NH Choices For Independence Program

The Choices for Independence (CFI) Program addresses the needs of older adults and disabled individuals in New Hampshire who require assistance and support to continue living independently. This Medicaid-funded initiative, overseen by the New Hampshire Department of Health and Human Services (DHHS), offers a lifeline to eligible adults, providing them with diverse services to facilitate their ability to remain within their cherished homes and communities. At the heart of this program lies the recognition and appreciation of family caregivers who selflessly dedicate their time and effort to ensure their loved one's well-being. As we delve into the realm of CFI, we aim to advocate for caregivers, recognizing their invaluable contribution to the healthcare system and championing the notion that they deserve remuneration for their unyielding dedication.

Overview of Choices for Independence Program

The Choices for Independence (CFI) Program, a Medicaid-funded 1915(c) Home and Community-Based Services (HCBS) Waiver in New Hampshire, is specifically designed to cater to the needs of seniors and adults with disabilities at risk of nursing home admission. Its primary objective is to serve as a nursing home diversion program, providing an array of long-term services and supports (LTSS) to enable individuals to continue living in their homes and communities.

Program participants can reside in their home, a family member's home, an adult family home (adult foster care home), or a residential care facility (assisted living facility). They can access services through licensed agency providers or choose to self-direct their benefits, giving them the autonomy to hire friends or relatives, such as adult children or spouses, as caregivers. The financial aspects of this option are managed by a Financial Management Services Agency, handling responsibilities like tax withholding, background checks, and caregiver payments.

Notably, the CFI Program is not an entitlement program, meaning meeting eligibility requirements does not guarantee immediate access to benefits. Due to limited participant enrollment slots, a waitlist for program participation may form when these slots are full. Throughout this article, we will explore the significance of the CFI Program and advocate for the recognition and fair compensation of family caregivers, who play an integral role in supporting the elderly and disabled population in New Hampshire.

Eligibility Requirements for Choices for Independence (CFI) Program

To be eligible for the Choices for Independence (CFI) Program in New Hampshire, applicants must meet specific criteria related to age, disability, income, assets, home ownership, and medical need.

• Age and Disability Criteria: Applicants must be New Hampshire residents who are either seniors aged 65 and above or individuals between 18 and 64 years old with a disability. Individuals with disabilities can continue to receive CFI services even after turning 65.
• Financial Criteria: The Choices for Independence (CFI) Program in New Hampshire has specific financial criteria for eligibility. For individual applicants, the income limit is $2,742 per month, which is 300% of the Federal Benefit Rate. The combined income limit for married couples applying together is $5,484 per month. When only one spouse applies, the individual income limit remains $2,742 per month, and the non-applicant spouse's income is not considered. Additionally, a Spousal Income Allowance of up to $2,465 per month allows the applicant spouse to transfer income to the non-applicant spouse. The Maximum Income Allowance depends on shelter and utility costs and stands at $3,716 per month. As for assets, the limit for single applicants is $2,500 in 2023, while married couples applying together have an asset limit of $5,000. In a married couple scenario, the non-applicant spouse can retain 50% of assets, up to $148,620, or all assets, up to $29,724, if below the 50% threshold.
• Home Ownership Criteria: The applicant's primary home is exempt (non-countable) for eligibility purposes under the following circumstances: (a) The applicant lives in the home or has the intent to return, and the home equity interest is no greater than $688,000 in 2023, (b) The applicant has a spouse, child under 21, or disabled/blind child living in the home.
• Functional Need: An applicant must require a Nursing Facility Level of Care (NFLOC) assessed by a registered nurse using the Medical Eligibility Assessment (MEA) instrument. Limitations in completing Activities of Daily Living (ADLs) such as bathing, dressing, eating, toileting, transferring, and continence are considered. Needing assistance with two or more ADLs qualifies for an NFLOC.

The CFI Program is not an entitlement program, and limited enrollment slots may result in waitlisting when capacity is reached. Furthermore, applicants should be cautious of asset transfers within 60 months of applying. Medicaid has a Look Back Rule and may impose a Penalty Period of Medicaid ineligibility for violating this rule.

Use this easy New Hampshire Medicaid Eligibility Test provided by the American Council on Aging.

Services and supports

Under the Choices for Independence (CFI) Program, a comprehensive range of home and community-based services and supports are available to eligible individuals, as indicated in their individualized service plans. These services aim to facilitate independent living and enhance the quality of life for program participants. Some of the services that can be accessed through CFI include:

• Adult Day Health Care
• Adult Family Care
• Community Transition Services: Assistance with the security deposit, utility set-up fees, and essential home appliances/furnishings, etc.
• Financial Management Services
• Home Health Aides
• Homemaker Services: Meal preparation, laundry, light housecleaning, essential shopping.
• Home Meal Delivery
• Home Modifications for safety and accessibility, e.g., wheelchair ramps, grab bars, widening doorways.
• Non-Medical Transportation
• Personal Care Assistance to help with bathing, dressing, eating, mobility, toileting, etc.
• Personal Emergency Response Systems
• Residential Care Facility Services / Assisted Living Services
• Respite Care: In-home and out-of-home care to relieve primary caregivers.
• Skilled Nursing Care
• Specialized Medical Equipment / Supplies
• Supported Employment
• Supportive Housing Services
• Vehicle Modifications for safety and accessibility.

While program participants can receive CFI Waiver services while residing in adult family homes or residential care facilities (assisted living residences), the program does not cover the cost of room and board in these living arrangements. The availability of self-directed options empowers participants to have greater control over their care, allowing them to choose services that best suit their unique needs and preferences.

Compensation for caregivers

As a Medicaid-funded initiative, the Choices for Independence (CFI) Program offers compensation for unpaid family caregivers. Through the CFI Program's self-directed option, eligible participants can hire friends or relatives, including adult children or spouses, as caregivers and pay them for their caregiving services. This compensation provides much-needed financial support to family caregivers, recognizing their invaluable contribution to the well-being of their loved ones. By compensating family caregivers, the program acknowledges their dedication and essential role in supporting elderly and disabled individuals to remain in their homes and communities, fostering a compassionate approach that promotes the overall welfare of caregivers and care recipients.

Learn more about Medicaid self-directed care >>

A note from Givers

If you are a caregiver in New Hampshire, determine if you qualify for payment under the CFI Program. Fill out this form today to assess your eligibility and receive the support you deserve for your selfless caregiving efforts.