How New Hampshire pays for disability services

Waiver inventory

The ABD waiver is included because the Bureau of Developmental Services administers it alongside the DD waiver, uses the same procedure code set, the same Area Agency network, the same room and board policy, and the same rate table, so New Hampshire's DD financing cannot be described without it. CFI is listed for completeness but is not a DD vehicle. No 1915(i), 1915(b)(3), 1915(k)/CFC, or 1115 authority for IDD was identified in the CMS factsheet or the DHHS waiver page.

State-only funded programs

• Family Support Services under RSA chapter 126-G, "Family Support Services," enacted 1989. The Department administers the program and establishes a family support council in each of the ten Area Agency regions, with a family support coordinator in each region. Services include family services coordination, individual and family centered assistance, information and referral, educational materials, emergency and outreach services, parent to parent support, respite, and assistance in accessing home modification or adaptive equipment. This runs outside the waivers and reaches families whose relative is not on a waiver. Annual appropriation not found as a separate line in retrieved sources; it is carried within the Developmental Services appropriation. Administering agency: DHHS Bureau of Developmental Services through the ten Area Agencies. gencourt.state.nh.us and dhhs.nh.gov
• BDS Room and Board funding. General Memorandum GM#25-02, effective July 1, 2025, sets out how provider agencies operating certified staffed residences request state general funds to cover room and board costs that exceed what residents pay in residential fees. The memo states plainly: "BDS has a limited amount of general funds available to assist with paying R&B costs," and "Medicaid funds cannot be utilized for room and board expenses for individuals." Requests are approved first come, first served, and BDS may cap the number of residences funded. Administered by DHHS Bureau of Developmental Services. dhhs.nh.gov
• Carryforward authorization for community-based residential services. The FY2026-2027 enacted budget authorized $10.0 million in unspent SFY2025 funds to carry forward for community-based residential services for people with disabilities, supporting room and board payment calculations. nhfpi.org

County / regional / local funding

None identified. New Hampshire's ten Area Agencies are private nonprofit corporations designated by DHHS under He-M 505, not units of county or municipal government, and they are funded through DHHS contracts rather than local taxation. New Hampshire counties do levy taxes and carry a statutory share of long-term care costs, but that obligation runs to nursing facility care for older adults, not to developmental services. No county levy, county board of developmental disabilities, or municipal appropriation for IDD services was found.

The ten Area Agencies and their regions (https://csni.org/area-agencies and dhhs.nh.gov):

Community Support Network Inc. (CSNI) is the statewide association of the ten Area Agencies. csni.org

Funding scale

• Developmental services appropriation: SFY2025 adjusted authorized $447.3 million; SFY2026 budgeted $438.0 million, a reduction of $9.3 million or 2.1%; SFY2027 budgeted $466.3 million. nhfpi.org
• Acquired brain disorder services: a 37.9% reduction between the SFY2025 adjusted authorized amount and the SFY2026 budgeted amount. nhfpi.org
• Carryforward authority: up to $30.0 million in SFY2026 and $50.0 million in SFY2027 from prior years' unspent funds in the Developmental Services Fund, the Acquired Brain Disorder Services Fund, and the In-Home Support Waiver Fund, matched with equal federal Medicaid dollars. nhfpi.org
• DD Waiver total service cost, renewal Year 1: $581,617,293.93 for 5,752 unduplicated participants. dhhs.nh.gov
• DD Waiver Factor D, the average annual waiver service cost per participant: Year 1 $101,115.66; Year 2 $106,147.28; Year 3 $111,330.48; Year 4 $116,770.58; Year 5 $121,951.74. Factor D prime adds $12,169 to $13,018 per year for state plan services. dhhs.nh.gov
• Institutional comparison: Factor G, the estimated ICF/IID cost, is $335,736 per year, with Factor G prime of $342,595, for a combined $678,331. The waiver is therefore demonstrated at roughly one sixth of institutional cost per person. dhhs.nh.gov
• DD Waiver residential spending, Year 1: $404,591,870.70 for Residential Habilitation, which is 69.6% of all waiver service spending, covering 3,573 users at an average of 230 days each and an average blended cost of $492.33 per day. dhhs.nh.gov
• IHS Waiver total service cost, Year 1: $10,762,726.60 for 940 participants, Factor D $11,449.71, rising to $11,587.86 in Year 2. In Home Residential Habilitation accounts for $4,356,000 of that, serving 450 children at $880 per month for an average of 11 months. dhhs.nh.gov
• Average length of stay on the DD waiver: 339 days. On the IHS waiver: 298 days. Same sources.
• FMAP FY2026: 50.00%, the federal floor. New Hampshire therefore pays half of every waiver dollar from state funds. kff.org
• Waiting list: New Hampshire operates with no waitlist for developmental disability services. NHFPI reports that the FY2026-2027 budget's increased allocations and carryforward authority "could help ensure there continues to be no waitlist for developmental disability services," including for young people aging out of school services and people moving to New Hampshire, and that the budget includes language allowing the Division of Long Term Supports and Services to request additional funding through the Joint Legislative Fiscal Committee if expenditure needs exceed allocated amounts. The legal architecture nonetheless permits one: the waiver states that "He-M 517 provides in part that eligibility for the waiver is contingent on the availability of funding" and that "State law RSA 171-A:1-a,I provides the criteria for funding for services and limitations on wait lists. Individuals are prioritized on the waiting list based on a number of objective factors." nhfpi.org and dhhs.nh.gov

