Home Health Care in New Hampshire: Regulations, Payment & Workforce Guide

Home Health Agency Requirements in New Hampshire

New Hampshire requires home care agencies to obtain licensure from the Department of Health and Human Services (DHHS) Health Facilities Administration (HFA).

License Types

DHHS licenses various home care provider types including:

• Home Care Provider: Agencies providing non-medical personal care services and assistance with activities of daily living
• Home Health Agency: Agencies providing skilled nursing, therapy, and medical home health services
• Individual Home Care Service Provider: Individual providers meeting specific criteria under He-P 820

Application Requirements

Home care provider license applications require:

• Business registration with New Hampshire Secretary of State
• EIN (Employer Identification Number) and tax identification
• Adequate liability insurance documentation
• Workers' compensation insurance (if applicable)
• Staff qualification verification including criminal background checks
• Administrator and caregiver certifications and training records
• Applicable licensing fees

Inspection and Compliance

DHHS may conduct inspections of agency physical locations to verify compliance with state standards for home care. The Health Facilities Administration enforces basic standards designed to promote safe and appropriate care.

License Renewal

Home Care Provider licenses must be renewed annually. Renewal requires:

• Submission of renewal application
• Updated documentation as required
• Payment of applicable renewal fees

2026 Paperless Transition

After March 1, 2026, paper fee coupons and CLIA certificates will no longer be available as DHHS transitions to paperless operations.

Contact Information

NH DHHS Health Facilities Licensing Unit:

• Address: 129 Pleasant Street, Concord, NH 03301
• Phone: (603) 271-9039
• Email: [email protected]
• Complaint Hotline: 1-800-621-6232

Licensed Nursing Assistant (LNA) Certification

New Hampshire is one of the few states that licenses rather than certifies nursing assistants. The Office of Professional Licensure and Certification (OPLC) oversees the Board of Nurses Education and Training, which manages LNA licensing.

Training Requirements

New Hampshire LNA training programs require:

• 90-106 hours of total training (varies by program)
• 45 hours of classroom-based learning minimum
• 45 hours of practical clinical experience minimum
• Costs typically range from $1,200 to $2,500

Curriculum Components

Training programs cover:

• Fundamental nursing techniques
• Infection prevention and control
• Effective communication skills
• Patient rights and ethics
• Hands-on clinical practice

Eligibility Requirements

• Minimum age: 18 years (most programs)
• High school diploma or GED required by many programs
• Criminal background check clearance

Licensure Pathways

Prospective LNAs may:

1. Complete a state-approved nursing assistant training program, or
2. Demonstrate equivalent training to the Board

Note: Candidates cannot take the examination without completing approved training in New Hampshire.

Certification Examination

The National Nurse Aide Assessment Program (NNAAP) consists of:

• Written examination: Tests knowledge of foundational nursing assistant concepts
• Practical skills evaluation: Candidates perform key LNA tasks under observation

Continuing Education

LNA license renewal requires:

• 12 contact hours annually of continuing education
• Workshops, conferences, lectures, or in-service educational offerings
• Content designed to enhance nursing assistant knowledge, judgment, and skills
• Successful completion of a state nursing assistant examination may fulfill CE requirements

Home Health Aide (HHA) Requirements

Home health aides in New Hampshire must meet competency requirements based on the employing agency type.

Medicare-Certified Agencies

HHAs working for Medicare-certified home health agencies must complete:

• 75 hours of training minimum
• 16 hours of supervised practical training
• Competency evaluation in required skill areas
• 12 hours of annual in-service training

State-Licensed Agencies

Personal care aides working for state-licensed home care providers must meet New Hampshire's standards for competency and supervision as outlined in applicable administrative rules.

New Hampshire Medicaid and Home Care Services

New Hampshire Medicaid provides coverage for home health services and supports community-based care through multiple programs.

2025-2026 Financial Eligibility

For HCBS Waiver programs:

Category	2025	2026
Income limit (single)	$2,901/month	$2,982/month
Income limit (married, both applying)	$5,802/month	$5,964/month
Asset limit (single)	$2,500	$2,500
Asset limit (married, both applying)	$5,000	$5,000
Community Spouse Resource Allowance	$157,920	$162,660

Look-Back Period

New Hampshire applies a 60-month look-back period to review applicants' financial history for asset transfers or below-market-value sales before the application date.

Title XX Services (2026)

Effective January 1, 2026, the monthly income limit for Title XX (Social Services Block Grant) services is $1,645.00 per person for both initial determinations and annual redeterminations.

Choices for Independence (CFI) Waiver

The Choices for Independence Waiver is New Hampshire's primary 1915(c) Home and Community Based Services waiver, previously called the Home and Community-Based Care Program for the Elderly and Chronically Ill Waiver.

Program Overview

CFI serves as a nursing home diversion program, providing long-term services and supports (LTSS) to enable individuals to remain in their homes and communities. The Bureau of Adult and Aging Services (BAAS) manages the waiver.

Current Waiver Period

The current CFI Waiver renewal covers 2022-2027. CMS requires states to renew 1915(c) waivers every five years.

