New Hampshire Medicaid for seniors and long-term care

Last verified: June 2026

What New Hampshire Medicaid covers for long-term care

New Hampshire Medicaid covers skilled nursing facility (nursing home) care and a range of home and community-based services for eligible seniors and adults with physical disabilities. The state's long-term care system emphasizes community-based options over institutional placement, consistent with the federal Olmstead mandate.

• Skilled nursing facility care
• Home health aide and personal care services
• Adult day programs
• Respite care for family caregivers
• Case management services
• Durable medical equipment and supplies
• Home modifications to support independent living
• Transportation to medical appointments
• Nutritional support services
• Hospice care

Source: NH DHHS Bureau of Elderly and Adult Services; Choices for Independence waiver documentation.

Choices for Independence (CFI) waiver

The Choices for Independence (CFI) waiver is New Hampshire's primary 1915(c) HCBS waiver for adults age 18 and over who are at risk of nursing facility placement. CFI allows eligible individuals to receive Medicaid-funded home and community-based services — such as personal care attendants, home modifications, and adult day programs — as an alternative to institutional care.

CFI eligibility requires meeting both financial criteria and a nursing facility level of care assessment. NH DHHS administers CFI through the Bureau of Elderly and Adult Services (BEAS). To apply, contact BEAS or your regional Area Agency on Aging.

There may be a waiting list for CFI services. Individuals on the waitlist may still qualify for other NH Medicaid services while waiting for a CFI slot.

Financial eligibility for NH long-term care Medicaid (2025)

NH long-term care Medicaid uses income and asset criteria distinct from MAGI-based Granite Advantage. These are the federal-minimum standards; verify current NH-specific figures with DHHS.

Source: NH DHHS Medicaid policy; federal spousal impoverishment protections, 42 U.S.C. § 1396r-5. NH's individual asset limit is $2,500 — slightly higher than the federal $2,000 minimum. Verify all figures with DHHS or a New Hampshire elder law attorney.

NH Medicaid estate recovery

New Hampshire operates a Medicaid estate recovery program. The state may seek reimbursement from the estate of a Medicaid member who received nursing facility care or certain long-term services at age 55 or older. NH applies a 60-month look-back period for asset transfers before a long-term care Medicaid application. The primary residence is typically exempt while a surviving spouse, a child under 21, or a disabled or blind child lives there. Consult a New Hampshire-licensed elder law attorney before making asset transfers if nursing facility Medicaid may be needed.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. New Hampshire's share of that population is administered through New Hampshire Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

New Hampshire Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, New Hampshire may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether New Hampshire uses this approach with New Hampshire Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through New Hampshire Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact New Hampshire Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult New Hampshire Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. New Hampshire's current CSRA is set by New Hampshire Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments