New Hampshire - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In New Hampshire, Homemaker Services provide essential general household support—such as meal preparation, laundry, shopping, and light housekeeping—for individuals who cannot perform these tasks independently. These services are primarily funded through the state's Medicaid Home and Community-Based Services (HCBS) programs, most notably the Choices For Independence (CFI) Waiver administered by the Bureau of Elderly and Adult Services (BEAS) [May 20, 2026 Henry Lipman, State Medicaid Director New Hampshire Department of Health and Human Services Division of Medicaid Services](https://www.medicaid.gov/medicaid/home-community-based-services/downloads/nh-cap-completion.pdf).

The single biggest structural barrier to entry for prospective Homemaker Service providers in New Hampshire is the strict sequential requirement to obtain a state license before applying for Medicaid enrollment. Unlike some states, New Hampshire requires licensing for all non-medical home care providers [Starting Home Care Agency in New Hampshire](https://www.waivergroup.com/post/starting-home-care-agency-in-new-hampshire). Applicants must first secure a Non-Medical Home Care Provider license (under administrative rule He-P 809) from the Health Facilities Administration (HFA); the Medicaid MMIS portal will automatically reject any enrollment application that does not include an already-approved, active HFA license.

1. Service Definition and Scope

Homemaker services in New Hampshire are designed to assist waiver participants with general household activities to maintain a safe, clean, and healthy living environment. These services are authorized when the individual is unable to manage these tasks alone and when no other informal caregiver is available to perform them.

Under the Choices for Independence (CFI) Waiver, homemaker tasks are strictly non-medical. Providers must adhere to the specific tasks outlined in the participant's person-centered Comprehensive Care Plan, which is developed by a designated Case Management Agency.

• Service Category: Homemaker Services under the Choices for Independence (CFI) Waiver.
• Covered Tasks: Light housekeeping, laundry, meal planning and preparation, and grocery shopping or errands.
• Exclusions: Hands-on personal care (which requires a separate Personal Care Service authorization) and skilled nursing tasks.
• Authorization: Must be explicitly specified in the participant's Comprehensive Care Plan developed by a Case Management Agency.
• Location: Delivered exclusively in the participant's private residence, not in licensed residential or institutional facilities.

2. Regulatory and Oversight Agencies

Multiple divisions within the New Hampshire Department of Health and Human Services (DHHS) oversee homemaker services. The regulatory framework splits duties between facility licensing, waiver administration, and Medicaid claims processing.

Providers must interact with the Health Facilities Administration for their physical license and the Bureau of Elderly and Adult Services for waiver compliance and policy adherence.

• NH Department of Health and Human Services (DHHS): The umbrella agency governing Medicaid and public health (https://www.dhhs.nh.gov/).
• Health Facilities Administration (HFA): The DHHS division that licenses Non-Medical Home Care Providers (https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration).
• Bureau of Elderly and Adult Services (BEAS): Administers the CFI Waiver and oversees adult protective services (https://www.dhhs.nh.gov/programs-services/adult-aging-care).
• NH Medicaid Provider Enrollment Portal: The MMIS system used for provider enrollment and claims processing (https://nhmmis.nh.gov/).
• Bureau of Developmental Services (BDS): Manages the Developmental Disabilities and Acquired Brain Disorder waivers, which may also utilize home supports (https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services).

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire operates an open enrollment model for Medicaid HCBS Homemaker providers. There is no Certificate of Need (CON) required for non-medical home care, nor are there competitive procurement (RFP) processes, closed managed care networks, or county-level moratoria blocking new entrants.

However, strict sequential prerequisites exist. A provider cannot simply apply to Medicaid; they must first establish their legal business entity in the state and complete the full licensure process with the Health Facilities Administration.

