: the medical benefit
In New Hampshire, skilled home health is Home Health Services (NH Medicaid). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.
Only a licensed home health agency enrolled with New Hampshire Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.
Home care: non-medical personal care through an agency
Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In New Hampshire the agency route is Choices for Independence Waiver (agency-delivered services) (CFI). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.
The agency recruits, trains, schedules and pays the aides, and it is the employer. Choices for Independence Waiver (agency-delivered services) (CFI) lets the agency hire a family member as the aide, with the agency still the employer.
Consumer-directed care: the person hires their own aide
New Hampshire's consumer-directed option is Participant Directed and Managed Services (CFI) (PDMS). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.
This is the route most families use to be paid: Participant Directed and Managed Services (CFI) (PDMS) allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.
Structured family caregiving: a paid live-in family caregiver
New Hampshire has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Participant Directed and Managed Services (CFI) (PDMS)), by the hour, as the participant's chosen aide.
Other ways New Hampshire pays for care at home
Adult family care: Adult Family Care (CFI) (AFC). The person lives in a family or foster home that is paid to provide housing and daily care.
State-funded: Title XX and State-Funded In-Home Services (BAAS). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.
Which one fits
- Needs nursing, wound care, injections or therapy at home: home health (Home Health Services (NH Medicaid)).
- Needs daily help and wants an agency to supply and manage the aide: Choices for Independence Waiver (agency-delivered services) (CFI).
- Wants to choose the aide, including a relative where allowed: Participant Directed and Managed Services (CFI) (PDMS).