Residential funding detail

New Hampshire closed Laconia State School in 1991 and funds no state institution. Residential support runs entirely through Area Agencies and their subcontracted providers, in four setting types (https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/bds-draft-dd-renewal-2026.pdf and dhhs.nh.gov):

• Agency residence, also called a staffed residence, certified under He-M 1001 and operated by provider agency staff, either leased or owned by the agency. This is New Hampshire's group home equivalent.
• Certified family setting under He-M 521 (family residences with three or fewer individuals) or He-M 525.
• Enhanced Family Care residence under He-M 1001 or He-M 525, a host family arrangement.
• The person's own home or family home, where residential staff support is delivered without the setting being an agency residence.

Payment structure is a per diem with seven acuity levels. Residential Habilitation is billed as T1020 with modifiers SE, UA, and U1 through U7 for the DD waiver, and SE, UB, U1 through U9 for the ABD waiver. The waiver defines the levels by support intensity:

• Level I: intermittent supports on a daily basis
• Level II: supports and supervision throughout the day
• Level III: substantial supports and supervision
• Level IV: frequent supports and supervision
• Level V: significant medical or behavioral needs requiring critical levels of support
• Level VI: extraordinary medical and behavioral needs requiring exceptional assistance and specialized care
• Level VII: the most extensive and extraordinary medical or behavioral management needs, individually determined

Provider payment is set through an individual budget process, not a pure statewide fee schedule. Providers must submit budgets on the DD/ABD Provider Traditional Budget Template, and BDS states that "budgets not submitted using one of the following templates will not be accepted." A separate Unit Change Request process governs changes. Out of service days are capped at 30 per year for residential. dhhs.nh.gov

In Home Residential Habilitation under the IHS waiver is paid monthly at $880, not per diem, and supports children living with their families.

Room and board falls to the individual, with a limited state backstop. The mechanics, per the 2026 Standard of Need memo dated January 1, 2026 and GM#25-02 effective July 1, 2025:

• SSI and Social Security benefit levels rose 2.8% for 2026 to $994 per month.
• The Standard of Need is $1,008 per month for a person in independent living, $1,070 for a person in a He-M 1001 certified staffed residence or He-M 521 or He-M 525 certified family setting with a residential service, and $1,188 for a person in a He-M 1001 or He-M 525 certified Enhanced Family Care residence.
• Maximum residential fees charged to the individual remain unchanged: $848 per month for certified staffed residences and certified family settings, and $966 per month for Enhanced Family Care residences.
• The Personal Needs Allowance rose to $222 per month from $195 for people in a staffed residence or enhanced family care home. People living independently or in their family's home have a PNA equal to the Nursing Facility Cap.
• The Nursing Facility Cap rose to $2,982 per month from $2,901; the Protected Income Limit for spend-down remains $916 per month.
• Residential fee payments go directly from the individual, guardian, or designated payee to the provider agency, and the agency must apply them to that person's room and board costs. Where the fees do not cover costs, the agency may request BDS general funds, subject to availability and a possible cap on the number of residences funded.

Rate structure link: dhhs.nh.gov

Comparable service rates

Additional rates on the same schedule: Crisis Response Services (H2011) $7.79 per 15 minutes; Specialty Services Skills Training and Development (H2014) Level 1 $26.89, Level 2 $41.83 per 15 minutes; Therapeutic Behavioral Services (H2019) Level 1 $26.89, Level 2 $41.83 per 15 minutes; Specialty Services Level 1 $53.77 and Level 2 $83.64 per 30 minutes; START Center $754.89 each; START Clinical $6,450.55 each; Health Risk Screening Tool (HRST) $117.15 each. Environmental and vehicle modifications (S5165, T2039), PERS (S5161), Individual Goods and Services (H2016), Assistive Technology (T2035), and Community Integration Services (H2032) are all individually determined.

The January 1, 2024 rates reflect a 7% increase over the rates in effect from July 1, 2023. The fact that the Case Management rate of $301.49 appears unchanged in the DD waiver renewal cost tables drafted January 6, 2026 and in the IHS waiver approved for January 1, 2026 indicates no across-the-board rate increase has taken effect since January 1, 2024.

