NH’s Home Care Showdown: Class-Action Nears Decision That Could Upend Long-Term Care

Concord, NH — A five-year fight over New Hampshire’s at-home care program is approaching a critical moment, with a federal class-action lawsuit poised to either settle or head to trial as early as early 2026, according to court records and parties involved.

The case centers on the state’s Choices for Independence (CFI) program, a Medicaid waiver that funds in-home services for older adults and people with disabilities. Plaintiffs argue the state has failed to deliver the hours of care it authorizes, leaving thousands with unmet needs and pushing some into nursing homes in violation of federal law.

Filed in late 2023 and certified as a class action in March 2024, the suit represents CFI participants statewide dating back to 2020. Court filings say the program serves about 3,800 people, with a waitlist exceeding 1,000. Advocates say workers often provide only 70% to 80% of approved hours because of staffing shortages and reimbursement rates that lag the market.

At stake are civil rights and costs. In-home care runs roughly $25,000 to $30,000 per person per year, compared to $90,000 or more for nursing home placement. The plaintiffs argue the state is paying more for worse outcomes by allowing gaps in home care to widen.

What the lawsuit alleges

The complaint claims New Hampshire’s Department of Health and Human Services (DHHS) is violating the Americans with Disabilities Act and the Supreme Court’s Olmstead ruling by failing to provide services in the most integrated setting possible. It also cites Medicaid obligations to ensure timely access to authorized care.

Stories from the case underscore the stakes. Sarah Thompson, 68, of Manchester, a stroke survivor, was approved for 60 hours of weekly assistance but receives closer to 40, according to filings. Her family has paid out-of-pocket to fill the gaps, and she’s had multiple emergency room visits this year. Robert Kline, 74, of Portsmouth, who has Parkinson’s disease, waited months for services and briefly entered a nursing home, where he developed a serious infection.

“The state is choosing to warehouse people in facilities that cost three times more, all while ignoring their right to live independently,” said Emily Adler, an attorney for the plaintiffs. “This lawsuit is a wake-up call.”

What the state says

New Hampshire officials acknowledge the need to expand home- and community-based services but point to tight budgets and a strained workforce. In recent filings, a DHHS spokesperson said the state has proposed additional funding and is working to increase provider rates, but “demands outpace resources amid workforce shortages.”

State budget documents indicate CFI funding rose modestly in 2025 and is slated to increase again in 2026, though advocates say the program remains tens of millions short of what’s needed to deliver all approved hours. Internal and public data cited in the case point to a roughly 20% workforce gap among aides.

Settlement talks intensify

After discovery stretched through 2025, the parties entered settlement talks with a federal magistrate judge. The plaintiffs are seeking back payments and a court order requiring DHHS to fully fund and staff the authorized services. If talks fail, a trial could begin in the first quarter of 2026.

The negotiations follow years of turmoil, including pandemic-era reductions to in-home hours and an audit that advocates say documented administrative diversions of CFI funds. Federal regulators have also flagged access problems in recent waiver renewals, according to policy documents.

Why it matters

Beyond the courtroom, the case could reshape how New Hampshire pays for long-term care. A court-ordered overhaul would likely raise reimbursement rates, stabilize the workforce, and reduce unnecessary nursing home admissions—changes that could ripple across a sector already under pressure from rising demand and staffing shortages. A win for the plaintiffs could also influence similar disputes in other states.

For families, the outcome is personal. “I want to stay in my home where I’ve lived for 40 years,” Thompson said in a statement. “Without full care, I’m one fall away from a nursing home.”

What’s next

Both sides say they prefer a settlement, but major questions remain: how fast the state can scale up staffing, how much new funding would be required, and what benchmarks a court might set to ensure compliance with federal law. For now, thousands of Granite Staters wait to see whether help will arrive at home—or in a courtroom.