NEW HAMPSHIRE
C-New Hampshire's system, honestly. A letter grade is a summary, not a verdict on your family — a low grade doesn't mean nothing is available, it means the path is narrower. What's behind it is below.
Do this first
Call the Area Agency for your region and ask for a service eligibility evaluation. Ask for it even if you do not need services this year — in New Hampshire, being found eligible is a standing determination that is separate from being funded, and the wait list, when there is one, is a funding queue made up of people who are already eligible. Getting that status settled early costs you nothing and is the thing everything else attaches to. Then ask which of the three waivers applies: the DD Waiver, the Acquired Brain Disorder Waiver, or, for a child, the In-Home Supports Waiver. Both the DD/ABD and In-Home Supports waivers are being renewed at the moment, with public comment sessions, so this is an unusually good year to say what is not working.
Last verified 2026-07-03
HOW WE GRADE NEW HAMPSHIRE
Full methodology (v2.1) →New Hampshire's strongest area is self-direction index; what pulls the grade down most is hcbs spending per capita.
Waitlist Burden
30% of grade—Not available
Nobody waiting scores 100. 225 per 100,000 scores 0.
- Not scored: New Hampshire's developmental services entitlement is capped by legislative appropriation rather than by demand. State law RSA 171-A:1-a is titled "Limits of Waiting Lists", newly eligible people are placed on a "projected service needs list", and Area Agencies have warned that budget shortfalls leave eligible people without services until funds are allocated.
Source:KFF State Health Facts, People Waiting for HCBS by Target … (FY2025 (KFF Medicaid HCBS Waiver Program Survey, FY 2025))US Census Bureau Vintage 2025 state population estimates (2025-07)
HCBS Spending Per Capita
25% of grade33/100$355 spent per resident
$200 per resident scores 0. $675 scores 100.
Source:CMS / Mathematica — Medicaid LTSS Annual Expenditures and … (CY2023)
Self-Direction Index
20% of grade86/10086 out of 100 on the self-direction index
Scored directly on its own 0–100 scale.
Source:CMS approved 1915(c) waiver application (2026-08-05)CMS approved 1915(c) waiver application (2026-08-05)
Waiver Program Count & Breadth
15% of grade50/10050 out of 100 on program breadth
Scored directly on its own 0–100 scale.
Source:Medicaid.gov State Waivers List, Authority=1915(c), Status… (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 2 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 1 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)
Each factor is scored against a fixed bar, not against the other states, so New Hampshire's grade moves when New Hampshire moves. Think we have it wrong? Every number above links to its source — email hello@spectrumpathways.ai and we will correct it in public.
WHAT THINGS ARE CALLED IN NEW HAMPSHIRE
Use these exact words when you search, call, or fill out forms — they're what New Hampshire's own offices use.
- Medicaid here is
- NH Medicaid (Granite Advantage)
- The DD agency is
- Bureau of Developmental Services (DHHS)
- You contact
- Area Agency (10 regional)
- The plan is
- Individual Service Agreement (ISA)
- Self-direction is
- Participant Directed and Managed Servicescontrolling your own budget and hiring your own people
- A denial arrives as a
- Notice of Decisionthe letter that gives you the right to appeal
WHO TO CONTACT, IN ORDER
Five different offices, and they don't talk to each other. Disability services, health coverage, and income each run through a separate agency — applying to one does not start the others. Ask each office for the name of the person you spoke to and write down the date; if something is later denied, that record is what an appeal is built on.
- 1
Developmental disability services
This is the office that decides whether your child is eligible for disability services. Ask for "intake" or "eligibility determination" by name. In New Hampshire, you contact Area Agency (10 regional).
- 2
Health coverage — NH Medicaid (Granite Advantage)
Almost every waiver and personal-care route requires this first, and it is decided by a different office from the one above. Apply in parallel rather than waiting.
- 3
Help at home, and who can be paid for it
Unless you say otherwise, services come the traditional way: the agency picks and pays the providers. Self-direction — where you get a budget and hire your own people — is opt-in almost everywhere and is not offered automatically. Here it is called Participant Directed and Managed Services. Ask for it by that name.
- 4
Income — SSI
Federal, so it's the same everywhere: 1-800-772-1213 (TTY 1-800-325-0778). There is no minimum age — you can apply for a newborn. Until 18, the parents' income is deemed to the child, so an early denial is usually about that rather than the child's disability. In many states an SSI award also opens Medicaid automatically — ask when you call.
- 5
If you get told no
Every state has a Protection & Advocacy agency by federal law — free legal help on disability services and appeals. Most families never hear of it, and it is the number to have before a deadline, not after. Yours is Disability Rights Center - New Hampshire.
Disability Rights Center - New Hampshire · 1-800-834-1721
RUNNING IT YOURSELF
In many states you can control the budget and hire your own people — including, sometimes, family. Most families are never told this is an option. Here's what we've verified for New Hampshire; where we haven't verified an answer we say so — it does not mean the answer is no, and it is worth asking.
Can you control the budget?
Not verified yet — ask, don't assume the answer is no.
Can a family member be paid to provide care?
Depends on the waiver — a spouse is barred on the DD route, allowed on Choices for Independence
Who is legally the employer of the people you hire?
Not verified yet — ask, don't assume the answer is no.
How freely can money move between services?
Not verified yet — ask, don't assume the answer is no.
Can the budget buy things, not just staff time?
Not verified yet — ask, don't assume the answer is no.
Is your case manager independent of your providers?
Not verified yet — ask, don't assume the answer is no.
Deadlines reflect this state’s rules as researched; they can change — always confirm the current deadline with your state agency or Protection & Advocacy office before relying on it.
HOW TO GET SERVICES & APPEAL IN NEW HAMPSHIRE
- Receive written Notice of Decision (or area-agency DD decision / MCO adverse benefit determination)
- DD/waiver eligibility: request administrative hearing within 30 calendar days (He-E 501.12); area-agency DD services: informal resolution or formal appeal within 30 business days (He-M 522.19)
- (Managed care) file MCO internal appeal within 30 days and exhaust it, then request State Fair Hearing within 120 days of the Notice of Resolution (He-W 506.09)
- Hearing before AAU presiding officer; decision within 90 days
- Judicial review under RSA 541-A
KEY AGENCIES & RESOURCES
NOTABLE WAIVERS
Developmental Disabilities Waiver
SourceAdults with developmental disabilities served through regional Area Agencies.
Waitlist: Funded through the state 'wait list' budget line; ask your Area Agency about funding year timing.
In-Home Supports Waiver for Children
SourceChildren with developmental disabilities living at home.
Waitlist: Capped; verify slots with your Area Agency.
Full milestone guide
View the New Hampshire Roadmap →
Six age-based stages — state-correct programs, benefits, and milestones from birth through adulthood.
Compare with the rest of the Northeast
Waiver rules, waitlists and self-direction options vary sharply between neighbouring states. Grades come from the same published methodology.
The words New Hampshire will use
Every one of these appears on an application, in a denial letter, or in a case manager's notes. Plain-English definitions, no jargon.
- HCBS Waiver (Home and Community-Based Services)
- Katie Beckett Waiver (TEFRA)
- EPSDT (Early and Periodic Screening, Diagnostic and Treatment)
- Self-Determination (Self-Direction)
- Person-Centered Planning
- Respite Care
- Supported Employment
- ABLE Account (Achieving a Better Life Experience)
- Special Needs Trust (Supplemental Needs Trust)
- IEP (Individualized Education Program)
