Mixed reactions among disabled Granite Staters on the CFI lawsuit settlement

Kathy Bates was elated when she heard that her attorneys and the state of New Hampshire settled a yearslong lawsuit over the Medicaid program that she relies on for care.

Husband and wife duo Jim and Pat Piet are more skeptical and fear that this settlement alone won’t fix the lackluster program without harming other programs.

Dan Hebert, on the other hand, is cautiously optimistic. He sees the potential for big upside, but he also sees pitfalls.

Bates, Piet and Hebert are all participants in New Hampshire’s Choices for Independence, a state-run Medicaid program that provides in-home care to people with disabilities and older adults. The goal of the program is to allow them to stay in their own home by hiring caregivers and other supports to avoid a nursing home, something that even the state acknowledges would cost roughly three times as much money.

After years of severe underinvestment in the program, a coalition of nonprofits focused on disability and elderly rights sued the state, arguing that by not properly funding the program the state was at risk of illegally institutionalizing people with disabilities. The case, which lasted almost six years and became a class action lawsuit, was set to go to trial next month before both sides came to an agreement to settle the case earlier this month.

The settlement still must be approved by federal Judge Paul Barbadoro, but class members like Bates, Piet and Hebert have all had a chance to review the settlement, which has major implications on their daily lives.

Elation

Bates is a named plaintiff in the suit. That means she’s been involved in the case since its earliest days and was a representative for the whole class.

“I’m really glad we got here,” she said, before joking, “I probably would’ve said no if I realized it would’ve taken this long.”

Bates, who lives in Somersworth, has cerebral palsy. In 2021, she and three other CFI participants represented by the AARP Foundation, the Disability Rights Center of New Hampshire, New Hampshire Legal Assistance and Nixon Peabody sued the state over the program. Soon after, the case became a class action and grew to encompass the thousands of New Hampshire residents in the CFI program. Bates said she’s relieved the case, which was time-consuming and draining, is over.

“It feels like it was a part-time job,” she said.  

Core to the plaintiffs’ arguments was that CFI participants weren’t getting the services the state had approved them for. Because of underfunding, CFI participants have long reported, wages were so low that hiring caregivers is near impossible. Vacancies mean shifts go unworked and CFI participants don’t get the help they need to do basic activities of living like getting out of bed, dressing themselves, showering, cooking meals and cleaning. This, their attorneys argued, was putting CFI participants at risk of being put in an institution, a violation of their rights under the 1990 Americans with Disabilities Act and the 1973 Rehabilitation Act. To settle the lawsuit and avert a trial, the state agreed to take a series of steps aimed at solving the issue:

• The Department of Health and Human Services agreed to hire a third-party consultant to analyze the state’s network of caregivers to determine whether it meets the needs of the participants. Specifically, the consultant must identify the level of service the state approved for participants versus how much they actually received.
• DHHS also agreed to ensure every participant has a contingency plan in place should they not receive their approved services and to execute that plan for any participants who received less than 50% of their approved services each month.
• Reimbursement rates set by the state determine caregiver salaries. DHHS agreed to perform an analysis on its reimbursement rates.
• DHHS also agreed to ask state lawmakers for biennial reimbursement rate increases to match inflation.
• DHHS agreed to expand use of “specialized rates” given to participants who struggle to hire aides.
• DHHS agreed to create an online portal and directory of caregivers.
• Finally, DHHS agreed to expand its existing grievance system to allow complaints about missed services.
• Twice a year, DHHS would be required to create a report outlining its compliance with the agreement.

Bates said the part she’s most excited for is the registry of caregivers. She’s long complained about how challenging it is to hire aides. Bate hires them herself and the caregivers are paid by a third party agency using state funds. She currently uses Craig’s List ads and staffing agencies to find caregivers but is excited to have a new tool she hopes will be more effective. Most of all she’s excited about what it means for the people that help her get out of bed in the morning, people she’s really grateful for.

She hopes “it’ll make the profession of caregiving and the people who do this work” more respected. She explained that lots of her caregivers are single mothers trying to support their own families in addition to supporting her.

“If they make more money in the profession, it becomes a real career option,” she said. “It’ll make life easier for them.”

She knows, however, that change will take time.

“I guess I’ll just have to be patient,” she said.

Skepticism

When Pat Vincent-Piet first heard about the settlement, her first question was “like everything, who pays for this again?”

In a class action lawsuit where the plaintiffs’ attorneys represent thousands of people in one suit, complete agreement among class members is very rare.

