New Hampshire DD Waiver: Eligibility, Application, and the Waiting List

What the DD Waiver Covers

New Hampshire's Developmental Disabilities Waiver is a Medicaid Home and Community-Based Services (HCBS) waiver that funds long-term supports for individuals with intellectual and developmental disabilities. Instead of institutional placement, the waiver pays for services delivered in the community — the individual's home, a day program, a job site, or a family residence.

Services include:

• Residential supports — staffed group homes, shared living arrangements, or in-home support workers
• Day habilitation — structured daytime programming focused on life skills, socialization, and community participation
• Supported employment — job coaching, workplace supports, and employer liaison services
• Community participation — individualized support to access community activities, recreation, and volunteer opportunities
• Respite care — temporary relief for family caregivers
• Personal care — assistance with daily living activities like bathing, dressing, and meal preparation
• Service coordination — an assigned coordinator who manages the service plan, monitors providers, and advocates for the individual

The waiver is administered by the Bureau of Developmental Services (BDS), but all services are delivered through ten regional Area Agencies — nonprofit organizations contracted to manage local service delivery.

Eligibility Under He-M 503

Eligibility is determined by the local Area Agency under state administrative rules He-M 503. Two requirements must both be met:

Clinical eligibility: For the DD Waiver, the individual must have an intellectual or developmental disability meeting He-M 503 criteria, including onset before age 22 and an expected indefinite duration; acquired brain disorders are evaluated under a separate BDS pathway. The Area Agency conducts a clinical review using diagnostic evaluations, medical records, and adaptive behavior assessments.

For developmental disability specifically, the individual must demonstrate substantial functional limitations in at least three of seven major life activities: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency.

Financial eligibility: The individual must have active Medicaid enrollment. The DD Waiver itself doesn't have separate income or asset limits beyond what Medicaid requires — but the individual must qualify for one of NH's Medicaid pathways (ABD, MEAD, or Granite Advantage) before the waiver application can proceed.

This is why filing the Medicaid application first — or on the same day as the BDS intake — is essential. A stalled Medicaid application holds up the entire waiver process.

The Application Sequence

The process moves through defined steps under He-M 503:

1. Contact your Area Agency — Identify your region's agency and request an intake appointment
2. Submit documentation — The agency collects medical history, IEP records, psychological evaluations, and diagnostic reports
3. Eligibility determination — The agency has 15 business days from a completed application to issue a decision
4. Level of Care submission — If eligible, the agency submits a Level of Care request to BDS within 5 business days
5. BDS LOC review — BDS has 15 business days to issue the LOC determination
6. Service Coordinator assignment — Within 15 days of LOC approval, the agency helps the individual select a Service Coordinator
7. Person-centered planning meeting — The Service Coordinator holds this meeting within 15 business days of assignment
8. ISA drafting — The Service Coordinator drafts the Individual Service Agreement and budget within 14 days
9. Client review — The individual or guardian has 10 business days to approve or dispute the ISA

On paper, this sequence from application to approved ISA takes about three months. In practice, it often takes longer.

The Waiting List Problem

Here's the reality that timelines don't capture. New Hampshire's DD Waiver system distinguishes between eligibility and service delivery. An individual can be approved for the waiver — meaning they're clinically and financially eligible and have an approved ISA — but still wait months for services to actually begin.

The bottleneck is provider capacity. Direct support professionals (DSPs) who staff group homes, day programs, and community support services are chronically understaffed across the state. State reimbursement rates for DSPs haven't kept pace with competing wages in retail and food service, making recruitment and retention difficult.

The result: families receive formal eligibility approval and funded service allocations, but no available workers to deliver those services. Northern and rural regions (Region 1 and Region 2 in particular) tend to face the most severe shortages.

Families can take several steps to manage the gap:

• Start the application early — Initiate BDS intake at age 16, not 18. This front-loads the eligibility process so services can begin closer to when FAPE ends at 22.
• Explore self-directed options — New Hampshire allows self-directed budgets where the individual (or their guardian) manages the service funding directly, hiring workers and purchasing services. This can access a wider labor pool than Area Agency-contracted providers.
• Use NHVR as a bridge — Vocational Rehabilitation services can fill some employment-related gaps while waiting for DD Waiver day and supported employment services to begin.
• Document the gap — Keep written records of every service need that goes unfilled and every timeline the Area Agency misses. This documentation supports appeals and advocacy.

The New Hampshire SSI at 18 & Adult Disability Benefits Guide includes an He-M 503 Timeline Tracker, SIS-A Preparation Worksheet, and Agency Communication Log for managing the application process and holding agencies to their administrative deadlines.

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