Eligibility Criteria

To qualify for CFI services, individuals must:

• Be at least 18 years of age
• Be eligible for Medicaid
• Meet nursing facility level of care requirements
• Be at risk of nursing home admission

Available Services

CFI provides a wide range of services including:

• In-home services for personal care (eating, bathing, dressing)
• Household task assistance and meal preparation
• Medical equipment and home modifications
• Adult day services
• Respite care

Residential Settings

CFI participants may reside in:

• Their own home
• A family member's home
• Adult family homes (adult foster care)
• Residential care facilities (assisted living)

Self-Direction Option

New Hampshire's CFI waiver allows participants to self-direct their benefits, providing autonomy to:

• Hire caregivers of their choosing
• Include friends or relatives as paid caregivers
• Manage their service delivery and schedules

This self-direction option creates both opportunities and competition for traditional agency providers.

Important Considerations

CFI is not an entitlement program. Meeting eligibility requirements does not guarantee immediate program entry—enrollment slots are limited and waitlists may form when capacity is reached.

Other HCBS Waivers

New Hampshire operates additional waiver programs serving specific populations.

Acquired Brain Disorder (ABD) Waiver

Current waiver period: 2021-2025. Serves individuals with acquired brain injuries requiring specialized supports.

Developmental Disabilities (DD) Waiver

Current waiver period: 2021-2026. Provides comprehensive services for individuals with developmental disabilities.

In-Home Supports (IHS) for Children

Serves children with developmental disabilities. Waiver renewal covers 2026-2030.

Electronic Visit Verification (EVV)

New Hampshire implements EVV requirements in compliance with the 21st Century Cures Act.

Required Data Elements

New Hampshire's EVV system captures:

• Type of service performed
• Individual receiving the service
• Date and location of service delivery
• Individual providing the service
• Time service begins and ends

Provider Responsibilities

Agencies must integrate EVV with billing and scheduling systems and train staff on proper documentation to maintain compliance.

Medicare Home Health in New Hampshire

Medicare-certified home health agencies in New Hampshire must maintain both federal certification and state licensure.

Certification Requirements

Agencies must:

• Hold valid New Hampshire home health agency license
• Meet all federal Conditions of Participation
• Complete successful initial and periodic surveys
• Maintain ongoing compliance with quality standards

PDGM Operations

New Hampshire agencies operate under the Patient-Driven Groupings Model (PDGM) with 30-day payment periods. Success requires accurate OASIS assessment, appropriate clinical coding, and efficient visit utilization.

New Hampshire Labor Laws for Home Care

New Hampshire's labor laws largely follow federal standards, with some state-specific provisions affecting home care employers.

Minimum Wage

New Hampshire's minimum wage is $7.25 per hour, matching the federal minimum wage. The state has not enacted a higher state minimum.

Overtime Requirements

New Hampshire does not have separate state overtime provisions—federal FLSA standards apply:

• Non-exempt employees receive 1.5x regular rate after 40 hours per workweek
• Exempt salary threshold: $684 per week ($35,568 annually)
• Home care workers employed by agencies are generally covered by FLSA overtime rules

Home Health Care Nurse Overtime Exception

New Hampshire's prohibition against mandatory overtime does not apply to nurses working in home health care settings until another qualified nurse or customary caregiver relieves them. This exception recognizes the unique continuity-of-care requirements in home settings.

Voluntary Paid Family and Medical Leave (NH PFML)

New Hampshire offers a voluntary Paid Family and Medical Leave program:

• Benefit: Up to 6 weeks per year of paid leave
• Coverage: Absences for covered common life events
• Employer participation: Voluntary—employers choose whether to offer PFML
• All employers have certain responsibilities regarding the program even if not participating

Workers' Compensation

New Hampshire requires workers' compensation coverage for employees. Home care agencies must maintain appropriate coverage for caregiving staff.

Workforce Challenges and Strategies

New Hampshire agencies face workforce dynamics shaped by low unemployment, proximity to Massachusetts wage competition, and self-direction program alternatives.

Key Challenges

• Federal minimum wage: $7.25 minimum creates recruitment challenges against higher-paying states
• Massachusetts competition: Border workers may commute to higher-wage Massachusetts positions
• Self-direction competition: CFI self-direction allows consumers to hire caregivers directly
• Annual LNA continuing education: 12-hour annual CE requirement adds compliance burden
• Rural geography: Significant portions of the state require extended travel for care delivery

Effective Strategies

• Competitive wages: Pay significantly above minimum wage to compete with border state opportunities
• Leverage licensing distinction: Market LNA credential as professional license (not just certification)
• CE support: Provide or subsidize continuing education to ease renewal burden
• Self-direction partnerships: Consider offering fiscal intermediary services for self-directing consumers
• Training pipeline: Partner with community colleges and hospital-based LNA programs
• Mileage reimbursement: Competitive travel compensation for rural coverage

Retention Best Practices

• Wages substantially above $7.25 federal minimum
• Benefits packages differentiating from self-employment options
• Career advancement from LNA to LPN to RN
• Continuing education stipends or in-house training programs
• Recognition programs celebrating worker contributions

Resources and Links

• DHHS Health Facilities Administration
• Health Facilities Administrative Rules
• OPLC LNA Applications
• Board of Nurses Education and Training
• Home and Community Based Care
• CFI Waiver 2022-2027
• NH DOL Wages and Hours FAQs

The Bottom Line

New Hampshire's home health care environment combines a distinctive Licensed Nursing Assistant credential with robust consumer self-direction options through the Choices for Independence waiver. The federal minimum wage floor creates both challenges and opportunities for agencies willing to compete on compensation and professionalism. Success in the Granite State requires understanding the LNA licensing distinction, leveraging the CFI waiver's service options, and building competitive workforce practices that attract workers who might otherwise choose self-employment or cross-border opportunities.