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

Last updated: February 09, 2022

 

New Hampshire Medicaid Definition

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

Medicaid is a health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides coverage for various groups of New Hampshire residents. This includes pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. The focus of this page, however, is Medicaid eligibility for New Hampshire elders, aged 65 and over. Specifically, long term care Medicaid is covered. In addition to care services in nursing 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 remain living at home.

  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 Medicaid long-term care programs for which New Hampshire seniors may be eligible. These programs have differing financial and medical (functional) eligibility requirements, as well as 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; 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) – These are not entitlement programs; There are a limited number of participant enrollment slots and wait 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) – This is an entitlement program; 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.

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.

2022 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 $2,523 / month* $2,500 Nursing Home $5,046 / month ($2,523 / month per spouse)* $5,000 ($2,500 per spouse) Nursing Home $2,523 / month for applicant* $2,500 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month† $2,500 Nursing Home $5,046 / month ($2,523 / month per spouse)† $5,000 ($2,500 per spouse) Nursing Home $2,523 / month for applicant† $2,500 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Old Age Assistance $855 / month $1,500 Help with ADLs $1,262 / month $1,500 Help with ADLs $1,262 / month $1,500 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a personal needs allowance of $74.00 / month, Medicare premiums, and potentially a monthly income allowance for a non-applicant spouse, must go towards nursing home costs.
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.

 

What Defines “Income”

Any income that a Medicaid applicant receives is counted. 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. Holocaust restitution payments and Covid-19 stimulus checks do not count as income, and therefore, have no impact on eligibility.

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) from their applicant spouse. The MMMNA is a spousal impoverishment provision and is the minimum amount of income a non-applicant spouse is said to require to avoid living in poverty. In New Hampshire, the MMMNA is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income falls under $2,288.75, income can be transferred 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 $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal 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. More on how Medicaid counts income.

 

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. 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, and burial funds (up to $1,500). One’s primary home is also exempt, given the Medicaid applicant resides there or has intent to return, and in 2022, their home equity interest is under $636,000. 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.

 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.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, spousal impoverishment rules permit the non-applicant spouse of a Medicaid nursing home or waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.

It is vital that one does not give away assets or sell them for less than fair market value within 60 months (5 years) of applying for long-term care Medicaid. This is because New Hampshire has a Medicaid Look-Back Period that immediately precedes the date of one’s Medicaid application. During this period, Medicaid checks all past transfers to ensure no assets 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.

 Non-Financial Eligibility Requirements – For New Hampshire long-term care Medicaid eligibility, an applicant must have a functional need for such care. 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 is required, but a NFLOC is not necessarily required.

 

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 – 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 2022, the medically needy income limit (MNIL), also called a protected income level (PIL), is $591 / month for an individual and $675 / 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. 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 and become asset eligible. This can be done 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. 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” or “over-asset” or both, 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. Read more or connect with a Medicaid planner.

 

Specific New Hampshire Medicaid Programs

Like all states, New Hampshire Medicaid pays for nursing home care for state residents who are medically and financially eligible for such care. NH Medicaid also offers Medicaid programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.

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 is part of the New Hampshire state Medicaid program and 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

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, fax it to 603-271-8604, or apply over the phone by calling 800-852-3345 ext. 9700. For question programs and assistance, DHHS Customer Service Center can be reached at 844-275-3447. One’s local Area Agency on Aging office may also be helpful.

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, 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. Furthermore, there is more to the application process than simply submitting a completed application. For example, supportive documentation must also be provided. For more information about applying for long-term care Medicaid, click here.

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