NH Medicaid CFI – December 2017 Provider Participation & Ongoing Responsibilities 2-1 2. Provider Participation & Ongoing Responsibilities The Choices for Independence (CFI) program is a Medicaid Home and Community Based Care (HCBC) waiver program formerly known as the Home and Community Based Care for the. Information about Medicaid Excess Income ('Spenddown' or 'Surplus Income') Program. Medicaid Excess Income ('Spenddown' or 'Surplus Income') Program. The Medicaid Excess Income program is sometimes referred to as the 'Spenddown program' or the 'Surplus Income program'. Here we will be referring to it as the Excess Income program.
Page Reviewed / Updated - Feb. 2019
Program Description
Personal Care Attendant Services (PCAS) are provided via the state Medicaid plan for physically disabled residents of New Hampshire. While one must be wheelchair-bound the majority of the time, this program is still relevant for aging seniors, as some conditions that become more common with aging, such as rheumatoid arthritis and strokes, can qualify one for this program. Personal Care Attendants provide assistance with the Activities of Daily Living (ADLs), such as personal hygiene, dressing, mobility, and transferring, as well as aid with Instrumental Activities of Daily Living (IADLs), such as the preparation of meals, laundry, and grocery shopping. Health maintenance support, such as medication administration and incontinence (the inability to control one’s bladder or bowel movements) care, is also provided. These services are intended to promote seniors’ independence and to help avoid nursing home placement until absolutely necessary. Services may be provided in one’s home, the home of a relative, or an adult foster care home.
Applicants are able to self-direct their own care, which means they are able to hire and manage the personal care attendant of their choosing. Friends can be hired to provide care, but relatives cannot be hired. However, personal care attendants must go through an Attendant Care Education Orientation run by the Center for Independent Living, Granite State Independent Living (GSIL). Personal care attendants are under the authority of a GSIL registered nurse.
Eligibility Guidelines
To receive PCAS through New Hampshire’s state Medicaid plan, one must first be enrolled in Medicaid. For seniors (65 years of age and older) the income limit, as of 2019, is $785 / month, and the asset (resource) limit is $1,500 / month. While the asset limit might seem low, one’s home (up to an equity value of $585,000, as of 2019) is exempt if the applicant or the applicant's spouse lives in it. Other exemptions include household furnishings, pre-paid burial plans, a life insurance policy with a face value up to $1,500, and an automobile.
For those over the income and asset limits, it’s possible to still qualify for Medicaid. The state of New Hampshire has a Medically Needy Pathway, which means those who have high, recurring medical bills can deduct these bills from their monthly income, effectively lowering their countable income. It's important to note that the medically needy income limit is different from the income limit above. As of 2019, the Medically Needy Pathway limits one's monthly income to $591 after medical deductions.
Seniors who are over the income and / or asset limit(s) are highly encouraged to seek the counsel of a professional Medicaid Planner, who can assist in reallocating income and assets in order for one to qualify for Medicaid.
Other qualifications of the PCAS program are as follows:
- Be a minimum of 18 years old
- Be legally responsible for oneself
- Be 80% wheelchair-bound (an assessment will be done for determination)
- Be able to direct one’s own care
- Not be institutionalized (in a nursing home, for example)
- Require assistance with a minimum of 2 of 7 ADLs (These ADLs include bathing/grooming, toileting, getting dressed/undressed, eating, mobility, passive range of motion exercise, and taking medication)
- Need a minimum of two hours / day of personal attendant services that is medically oriented, but do not require 24-hour care
Benefits and Services
Up to approximately 40 hours / week of personal attendant care can be provided via this program. Personal care attendants provide health maintenance support (bowel/bladder care, ostomy care, administering of medications, etc.) and assistance with ADLs and IADLs (bathing, dressing, grooming, shaving, nail care, oral hygiene, using the toilet, transferring from a lying position to a seated position, medication assistance, light housekeeping, shopping for groceries).
Program participants are able to hire and train the personal care attendant from which they would like to receive services. This benefit is referred to as Consumer Directed or Participant Directed.
How to Apply / Learn More
Applicants for the Personal Care Attendant Services Program must first be enrolled in Medicaid. To apply for Medicaid, persons need to contact their local New Hampshire Department of Health and Human Services’ office.
To learn more about the Personal Care Attendant Services Program, click here. One can also call Granite State Independent Living at 603-228-9680 or 800-826-3700 for additional information or to apply (if already on Medicaid) for PCAS. Registered nurses from GSIL determine functional eligibility for Personal Care Attendant Services.
February 1, 2019
CMS Approves Request to Amend New Hampshire's Building Capacity for Transformation Waiver
The Centers for Medicare & Medicaid Services (CMS) has approved New Hampshire's request to amend to its section l l l 5(a) demonstration titled, 'Building Capacity for Transformation' (BCT) (Project Number l l-W-00301/1). With this approval, the state will replace one existing Designated State Health Program (DSHP) authorized in the Special Terms and Conditions (STC) with three different ones- there are no changes to the DSHP spending limits that were already approved/established- it only replaces the DSHPs for which the state may currently draw federal financial participation (FFP). The BCT demonstration will remain in effect through December 31 , 2020.