Official rate schedule links

• BDS Waiver Procedure Codes and Rates effective January 1, 2024: dhhs.nh.gov
• Medicaid Provider Rate Increase Guidance for January 1, 2024: dhhs.nh.gov
• Medicaid Provider July 1, 2023 Rate Increase Letter and Rates: dhhs.nh.gov
• Rate Increase Clarification Letter, July 2023: dhhs.nh.gov
• BDS 2026 Standard of Need and Income Changes, January 1, 2026: dhhs.nh.gov
• BDS Room and Board Policy, GM#25-02, effective July 1, 2025: dhhs.nh.gov
• DD/ABD Provider Traditional Budget Template: dhhs.nh.gov
• DD/ABD Budget Facesheet V3, for service authorizations from January 1, 2024: dhhs.nh.gov
• IHS Budget Facesheet V2, for service authorizations from January 1, 2024: dhhs.nh.gov
• Unit Change Request Guidance 2023: dhhs.nh.gov
• Out of Service Unit Billing Guidance GM-23-007: dhhs.nh.gov
• Developmental Services Funding Templates and Trainings index: dhhs.nh.gov

Notable features and flags

• January 1, 2024: BDS applied a 7% rate increase across DD and ABD waiver procedure codes, following an earlier increase effective July 1, 2023. No further across-the-board increase has taken effect since; the January 2024 rates are still the rates embedded in the 2026 waiver renewal cost tables. dhhs.nh.gov
• July 1, 2025: The FY2026-2027 budget took effect, cutting the developmental services line by $9.3 million (2.1%) in SFY2026 relative to SFY2025 and cutting acquired brain disorder services by 37.9%, while authorizing up to $30.0 million in SFY2026 and $50.0 million in SFY2027 in carryforward from prior-year unspent balances, matched with federal Medicaid dollars, plus $10.0 million carried forward for community-based residential services. nhfpi.org
• July 1, 2025: BDS General Memorandum GM#25-02 took effect, restating that Medicaid cannot pay room and board, capping requests to available general funds, allowing BDS to limit the number of agency residences funded, and routing requests on a first come, first served basis. Providers of Residential Habilitation, Respite, and Crisis Response services in certified agency residences are the only eligible requesters. dhhs.nh.gov
• January 1, 2026: The IHS waiver renewal (NH.0397.R05.00) took effect for 2026-2030 with 940 unduplicated participants in Year 1, and the 2026 Standard of Need memo raised the Personal Needs Allowance to $222 per month while holding maximum residential fees flat at $848 and $966. dhhs.nh.gov and dhhs.nh.gov
• January 7 to February 11, 2026: Public comment on the DD waiver renewal for 2026-2031 (draft NH.009.08.00, effective September 1, 2026). The renewal renames "Residential Habilitation / Personal Support" to "Residential Habilitation" to align with the other two BDS waivers, adds language that remote services shall not be an option where in-person assistance is required, requires monthly monitoring and quarterly in-person home visits for people receiving Residential Habilitation, and states that Service Coordination alone shall not establish need for waiver services. Preceded by six UNH Institute on Disability feedback sessions in September 2025. dhhs.nh.gov and dhhs.nh.gov
• April 20 to May 22, 2026: Public comment on the ABD waiver renewal for 2026-2031, with anticipated completion Fall 2026. dhhs.nh.gov
• Self-direction: New Hampshire offers a Participant Directed and Managed Services (PDMS) option, visible throughout the rate table as the U9 modifier, with rates individually determined rather than set on the standard ladder. He-M 525 governs the process and the education of families about participant direction. dhhs.nh.gov and dhhs.nh.gov
• No managed care carve-in: DD, ABD, and IHS waiver services are delivered through Area Agencies on a fee-for-service basis. A cancelled RFP for the Supports Intensity Scale (RFP-2024-DLTSS-02-SUPPO) appears in the DHHS news archive, indicating a stalled procurement for a standardized needs assessment instrument. dhhs.nh.gov

Confidence

Solid: the waiver inventory with CMS control numbers and effective dates; the complete January 1, 2024 procedure code and rate table, taken directly from the DHHS PDF, including all seven DD residential levels and all nine ABD levels; the DD waiver renewal's unduplicated participant counts, Factor D and Factor G values, and the Year 1 service-by-service cost table showing residential habilitation at 69.6% of waiver spending; the IHS waiver's 940 participants and $880 monthly In Home Residential Habilitation rate; the room and board mechanics from GM#25-02 and the 2026 Standard of Need memo, including exact SSI, Standard of Need, residential fee, and Personal Needs Allowance figures; the ten Area Agencies and their regions; and the 50% FMAP. Estimated: none of the dollar figures are estimated, but note that the Year 1 average of $492.33 per residential day is a blended figure the state computed across all seven levels, not a published rate for any single level. Reported with a caveat: NHFPI's acquired brain disorder figures as summarized are internally inconsistent, describing a $21.4 million decline from an SFY2025 adjusted authorized amount of $21.4 million, so I have reported only the 37.9% percentage. Could not find: an appropriation figure specific to RSA 126-G Family Support Services; a published statewide unit rate for New Hampshire residential habilitation more recent than January 1, 2024; ABD waiver enrollment; the amount of general funds actually available for the BDS Room and Board program; and any DHHS page publishing a consolidated developmental services fee schedule, since the state relies on individual budget templates plus the procedure code and rate memo. The DHHS website blocks direct programmatic retrieval, so all New Hampshire DHHS documents were reached through a rendering proxy against the exact URLs published on the DHHS pages.