An October 7, 2026, order issued by the U.S. District Court for the District of New Hampshire provides preliminary approval of a proposed settlement agreement in Fitzsimmons v. New Hampshire Department of Health and Human Services, Commissioner, et al. (Case No. 21-cv-025-PB).

Plaintiffs filed a class action complaint challenging the New Hampshire Department of Health and Human Services’ (NHDHHS) failure to provide them with community-based, long-term care services available through New Hampshire’s Medicaid HCBS waiver, known as the Choices for Independence Medicaid Waiver (CFI waiver).

The plaintiffs alleged that NHDHHS’ administration of the CFI waiver placed them at risk for unnecessary institutionalization in violation of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.

The heart of the issue lies with the state’s “longstanding and well-documented shortage of available service providers,” which has resulted in the limitation of the delivery of CFI waiver services.

The proposed settlement agreement would require NHDHHS to take measures to better serve CFI waiver beneficiaries, including by: conducting an annual assessment of the sufficiency of the provider network to meet the needs of CFI waiver beneficiaries and, upon a finding of insufficiency, taking steps to increase CFI reimbursement rates; conducting a reimbursement rate review for CFI services and, where rate adjustments are recommended, seeking legislative appropriations to fund rate increases; maintaining an online portal and directory of CFI providers; identifying beneficiaries who are not receiving adequate CFI services and taking steps to obtain a CFI worker; and expanding the grievance system to address the lack of authorized CFI services.

Assuming that the agreement goes forward, we will be monitoring its implementation, particularly with an eye towards how the state navigates its obligation to seek funding increases for the CFI waiver program and its ability to actually address the workforce shortage. Class members will be notified of the proposed settlement by November 6, 2026 and will have the opportunity to raise any objections during the Final Approval Hearing that is scheduled for January 21, 2027.