New Hampshire Medicaid / Medical Assistance Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In New Hampshire, Medicaid is also called Medical Assistance. This article focuses on New Hampshire Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or Old Age Assistance. This is different than regular Medicaid, which is for financially limited people of all ages.

New Hampshire Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

New Hampshire Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited New Hampshire seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Skilled nursing care
• Physician’s visits
• Prescription medication
• Medication management
• Mental health counseling
• Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

New Hampshire Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $74/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

New Hampshire Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Home and Community Based Services (HCBS) Waivers

New Hamsphire Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited New Hampshire seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for New Hampshire residents who live in their own home, the home of a loved one, an adult family home (adult foster care) or a residential care facility (assisted living residence). While New Hampshire’s HCBS Waivers may cover long-term care benefits in those settings, it will not pay for room and board costs such as mortgage payments, rent, utility bills and food expenses.

The HCBS Waiver relevant to New Hampshire seniors is the Choices for Independence Waiver.

Choices for Independence Waiver
New Hampshire’s Choices for Independence Waiver (CFI) provides long-term care services and supports to New Hampshire Medicaid recipients who need a Nursing Facility Level of Care (NFLOC) but live in their own home, the home of a loved one, an adult family home (adult foster care) or a residential care facility (assisted living residence). While CFI will pay for services in those settings, it will not cover room and board costs. A registered nurse will conduct a functional assessment using the Medical Eligibility Assessment tool to determine if New Hampshire CFI applicants require a NFLOC. For CFI purposes, individuals who need help with two or more of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) are considered to need a NFLOC.

Available CFI benefits include skilled nursing, adult day care, meal delivery, housekeeping services and personal care assistance with the Activities of Daily Living. Benefits are made available depending on each program participant’s needs and circumstances. The state will assign a licensed caregiver to provide the benefits, or CFI recipients can self-direct their care by hiring caregivers of their choice, including friends, spouses and family members.

Unlike Nursing Home Medicaid, CFI is not an entitlement. Instead, it has a limited number of enrollment spots (5,185 per year as of 2023). Once those spots are full, additional applicants are placed on a waitlist.

Old Age Assistance

New Hampshire’s Old Age Assistance (OAA), provides healthcare coverage and long-term care services and supports to financially limited New Hampshire residents who are aged (65 and over). OAA can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. OAA is an entitlement, which means that anyone who meets the requirements is guaranteed to receive healthcare coverage without wait. Access to long-term care benefits via OAA depends on the availability of funds, programs and caregivers in the area where the beneficiary lives. OAA is similar to Aged, Blind, and Disabled Medicaid in other states.

OAA beneficiaries can receive some long-term care services and supports through the Personal Care Attendant program.

Personal Care Attendant
The Personal Care Attendant (PCA) program offers long-term care benefits to Old Age Assistance (OAA) recipients who require a Nursing Facility Level of Care but live in their own home or the home of a loved one. To be medically eligible for PCA services, an individual must need help with at least two of the following activities – mobility, bathing, dressing, eating, toileting, taking medication and passive range of motion exercise.

PCA program benefits include assistance with medication management, homemaker services, grocery shopping and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). The state will assign a licensed caregiver to provide these benefits, or the PCA program participant can self-direct their care. This means the program participant is in charge of interviewing, hiring, training, paying, terminating and replacing their caregivers. They can hire caregivers of their choice, but not family members.

Like New Hampshire’s Old Age Assistance, the PCA program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and long-term care coverages into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although New Hampshire does not have a PACE program of its own as of Jan. 1, 2024, there are eight programs in neighboring Massachusetts. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

Eligibility Criteria For New Hampshire Medicaid Long Term Care Programs

To be eligible for New Hampshire Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Old Age Assistance (OAA).

New Hampshire Nursing Home Medicaid Eligibility Criteria

Financial Requirements
New Hampshire residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through New Hampshire Medicaid. For a single applicant in 2024, the asset limit is $2,500, which means they must have $2,500 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for New Hampshire Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, New Hampshire Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $74/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through New Hampshire Medicaid is a combined $5,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,500 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through New Hampshire Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) is the primary factor in determining level of care need in New Hampshire, but the applicant’s ability to complete the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry), as well as their cognitive abilities and behavioral issues, may also be taken into consideration.

New Hampshire Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
New Hampshire residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in New Hampshire is $2,500, which means they must have $2,500 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for New Hampshire HCBS Waivers for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in New Hampshire is a combined $5,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,500 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through New Hampshire Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. A registered nurse will conduct a functional assessment using the Medical Eligibility Assessment process to determine if New Hampshire HCBS Waiver applicants require a Nursing Facility Level of Care. For HCBS Waivers purposes, individuals who need help with two or more of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) are considered to need a Nursing Facility Level of Care.

New Hampshire Old Age Assistance Eligibility Criteria

Financial Requirements
New Hampshire residents have to meet an asset limit and an income limit in order to be financially eligible for Old Age Assistance. For a single applicant in 2024, the asset limit is $1,500, which means they must have $1,500 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $957/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants in 2024, the asset limit for Old Age Assistance through New Hampshire Medicaid is a combined $3,000, and the income limit is a combined $1,416/month. This applies to married couples with both spouses applying or with just one spouse applying.

Functional Requirements
The only functional requirement for receiving basic healthcare coverage through Old Age Assistance (OAA) is being age 65 or over. For OAA applicants and recipients who need long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long-term benefits the state will cover.

How New Hampshire Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

• If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
• If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
• If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – OAA applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

New Hampshire Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in New Hampshire and how you can protect your home from it, click here.

Applying For New Hampshire Medicaid Long Term Care Programs

The first step in applying for New Hampshire Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Old Age Assistance.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for New Hampshire Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the New Hampshire Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, New Hampshire residents can apply for Medicaid online at NHEasy. They can also download Application for Assistance (Form 800) and mail it to their local Department of Health and Human Services office, or they can fax the completed application to 603-271-8604. They can also apply over the phone by calling 800-852-3345.

For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) Old Age Assistance.

Choosing a New Hampshire Medicaid Nursing Home

After being approved for nursing home coverage through New Hampshire Medicaid, seniors need to choose which Medicaid-accepting nursing home best meets their needs. Even though New Hampshire Medicaid nursing home coverage is an entitlement, not all nursing homes take Medicaid, and those that do may not have available spaces. Finding the right nursing home can be time-consuming, especially if you’re looking in a specific location.

New Hampshire has roughly 70 total nursing homes that accept Medicaid. Fifteen (15) of them are within 10 miles of Manchester, and there are three more around Nashua. There are about a dozen in the Seacoast Area around Portsmouth. Outside of those two areas, the choices narrow. Concord and the Capital Region has just five nursing homes that accept Medicaid, and there are six more in Plymouth and the Lakes Region.

Residents in many New Hampshire communities cross the state line for personal and business reasons, including healthcare. Medicaid coverage, however, does not cross state lines. So, someone with New Hampshire Medicaid would not be covered for a nursing home stay in Andover, Massachusetts, or York, Maine, even if facilities in those places are well-suited and convenient for the New Hampshire resident.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can also be a great source of information. And you can use ServiceLink, which is the New Hampshire Department of Health and Human Services’ Aging and Disability Resource Center network, to find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? How does it handle dental and vision care? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data shows that nursing homes in New Hampshire compare very favorably to facilities across the country when it comes to health conditions. New Hampshire nursing homes averaged just 13.4 health deficiencies that led to citations during a three-year time-period from 2019-2022, while the national average was 25.7 during that same time-period.