New Hampshire’s Choices For Independence Waiver (formerly Elderly and Chronically Ill Waiver)
What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
This program provides support to help New Hampshire residents live at home or in assisted living communities instead of nursing homes.
This New Hampshire Medicaid program is designed to help adults with chronic illnesses and the elderly. It does so by providing services and support for individuals that are clinically eligible for nursing home placement, but choose to remain living in the community or at home. The definition of "community" under this waiver is broad and includes many types of non-nursing home care such as Assisted Living, Residential Care Homes, Adult Foster Care and other types of Supportive Housing.
Services and support are provided to individuals at these places of residence provided the costs of services do not exceed a certain percentage of what the costs would otherwise be if they were provided in a nursing home. A complete list of possible services is located further down this page. Most popular among them is personal care and support for home modifications to increase the participant's independence.
Choices For Independence offers participants a degree of consumer direction or self-direction in which they are able to choose some of their care service providers. This applies largely to unskilled or custodial care services.
The waiver was formerly referred to as the Elderly and Chronically Ill Waiver or the HCBC-ECI Waiver. This is New Hampshire's sole waiver which specifically targets the elderly population. It is under the administration of the New Hampshire Bureau of Elderly and Adult Services.
New Hampshire has complicated and frequently changing eligibility guidelines. Some of these requirements change depending on the age, level of impairment or marital status of the applicant.
- Age - In absolute terms, applicants must be at least 18 years of age. However, persons between the ages of 18 and 64 must be officially designated as disabled by Social Security. Disability is not a requirement for those 65 and older.
- Level of Impairment - Applicants must be disabled, if under 65 or require nursing home level care if 65 or older.
- Income - Applicants must meet the requirements for NH Medicaid. This factor is again impacted by age. In 2016, for seniors, both their income and their monthly medical and care expenses are taken into consideration. If their monthly income exceeds their expenses by less than $591, they are eligible. Alternatively, in absolute terms, those with income less than $1,214 will qualify.
- Assets - single applicants must have less than $2,500 in countable resources. Married couples with both spouses applying can have up to $4,000. Married applicants whose husband or wife is not receiving Medicaid, can transfer joint assets to the non-applicant up to a value of $119,220. An owner-occupied home with home equity valued up to $552,000 can be excluded from countable assets.
Persons Exceeding these Limits - can transfer excess income into qualifying income trusts and convert countable assets into exempt ones. This is called Medicaid planning and may require assistance from persons expert in Medicaid rules Learn more.
Benefits and Services
Under Choices for Independence, a large number of supports, services and assistance are available. The purchase of some of the following goods and services can be self-directed.
- Adult Day Care
- Adult Family Care
- Assistive Technology
- Case Management
- Chore Services
- Community Transition Assistance
- Environmental Accessibility for Homes and Vehicles
- Home Delivered Meals
- Home Health Services
- Homemaker Provides
- In-Home Care
- Meal Preparation
- Medical Day Services
- Personal Care Assistance
- Personal Emergency Response Service
- Residential Care
- Respite Care for the Caregiver
- Shared Housing
- Specialized Durable Medical Equipment
The total value of the services received by a program participant cannot exceed 50% - 60% of what those services would otherwise cost were the participant to reside in a Medicaid funded nursing home.
How to Apply / Learn More
To begin the application process, one can call 1-866-634-9412, use this online form or contact their local area agency on aging.
The administering body for this waiver is the NH Dpt. of Health and Human Services, Division of Community Based Care Services, Bureau of Elderly and Adult Services (BEAS). The waiver is available statewide and there is no waiting lists for services.
One can also download a brochure.