- Read the Approval Letter and STCs
- Read Commissioner Meyers' Acceptance Letter (February 5, 2019)
NH DSRIP Waiver Program
By providing funding to support delivery system transformation—rather than to cover the costs of specific services rendered by providers—the waiver will enable health care providers and community partners within a region to form relationships focused on transforming care. This funding will also provide prompt resources for combating the opioid crisis and strengthening the state's strained mental health delivery system.
- Transforming How New Hampshire Responds to the Opioid Crisis
New Hampshire DSRIP Waiver Program Presentations
- NH DSRIP Annual Report 2018 (03/08/2019)
- DSRIP Progress – Year 1 (05/15/2017)
- APMs in New Hampshire Medicaid
- Introduction to Alternative Payment Models
NH DSRIP IDN Semi-Annual Reports and Implementation Plans
Reporting Period July 1, 2018 – December 31, 2018
- IDN 1: Greater Monadnock, Greater Sullivan County, Upper Valley Region Semi-Annual Report (8MB)
- IDN 2: Capital Area Region Semi-Annual Report (1MB)
- IDN 3: Greater Nashua Region Semi-Annual Report (8MB)
- IDN 4: Greater Derry, Greater Manchester Region Semi-Annual Report (13MB)
- IDN 5: Central NH, Winnipesaukee Region Semi-Annual Report (17MB)
- IDN 6: Strafford County, Seacoast Region Semi-Annual Report (6MB)
- IDN 7: North Country, Carroll County Region Semi-Annual Report (4MB)
Reporting Period January 1, 2018 – June 30, 2018
- IDN 1: Greater Monadnock, Greater Sullivan County, Upper Valley Region Semi-Annual Report
- IDN 2: Capital Area Region Semi-Annual Report
- IDN 3: Greater Nashua Region Semi-Annual Report
- IDN 4: Greater Derry, Greater Manchester Region Semi-Annual Report
- IDN 5: Central NH, Winnipesaukee Region Semi-Annual Report
- IDN 6: Strafford County, Seacoast Region Semi-Annual Report
- IDN 7: North Country, Carroll County Region Semi-Annual Report
Reporting Period July 1, 2017 - December 31, 2017
- IDN 1: Greater Monadnock, Greater Sullivan County, Upper Valley Region Semi-Annual Report
- IDN 2: Capital Area Region Semi-Annual Report
- IDN 3: Greater Nashua Region Semi-Annual Report
- IDN 4: Greater Derry, Greater Manchester Region Semi-Annual Report
- IDN 5: Central NH, Winnipesaukee Region Semi-Annual Report
- IDN 6: Strafford County, Seacoast Region Semi-Annual Report
- IDN 7: North Country, Carroll County Region Semi-Annual Report
Reporting Period January 1, 2017 – June 30, 2017
- IDN 1: Greater Monadnock, Greater Sullivan County, Upper Valley Region Semi-Annual Report
- IDN 2: Capital Area Region Semi-Annual Report
- IDN 3: Greater Nashua Region Semi-Annual Report
- IDN 4: Greater Derry, Greater Manchester Region Semi-Annual Report
- IDN 5: Central NH, Winnipesaukee Region Semi-Annual Report
- IDN 6: Strafford County, Seacoast Region Semi-Annual Report
- IDN 7: North Country, Carroll County Region Semi-Annual Report
NH DSRIP IDN Project Plans
- IDN 1 Project Plan: Narrative | Supplemental Template
- IDN 2 Project Plan: Narrative | Supplemental Template
- IDN 3 Project Plan: Narrative | Supplemental Template
- IDN 4 Project Plan: Narrative | Supplemental Template
- IDN 5 Project Plan: Narrative | Supplemental Template
- IDN 6 Project Plan: Narrative | Supplemental Template
- IDN 7 Project Plan: Narrative | Supplemental Template
NH DSRIP Evaluation Design
- CMS-Approved Evaluation Design
NH DSRIP Overview Slide Deck
- NH DSRIP Overview Slide Deck
Frequently Asked Questions
- DSRIP Frequently Asked Questions, as of June 17, 2016
(Includes questions from IDN Administrative Leads)
Draft Process Measures Reporting Guide
- Draft IDN Process Measures Semi-Annual Reporting Guide for Year 2 and Year 3
Nh Medicaid Waiver Form
Nh Choices For Independence Waiver
DSRIP Alternative Payment Models Roadmap
- DSRIP Alternative Payment Models Roadmap For Year 2 (CY2017) & Year 3 (CY2018)
Adobe Acrobat Reader format. You can download a free reader from Adobe.
Acquired Brain Disorder Waiver Nh
Microsoft Excel format. You can download a free reader from Microsoft.