More from this section

Instacart's New Hampshire Halloween report: Reese's is No.1, regional candy quirks and the iconic banana costume

Pat and Jim Piet live in Concord and both have cerebral palsy. However, cerebral palsy, like many disabilities, has a spectrum of symptoms. Pat does not need the same level of care as Jim, who uses a wheelchair and has caregivers help him perform many of the daily activities of life.

The couple is skeptical. The settlement doesn’t commit the state to spending more money on the program, which would be needed to raise caregiver salaries and ensure all services are provided. It merely instructs DHHS to ask lawmakers to increase funding to match inflation and create reports about the program. The plaintiffs’ attorneys hope the reports demonstrate the dire needs of this program and convince lawmakers to properly fund the program, but DHHS can’t force lawmakers to give it additional funding. And the reports mandated by the settlement do not have to be produced until after the Legislature commences its budget-making process early next year.

“The only way that works is if we take some money from someone else.” Pat said.

Pat is concerned that to fix one Medicaid program, DHHS will have to raid the coffers of another, such as the developmental disability waiver, another Medicaid program that supports people with intellectual and developmental disabilities rather than purely physical ones. She has little confidence the Legislature will give DHHS the funding needed to reform CFI. She pointed to recent cuts to the Medicaid program over the past two years.

Medicaid, which is run jointly by states and the federal government, encompasses several programs. In addition to the several that support people with various disabilities, traditional Medicaid offers health coverage to low-income Americans. In 2025, Congress passed a law that KFF estimated will cut $991 billion from Medicaid nationwide. That same year, New Hampshire lawmakers implemented multiple cost-saving measures on the state level. They are set to begin charging premiums to certain traditional Medicaid recipients soon and have decreased the amount of prescription costs the state will cover. Pat argues “all of those things are connected.”

Jim and Pat also questioned whether the state has the staff to create these reports and do the extra work this settlement requires. They said the Medicaid personnel they interact with to get reapproved for services every year and complete other bureaucratic tasks tell them they’re too understaffed to get the work they currently have on their plate done.

“There’s no one to implement these requirements,” Jim said.

Jim and Pat feel they’re luckier than most CFI participants. When they can’t find a caregiver to cover a shift, Pat steps in to help. Single participants don’t have that luxury. Still, Jim wants his wife to be his wife, not his aide. It’s also hindered Pat’s career and her ability to earn a living, pay taxes and contribute to the community.

Cautious optimism

Dan Hebert, who also lives in Concord, had dates set on his calendar for a potential trial and was surprised to learn about the settlement. His takeaway is cautious optimism.

What he likes about the settlement: “a greater push toward transparency” and “what’s hopefully going to be an increase in compensation for the caregivers.”

Hebert agrees with the attorneys’ argument that demonstrating the lackluster nature of CFI could push lawmakers to better fund it.

“I counted no less than five reports that are mandated in this,” he said. “And while the department has had this information already, having it in five reports transparently and announced means that everyone sees it upfront and it’s readable. I think that’s important.”

He’s also planning to utilize the grievance system.

“I can’t tell you that it’s going to work,” he said. “I can’t tell you that it’s not going to work. I don’t know, but I do know that the monitoring is going to tell us the truth, and we’re all going to see it.”

Hebert is disappointed the reports won’t be ready before state lawmakers begin budget deliberations as this likely pushes back any real fiscal solution to the problems CFI faces until 2029, the following budget year. He wishes this could be solved sooner.

Overall, he said he’s happy the settlement was struck.

“I think that the attorneys that we have negotiated this settlement to try to do the best that they could,” he said. “And if this is what we’re gonna try, I’m optimistic.”

The Disability Rights Centers, one of the organizations litigating the case, is holding two webinars to inform CFI participants about the settlement on Nov. 17 at 10 a.m and Nov. 30 at 6 p.m. More details are available online at https://cfi.drcnh.org.

Any class member that objects to the settlement can have their voice heard in court on Jan. 21 at the U.S. District Court in Concord. They can also mail in their written complaints by Dec. 7 with the U.S. District Court at 55 Pleasant St. in Concord, NH (ZIP code 03301). Barbadoro, the judge, will decide whether to approve the settlement soon after.

Meanwhile, Hebert still relies on family and friends to help him out because he can’t find enough professional caregivers willing to work for the rates CFI offers.

“My world hasn’t changed today,” Hebert said. “But I’m hoping that it will.”