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

Last updated: June 24, 2021


New Hampshire Medicaid Definition

Medicaid in New Hampshire is also called Medical Assistance, and the agency that administers the program is the New Hampshire Department of Health and Human Services (DHHS).

Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of New Hampshire residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. However, this page is focused strictly on Medicaid eligibility for New Hampshire elders, aged 65 and over, and specifically for long term care, whether that be at home or in another setting (i.e., adult foster care home, nursing home, residential care home / assisted living facility).

  The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.


Income & Asset Limits for Eligibility

There are several different Medicaid long-term care programs for which New Hampshire seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that New Hampshire offers multiple pathways towards Medicaid eligibility.

1) Institutional / Nursing Home Medicaid – this is an entitlement program. This means anyone who meets the requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, adult foster care, or in assisted living.
3) Regular Medicaid / Old Age Assistance (OAA) – this is an entitlement program, which means if eligibility requirements are met, one will receive assistance. Benefits are provided at home or adult day care.

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 program. Alternatively, one can take the Medicaid Eligibility Test.  IMPORTANT: Not meeting all of the criteria below does not mean one is ineligible or cannot become eligible for Medicaid in New Hampshire. More.

2021 New Hampshire Medicaid Long Term Care Eligibility for Seniors
Type of Medicaid Single Married (both spouses applying) Married (one spouse applying)
Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required
Institutional / Nursing Home Medicaid $2,382 / month* $2,500 Nursing Home $4,764 / month (Each spouse is allowed up to $2,382 )* $5,000 (Each spouse is allowed up to $2,500) Nursing Home $2,382 / month for applicant* $2,500 for applicant & $130,380 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,382 / month $2,500 Nursing Home $4,764 / month (Each spouse is allowed up to $2,382 ) $5,000 (Each spouse is allowed up to $2,500) Nursing Home $2,382 / month for applicant $2,500 for applicant & $130,380 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $808 / month $1,500 None $1,192 / month $1,500 None $1,192 / month $1,500 None
What Defines “Income”

For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. An exception exists for Covid-19 stimulus checks, which are not counted as income by Medicaid, and therefore, have no impact on eligibility.

When only one spouse of a married couple is applying for nursing home Medicaid or a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. However, for couples with one spouse applying for Regular Medicaid, the income of both spouses are included towards the income limit. Learn more about how Medicaid counts income for married couples here.

For married couples, with non-applicant spouses’ of nursing home Medicaid or HCBS Medicaid waiver applicants that have insufficient income in which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to ensure non-applicant spouses do not become impoverished. Basically, if the non-applicant spouse, also called a community spouse or well spouse, has income under $2,177.50 / month (effective 7/1/21 – 6/30/22), he or she is entitled to a portion of the applicant spouse’s income. If the well spouse has income equivalent to $2,177.50 / month or more, the applicant spouse may be entitled to a greater amount of their applicant spouse’s income if he or she has high shelter and utility costs. However, the maximum monthly maintenance needs allowance a non-applicant spouse can receive is $3,260.00 / month (effective 1/1/21 – 12/30/21). This spousal income allowance rule does not apply to married couples with one spouse applying for regular Medicaid.

*As one can see in the chart above, there is an income limit for nursing home Medicaid. However, a beneficiary cannot retain up to this amount of monthly income. Instead, all of one’s income must be paid to the nursing home, with the exception of a personal needs allowance of $70.00 / month, and potentially an income allowance for a non-applicant spouse.


What Defines “Assets”

Countable assets include cash, stocks, bonds, investments, promissory notes, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are many assets that are not counted. In other words, they are exempt from Medicaid’s asset limit. Exemptions include personal belongings, such as clothing, household furnishings, an automobile, a burial plot, and burial funds (up to $1,500). One’s primary home is also exempt, given the Medicaid applicant resides there or “intends” to in the future, and his / her equity interest is under $603,000 (in 2021). (Equity interest is the amount of the home’s value owned by the applicant). The home is also exempt, regardless of any other circumstances, if a non-applicant spouse lives there.

For married couples with only one spouse as an applicant for nursing home care or HCBS via a Medicaid waiver, the community spouse can retain half of the couples’ joint assets (up to a maximum of $130,380 in 2021), as the chart indicates above. However, if a couple has assets that are equal to or less than $26,076, the non-applicant spouse can retain 100% of the assets. This is called the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished. As with the spousal income allowance discussed above, this spousal resource allowance is not relevant for married couples with one spouse as an applicant for regular Medicaid.

It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because New Hampshire has a Medicaid Look-Back Period, which 60 months (5 years) that immediately precedes the date of one’s Medicaid application. During this time frame, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. If one is found to be in violation of the look-back period, a penalty period of Medicaid ineligibility will be calculated.

 In order to be eligible for long-term care Medicaid, an applicant must have a functional need for such care. For Medicaid nursing home care and home and community based services via a Medicaid waiver, a nursing facility level of care is required. For some program benefits, additional eligibility criteria may need to be met. As an example, for home modifications, an inability to safely live at home without modifications may be necessary. 


Qualifying When Over the Limits

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

1) Medically Needy Pathway – In New Hampshire, the Medically Needy Pathway, also called a Spend-Down Program, allows seniors who would otherwise be over the income limit to qualify for Medicaid if they have high medical expenses. In simple terms, one may still qualify for Medicaid services by “spending down” their “excess” income (their income over the Medicaid eligibility limit) on medical bills. This may include private health insurance, unpaid medical bills, and medical expenses that Medicaid does not cover. Once one has spent their income down to the income limit, Medicaid will kick in for the remainder of the “spend down” period. As of January 2021, the Medically Needy Income Limit (MNIL) is $591 / month for a single applicant and $675 / month for a married couple. The asset limits for the Medically Needy Pathway are $2,500 for a single applicant and $4,000 for a married couple.

Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in reducing his / her countable assets. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications (i.e., the addition of wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt.

2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care.  For persons in this situation, 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. Read more or connect with a Medicaid planner.


Specific New Hampshire Medicaid Programs

1) Choices for Independence Program – this Medicaid Waiver, which was previously called the Elderly and Chronically Ill Waiver, is intended for seniors and chronically ill adults who require a nursing home level of care. Supports via this waiver can be received in one’s home, assisted living / residential care homes, and adult foster care. Benefits may include adult day care, home health care, durable medical equipment, respite care, home and vehicle modifications, and more.

2) Personal Care Attendant Services (PCAS) – this program, which is part of the New Hampshire state Medicaid program, is for physically disabled adults who are mostly wheelchair bound. 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, with the exception of relatives.


How to Apply for New Hampshire Medicaid

To apply for long-term care Medicaid in New Hampshire, seniors can do so online at NHEasy Gateway to Services. In addition, persons can mail a completed “Application for Assistance (Form 800)” to their local Department of Health and Human Services (DHHS) office, fax it to 603-271-8604, or apply over the phone by calling 800-852-3345 ext. 9700. Questions can be answered and assistance provided by calling the DHHS Customer Service Center at 844-275-3447. In addition, the Area Agency on Aging office in one’s area may be helpful in answering program questions and providing assistance with the application process.

Please note that applying for Medicaid in New Hampshire can be complicated, particularly since there are several programs relevant to aging seniors. Furthermore, it is extremely important that one be certain all eligibility requirements, as discussed above, 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. Applying for Medicaid is more involved than simply submitting a completed application. For example, supportive documentation must also be included with the application. For more information about applying for long-term care Medicaid, click here.

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