New Hampshire Medicaid Home and Community-Based Waivers for Long-Term Care (2026)

Rung One: Category and Residency

The first test is the easiest and the one nobody fails by surprise. You must be a New Hampshire resident, and you must fall into a covered category: generally age 65 or older, or an adult with a disability determined under Social Security standards, or an adult with a chronic illness meeting the program’s criteria. You must be a citizen or a qualified non-citizen, and you need a Social Security number.

Residency in New Hampshire means physical presence with intent to remain. There is no waiting period and no minimum length of stay. What families get wrong is the reverse: a parent who moves in with a child in Massachusetts or Maine does not keep New Hampshire eligibility. Coverage does not travel across a state line. If a move is being considered, ask both states about closing and opening dates before anything happens, because a gap of even a few weeks means private-pay months.

If the applicant is under 65 and the disability has not been formally determined, that determination can add substantial time. Federal rules generally allow 45 days for an eligibility decision, extended to as much as 90 days where a disability determination is required. Ask the district office which clock your application is on the day you file.

Where to start the climb: call a ServiceLink Resource Center and ask for a long-term care options counseling appointment, and separately file the financial application with a district office. Running the two tracks in sequence rather than in parallel is the most common self-inflicted delay in New Hampshire.

Rung Two: The Functional Test, and Why It Is Not About Diagnosis

The second gate is clinical eligibility: you must be determined to need the level of care a nursing facility provides. This is assessed by the Bureau of Elderly and Adult Services or its contracted assessors, not by your own physician, and a diagnosis alone does not clear it.

What clears it is documented functional dependency. Bathing, dressing, toileting, transferring in and out of bed or a chair, eating, mobility, continence, medication management, and the supervision needs that come with cognitive impairment. The instrument scores what is recorded.

Families fall off this rung by being stoic. Prepare a two-week written log before the assessment: date, time, task, exactly what help was given, and what happened when help was not there. Describe the worst realistic day. Give dates for falls. Give times for nighttime confusion. If a spouse is providing the care that makes the applicant look independent, that has to be said out loud, because an assessor who sees a well-dressed, well-fed person in a clean kitchen is looking at the caregiver’s work, not the applicant’s ability.

Ask for a written copy of the assessment result. If it finds you do not meet the level of care, the appeal is decided on the record the assessment created, and you will want to know what that record says. The appeal deadline runs from the date printed on the notice, and a separate, shorter window usually applies if you need existing services continued during the appeal.

Rung Three: Income, and the Spend-Down Route

The third gate is income. New Hampshire long-term care eligibility applies a special income limit set at 300 percent of the federal SSI benefit rate, roughly $2,901 per month for an individual in 2025 and adjusted every January. Confirm the 2026 figure with a district office.

Income above that figure does not automatically end the climb. New Hampshire operates a medically needy pathway, under which medical expenses are applied against excess income to reach an eligibility level, and there is a post-eligibility calculation that determines how much of your monthly income goes toward the cost of your care after a personal needs allowance and, if you are married, an allowance for the spouse at home. Ask the district office which pathway applies to your case and to show you the calculation in writing.

If you are married, the spousal figures matter more than the individual ones. The federal community spouse resource allowance maximum was $157,920 in 2025 and is adjusted annually, with a federally set minimum and a minimum monthly maintenance needs allowance for the spouse remaining at home. Request a spousal resource assessment; it fixes the snapshot date and it is the single most valuable piece of paper a married New Hampshire couple can obtain early.

Do not compute this yourself and act on the result. Take it to a New Hampshire elder law attorney or ask the State Health Insurance Assistance Program to walk through it with you. Getting the pathway wrong costs a month of coverage at a minimum.

Rung	The test	Decided by
1	Category, residency, citizenship	DHHS district office
2	Nursing facility level of care	Bureau of Elderly and Adult Services assessment
3	Income against the special income limit	DHHS district office
4	Countable resources, about $2,500 for an individual	DHHS district office
5	Transfers inside the 60-month look-back	DHHS district office
6	An available waiver slot and an available worker	Bureau of Elderly and Adult Services and the provider agency

Rung Four: The $2,500 Resource Test, Where Most Families Fall

This is where the climb usually ends. New Hampshire has applied a countable resource limit of roughly $2,500 for an individual, an unusual figure that sits between the common $2,000 baseline and the more generous limits in other states. Confirm it with a district office before planning around it.

What does not count: the homestead while you live there or intend to return, subject to the lower federal home equity limit, which was roughly $730,000 at the federal minimum in 2025 and is adjusted annually; one vehicle; household goods and personal effects; and a properly structured irrevocable burial arrangement within the limits the state allows.

What counts: cash, checking and savings, certificates of deposit, brokerage accounts, a second vehicle, non-homestead real estate, and the cash surrender value of permanent life insurance above the exclusion threshold. Retirement accounts are the recurring surprise, and their treatment depends on payout status; ask rather than assume.

Two rules govern the fix. Spending down on things you need is permitted: home repairs, a newer vehicle, dental and vision work, an irrevocable funeral arrangement, paying off debt. Giving assets away is not, and that is rung five. The other rule is timing: resources are tested as of a point in the month, so a balance that was over on the first and under on the fifteenth may still fail. Ask the district office exactly which date it tests, and see how the Medicaid spend-down works before you move any money.