• Licensure Prerequisite: Applicants must hold an active Non-Medical Home Care Provider license (He-P 809) from HFA before a Medicaid enrollment application will be accepted.
• Business Registration: Must register the business name with the NH Secretary of State and remain in good standing [New Provider and Onboarding Resources](https://www.dhhs.nh.gov/programs-services/disability-care/developmental-services/new-provider-and-onboarding-resources).
• NPI Requirement: Must obtain a Type 2 National Provider Identifier (NPI) from the federal NPPES registry prior to application.
• Network Affiliation: None required; New Hampshire does not restrict CFI waiver homemaker providers to closed managed care networks.
• Certificate of Need (CON): Explicitly not required for non-medical home care agencies in New Hampshire.

4. Licensure and Certification Requirements

To legally provide Homemaker services in New Hampshire, agencies must be licensed as a Non-Medical Home Care Provider. This process is governed by the NH Code of Administrative Rules He-P 809 and managed by the DHHS Health Facilities Administration (HFA).

The application requires a comprehensive submission of the agency's operational framework, including business plans, organizational charts, and proof of insurance. HFA will conduct an initial review and an on-site survey before issuing the license.

• Rule Citation: NH Code of Administrative Rules He-P 809 (Non-Medical Home Care Providers).
• Application Form: Application for Initial License for a Non-Medical Home Care Provider submitted to HFA.
• Licensure Fee: Typically $250 annually, plus $25 for each branch office location.
• Required Attachments: Business plan, organizational chart, and proof of general and professional liability insurance.
• Administrator Qualifications: Must designate an administrator with at least a high school diploma and one year of relevant supervisory or administrative experience.

5. Medicaid Provider Enrollment

Once the He-P 809 license is secured, providers must enroll in New Hampshire Medicaid to bill for waiver services. This is done electronically through the NH MMIS Provider Enrollment Portal [HOME HEALTH CARE SERVICES PROVIDER IN NEW HAMPSHIRE](https://www.waivergroup.com/post/home-health-care-services-provider-in-new-hampshire).

Providers enroll as HCBS Waiver Providers and must link their HFA license to their Medicaid profile. The state reviews the application to ensure all ownership disclosures and federal background checks are complete.

• Enrollment Portal: NH MMIS Provider Portal (https://nhmmis.nh.gov/).
• Provider Type: HCBS Waiver Provider (Provider Type 45 or the specific code designated for CFI Waiver non-medical services).
• Application Fee: The standard federal Medicaid application fee applies to institutional providers unless waived by prior Medicare enrollment.
• Required Documents: Signed W-9, copy of the active He-P 809 license, and a voided check or bank letter for Electronic Funds Transfer (EFT) setup.
• Revalidation: Required every 5 years under federal regulation 42 CFR 455.414 to maintain active billing status.

6. Staffing, Training and Background Checks

Homemaker staff in New Hampshire do not require medical certifications like a CNA or LNA, but they must meet strict background and training standards under He-P 809 and BEAS rules. Agencies are responsible for ensuring all direct care workers are fully vetted before they enter a client's home.

Agencies must maintain a dedicated personnel file for every employee, documenting their background clearances, initial orientation, and ongoing continuing education.

• Criminal Background Check: Required via the NH State Police Criminal Records Unit before any direct client contact occurs.
• Registry Checks: Employees must clear the BEAS State Registry (He-C 4002) and the NH Sex Offender Registry.
• Initial Training: Minimum orientation must cover client rights, infection control, emergency procedures, and the agency's specific operational policies.
• Ongoing Training: Staff must complete at least 6 hours of annual continuing education related to non-medical care, safety, and household management.
• Health Screening: Tuberculosis (TB) screening is required upon hire in accordance with NH DHHS public health guidelines.

7. Documentation, Policies and Records

New Hampshire HFA and BEAS require comprehensive operational policies to ensure client safety and service quality. Providers must maintain detailed client records and administrative manuals that are subject to unannounced state surveys.

Record-keeping must be meticulous, particularly regarding the delivery of authorized services, incident reporting, and the protection of client rights.

• Service Plan: The agency must maintain a current copy of the BEAS-authorized Comprehensive Care Plan for each client in their file.
• Visit Documentation: Electronic Visit Verification (EVV) is required to record clock-in/out times, location, and specific tasks completed during the homemaker visit.
• Required Policies: Must maintain written policies for complaint resolution, emergency preparedness, infection control, and client rights.
• Record Retention: Client and personnel records must be retained securely for a minimum of 6 years after discharge or termination of employment.
• Incident Reporting: Critical incidents, including suspected abuse, neglect, or exploitation, must be reported to BEAS Adult Protective Services within 24 hours.

8. Billing, Rates and Claims

Homemaker services are billed to NH Medicaid via the MMIS portal using specific HCPCS codes. Rates are standardized by DHHS and published in the CFI Waiver fee schedule, meaning providers cannot negotiate higher rates.

Because homemaker services are delivered in the home, they are subject to the federal Electronic Visit Verification (EVV) mandate. Claims submitted without matching EVV data will be denied [New Hampshire Home Care Medicaid Eligibility & Guidelines](https://www.caresmartz360.com/medicaid-home-care/new-hampshire).

• Billing System: Claims are submitted electronically via the NH MMIS Provider Portal.
• HCPCS Code: S5130 (Homemaker service, NOS, per 15 minutes) is the standard code, subject to the current BEAS fee schedule.
• EVV Mandate: Claims must be supported by EVV data; failure to capture EVV results in automatic claim denial.
• Prior Authorization: All services require a prior authorization (PA) generated by the Case Management Agency and loaded into the MMIS before billing.
• Payment Cycle: NH Medicaid typically processes clean claims on a weekly payment cycle via Electronic Funds Transfer (EFT).

9. Approval Sequence and Timeline

The path to becoming a billing Homemaker provider in New Hampshire is strictly sequential. You cannot begin the Medicaid enrollment phase until the HFA license is fully issued and in hand.

Prospective providers should plan for a multi-month process, as state survey schedules and MMIS processing times can vary based on application volume.

• Step 1: Register the business entity with the NH Secretary of State and obtain an EIN and NPI (1-2 weeks).
• Step 2: Submit the He-P 809 license application to HFA and undergo the initial readiness survey (60-90 days).
• Step 3: Submit the Medicaid Provider Enrollment application via the NH MMIS portal using the approved HFA license (30-60 days).
• Step 4: Establish EVV system integration and begin receiving authorizations from Case Management Agencies (2-4 weeks).
• Total Estimated Timeline: 4 to 6 months from initial business registration to the first billable service.

10. Common Denials and Survey Findings

Applications and surveys are frequently delayed or denied due to incomplete documentation or failure to adhere strictly to He-P 809 standards. HFA conducts initial and renewal surveys to ensure compliance, and deficiencies can halt operations.

On the billing side, Medicaid claims are most often denied due to authorization mismatches or missing EVV data.

• Application Denial: Submitting the Medicaid enrollment application before the HFA license is officially issued and active.
• Survey Deficiency: Incomplete personnel files, specifically missing BEAS State Registry checks or initial TB screening results prior to client contact.
• Survey Deficiency: Failure to document that the client received, understood, and signed the statement of client rights upon admission.
• Claim Denial: Billing for units that exceed the prior authorization limit set by the Case Management Agency.
• Claim Denial: Missing, incomplete, or mismatched Electronic Visit Verification (EVV) data for the billed date of service.

11. Key Contacts and Resources

Providers should rely on official state resources for the most current applications, rule references, and direct assistance. The DHHS websites provide access to all necessary forms and fee schedules.

For specific questions regarding licensure, contact the Health Facilities Administration directly. For waiver policy questions, contact the Bureau of Elderly and Adult Services.

• NH DHHS Health Facilities Administration (HFA): https://www.dhhs.nh.gov/doing-business-dhhs/licensing-certification/health-facilities-administration
• NH Bureau of Elderly and Adult Services (BEAS): https://www.dhhs.nh.gov/programs-services/adult-aging-care
• NH MMIS Provider Portal: https://nhmmis.nh.gov/
• NH Secretary of State QuickStart: https://quickstart.sos.nh.gov/online
• NH Administrative Rules (He-P 800s): https://www.gencourt.state.nh.us/rules/state_agencies/he-p.html

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