New Hampshire Medicaid Eligibility for Long Term Care: Income & Asset Limits

New Hampshire Medicaid Long-Term Care Definition

Medicaid is a health insurance program for low-income individuals of all ages. While it provides coverage for many groups of New Hampshire residents, the focus here is long-term care Medicaid eligibility for elders, aged 65 and over. In addition to care services in nursing homes, adult family homes / adult foster care homes, and assisted living facilities / residential care homes, NH Medicaid pays for non-medical services and supports to help frail seniors live at home. There are three categories of Medicaid long-term care programs for which NH seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who meets the requirements will receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; there are a limited number of participant enrollment slots and waiting lists may exist. Intended to delay and prevent the need for nursing home admissions, benefits are provided at home, adult day care, adult foster care, or in assisted living. More on Waivers.

3) Regular Medicaid / Old Age Assistance (OAA) – An entitlement; if eligibility requirements are met, one will receive assistance. Various long-term care services, such as personal care assistance or adult day care, may be available.

Medicaid in New Hampshire is also called Medical Assistance. While Medicaid is jointly funded by the state and federal government, it is state administered. The New Hampshire Department of Health and Human Services (DHHS) is the administering agency.

Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have differing financial and medical (functional) eligibility requirements. Further complicating financial eligibility is that the requirements change annually, vary with marital status, and New Hampshire offers multiple pathways towards Medicaid eligibility.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a New Hampshire Medicaid / Medical Assistance program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in New Hampshire. More.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in NH, the VA Aid & Attendance Allowance which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) / Spousal Income Allowance from their applicant spouse. The MMMNA is a Spousal Impoverishment Provision and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid living in poverty.

In New Hampshire, the MMMNA is $2,555 (eff. 7/1/24 – 6/30/25). If a non-applicant’s monthly income falls under $2,555, income can be transferred to them from their applicant spouse, bringing their income up to this level. A non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s monthly income over $3,854. This is the Maximum Monthly Maintenance Needs Allowance. More about how this allowance is calculated.

Income is counted differently when only one spouse applies for Regular Medicaid / Old Age Assistance; the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, promissory notes, bank accounts (credit union, savings, and checking accounts), and real estate in which one does not reside. In New Hampshire, IRAs / 401Ks are also counted. There are also many assets that are not counted; they are exempt. Exemptions include personal belongings, such as clothing, household furnishings, an automobile, a burial plot, burial funds (up to $1,500), and generally one’s primary home.

Treatment of Assets for a Couple
For Nursing Home Medicaid and Regular Medicaid, all assets of a married couple are considered jointly owned. This holds true regardless of if one or both spouses are applicants. Spousal Impoverishment Rules, however, permit the non-applicant spouse of a Medicaid nursing home applicant a Community Spouse Resource Allowance (CSRA).

In 2024, the CSRA allows the community spouse (the non-applicant spouse) to retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s share of the assets falls under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant.

For HCBS Waivers, the assets of a married couple are not considered to be jointly owned. In other words, the assets of a non-applicant spouse are not calculated towards the applicant spouse’s eligibility. However, a resource assessment of the couple’s assets can be requested, and a non-applicant spouse may receive a Community Spouse Resource Allowance.

To be clear, there is no CSRA for Regular Medicaid.

Medicaid’s Look-Back Rule
It is vital that one does not give away assets or sell them for less than fair market value up to 60-months (5 years) of applying for Nursing Home Medicaid or a Medicaid Waiver. This is because New Hampshire has a Medicaid Look-Back Period that immediately precedes the date of one’s application. During this period, Medicaid checks all past asset transfers to ensure none were transferred for less than fair market value. If this has been done, even unintentionally, it is a violation of the Look-Back Rule. A Penalty Period of Medicaid ineligibility is calculated for persons who violate this rule.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows individuals to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

There is no Look-Back Rule for Regular Medicaid.

New Hampshire Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. After 6 months, even with Intent to Return, a single Medicaid beneficiary might be required to sell their home. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, New Hampshire’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Medical / Functional Need Requirements

An applicant must have a functional need for long-term care Medicaid. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, additional criteria may need to be met for specific program benefits. As an example, for a Medicaid Waiver to cover the cost of home modifications, an inability to safely and independently live at home without modifications may be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.

Qualifying When Over the Limits

For New Hampshire elderly residents (aged 65 and over), who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – New Hampshire has a Spend-Down Program for seniors who have income over the Medicaid income limit. This program allows them to become income-eligible for Medicaid services by spending the majority of their income on medical expenses. This may include private health insurance, unpaid medical bills, and medical expenses that Medicaid does not cover. In 2024, the Medically Needy Income Limit (MNIL), also called a Protected Income Level (PIL), is $888 / month for an individual and $1,033 / month for a couple. The “spend down” amount is the difference between one’s monthly income and the PIL. Once one has met their “spend down”, they will be income-eligible for the remainder of the month. Note that a Nursing Home Medicaid beneficiary’s monthly income cannot be greater than the Medicaid pay rate for nursing facility care at the residence in which they are residing. The asset limits for the Medically Needy Pathway are $2,500 for an individual and $4,000 for a couple.

2) Asset Spend Down – Seniors who have assets over Medicaid’s limit can “spend down” countable assets on non-countable ones to become asset-eligible. Examples include making home modifications (i.e., the addition of wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember that assets cannot be gifted or sold under fair market value, as it violates Medicaid’s Look-Back Rule. When “spending down”, it is best to keep documentation of how assets were spent as evidence the Look-Back Period was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid-eligible, as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

Specific New Hampshire Medicaid Programs

In addition to paying for nursing home care, Medicaid in New Hampshire offers the following programs that help seniors to live at home or in the community.

1) Choices for Independence Program – Previously called the Elderly and Chronically Ill Waiver, this Waiver is intended for seniors and adults with disabilities who require a Nursing Home Level of Care. Available supports can be received in one’s home, assisted living / residential care homes, and adult family care homes. Benefits may include adult day care, home health aides, specialized medical equipment, respite care, home and vehicle modifications, and more.

2) Personal Care Attendant Services (PCAS) – Part of New Hampshire’s Regular Medicaid program, PCAS is for adults who are physically disabled and mostly rely on wheelchairs for mobility. This program is also relevant to the elderly, as some conditions that are more prevalent with aging, such as strokes, may qualify one medically. Personal care attendants provide assistance with daily living activities, and program participants are able to hire the caregiver of their choosing, including relatives.

3) Money Follows the Person – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or another community setting.

How to Apply for New Hampshire Medicaid

Seniors can apply for long-term care Medicaid in New Hampshire online at NHEasy Gateway to Services. Alternatively, they can mail a completed “Application for Assistance (Form 800)” to their local Department of Health and Human Services (DHHS) office. For questions regarding programs and application assistance, DHHS Customer Service Center can be reached at 844-275-3447 (844-ASK-DHHS). The application process may vary based on the program for which one is applying.

Applying for Medicaid / Medical Assistance in New Hampshire can be complicated, particularly since there are several programs relevant to aging seniors. It is extremely important that one be certain all eligibility requirements are met prior to beginning the application process. Not meeting the criteria can result in a denial or delay of Medicaid benefits. For seniors who are uncertain of their eligibility status, or know their financial means exceed the income and / or asset limits(s), Medicaid planning is highly suggested. Furthermore, supportive documentation must be provided with the completed application. Learn more about applying for long-term care Medicaid.