Rung Five: The Transfer Test, Which Reaches Back Five Years

Even a household that clears the resource limit today fails here if assets left in the wrong way. New Hampshire applies the federal 60-month look-back to transfers made for less than fair market value. The penalty is the transferred value divided by an average private-pay nursing facility rate the department publishes as a divisor, producing a period of ineligibility that begins when the person is otherwise eligible and receiving care.

Ask the district office for the current New Hampshire divisor in writing. New Hampshire facility costs run high by national standards; recent cost-of-care surveys have generally placed New England semi-private nursing facility rates well above the national median, which affects the arithmetic in both directions.

The federal exceptions apply: transfers to a spouse, to a child under 21 or a blind or disabled child, to a sibling with an equity interest who lived in the home for a year before institutionalization, and the caregiver child exception where an adult child lived in the home for two years and provided care that delayed placement. That last exception is lost far more often to missing documentation than to ineligibility. If an adult child has been doing this, start a dated file now: proof of residence, a physician’s statement, and a record of the care actually provided.

Undocumented cash to family is the other common failure. Three years of $1,200 monthly payments to a daughter is $43,200 that looks like a gift on a bank statement. The clean route is either enrollment as a paid provider or a written personal care agreement drafted by a New Hampshire elder law attorney before the care begins.

Rung Six: A Slot, a Worker, and What the Policy Does to the Climb

The last rung is the one that is not about you. Choices for Independence is a waiver program with a fixed number of federally approved slots, and New Hampshire has faced well-documented pressure on both waiver capacity and the direct-care workforce, with authorized hours going unfilled because no worker is available. Ask the Bureau of Elderly and Adult Services whether a waiting list is open and whether a provider agency is accepting clients at your address; those are two different questions and both have to be yes.

Ask also whether your case is managed by a Medicaid managed care organization. New Hampshire has been phasing long-term services and supports into its Medicaid Care Management program, which changes who your care coordinator works for. Confirm the current arrangement with the bureau rather than assuming.

Now the policy. Waiver eligibility uses the same countable-asset test as institutional Medicaid, so a life insurance policy that blocks a nursing facility application blocks home care identically. Term insurance with no cash value does not count. A permanent policy is excluded if total face value on one insured stays at or under a low threshold, historically $1,500 under the federal baseline; above that, cash surrender value counts against the roughly $2,500 limit. A $50,000 whole life policy with $16,000 of cash value stops the climb at rung four.

Options in order: an irrevocable funeral arrangement, which absorbs value as a permitted spend rather than a gift; a reduced paid-up election, which ends premiums and shrinks the death benefit while usually leaving cash value on the books; surrender; and only then a life settlement, which may exceed surrender value but produces countable cash and lands inside the look-back as a transaction the district office will examine. See what cash surrender value is before comparing any of these.

Keeping the policy is frequently right: a small face amount, no cash value, a spouse who will need the death benefit, or an insured in good health for their age. Where New Hampshire departs from the baseline is the roughly $2,500 resource limit, the ServiceLink front door, and the ongoing shift of long-term services into managed care; where it follows the baseline is the 60-month look-back, the level of care standard, spousal impoverishment protections, and the federal home equity limit. For a read on what a policy is worth before you surrender it, a free policy review is available at (732) 978-9575; Pine Lake Legacy does not purchase policies, and legal, tax and eligibility questions belong with your own attorney, your CPA, the district office, or the State Health Insurance Assistance Program.

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Frequently Asked Questions

Is New Hampshire’s Medicaid asset limit really $2,500?

New Hampshire has applied a countable resource limit of roughly $2,500 for an individual, an unusual figure that sits above the $2,000 baseline most states use. Treat it as the 2026 working number and confirm it with a Department of Health and Human Services district office before you spend down, because published limits go stale when a rule changes and a wrong number costs real money.

What is Choices for Independence?

Choices for Independence is New Hampshire’s Medicaid home and community-based waiver for older adults and adults with chronic illness or disability who would otherwise need nursing facility care. It is administered by the Bureau of Elderly and Adult Services within the Department of Health and Human Services, and it covers services such as personal care, homemaker help, adult day services, respite, home modifications, and a personal emergency response system.

Where do I start a New Hampshire application?

Call a ServiceLink Resource Center, New Hampshire’s aging and disability resource network, and ask for long-term care options counseling. At the same time, file the financial application with a Department of Health and Human Services district office. The functional and financial tests run in parallel and neither waits for the other, so completing one before starting the other adds weeks for no benefit.

Does approval mean someone will actually come to the house?

Not automatically. An authorization is a funding decision, and New Hampshire has faced well-documented direct-care workforce shortages, with approved hours going unfilled because no worker was available. Ask separately whether a waiver slot exists and whether a provider agency is accepting clients at your address. Report unfilled hours to your case manager in writing every time, because that record supports reassessment and appeal.

Can my son be paid to care for me under Choices for Independence?

Ask the Bureau of Elderly and Adult Services and your case manager which self-directed or participant-directed options apply to your plan, whether the specific relative is eligible, and how long enrollment takes before the first payable shift. Spouses and legal guardians are typically excluded. Nobody is paid retroactively for care already provided, so the sequence is approval, then enrollment, then paid hours.

Related Reading

• New Hampshire Medicaid Asset Income Limits
• Medicaid Estate Recovery New Hampshire
• New Hampshire Insurance Department Consumer Help
• Nursing Home Medicaid Spend Down
• What Is Cash Surrender Value
• What Is The Medicaid Look Back Period
• Home Care Hourly Cost Funding
• Life Insurance Counts Medicaid Asset

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Pine Lake Legacy does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.