Long-Term Care Planning in New Hampshire: Costs, Medicaid & Your Options (2026 Guide)

New Hampshire's long-term care costs are well above national averages — nursing home care averages $12,243 per month, approximately 28% above the national average of $9,581, while assisted living averages $8,025 per month, approximately 29% above the national average of $6,200. Home care averages $7,627 per month, approximately 14% above the national rate of $6,673. New Hampshire Medicaid is also called Medical Assistance and is administered by the New Hampshire Department of Health and Human Services (DHHS). For Nursing Home Medicaid, the income limit is $2,982/month — but all of a beneficiary's monthly income, with the exception of a $93/month Personal Needs Allowance, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs. The asset limit is $2,500 for individuals, though New Hampshire applies an asset disregard allowing up to $7,500. This guide covers what care costs in New Hampshire, how to qualify for Medicaid, and what options exist for veterans and family caregivers in Manchester, Nashua, Concord, Dover, and across the Granite State.

New Hampshire's Aging Population: The Numbers Behind the Need

New Hampshire is home to more than 300,000 residents aged 60 or older — a significant portion of the state's roughly 1.4 million total population. The senior population is concentrated in Manchester (Hillsborough County — New Hampshire's largest city), Nashua (Hillsborough County), Concord (Merrimack County — the state capital), Dover (Strafford County), and Rochester (Strafford County). Other significant aging communities include Portsmouth, Keene, Laconia, Lebanon, and Derry.

New Hampshire's geography — a mix of southern urban corridors and rural northern regions including the White Mountains and the Lakes Region — creates long-term care access challenges. The Manchester–Nashua corridor and Concord have the most facility options, while the North Country, Upper Valley, and rural communities have fewer providers and limited home care availability.

Unpaid Caregivers in New Hampshire: Scale and Impact

An estimated 150,000 unpaid family caregivers in New Hampshire provide care to aging relatives and adults with disabilities. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

New Hampshire offers support for family caregivers through the Choices for Independence (CFI) Program, which provides home and community-based services as an alternative to nursing home placement. The Personal Care Attendant Services (PCAS) program allows physically disabled adults who mostly rely on wheelchairs to hire the caregiver of their choosing, including relatives such as adult children or spouses, as paid personal care attendants.

What Long-Term Care Costs in New Hampshire

New Hampshire's care costs vary by type of care:

• Assisted Living: $8,025 per month — approximately 29% above the national average of $6,200
• Nursing Home (semi-private room): $12,243 per month — approximately 28% above the national average of $9,581
• Home Care (home health aide): $7,627 per month — approximately 14% above the national average of $6,673
• Adult Day Care: $2,015 per month — approximately 2% below the national average of $2,058

At these rates, a three-year nursing home stay in New Hampshire costs approximately $441,000 — while home care totals roughly $275,000 over the same period. Assisted living, at $8,025/month, totals approximately $289,000 over three years. For a detailed breakdown of care costs by type and how New Hampshire compares to other states, visit our New Hampshire Care Costs page.

How to Qualify for New Hampshire Medicaid: Eligibility Rules for 2026

New Hampshire Medicaid (Medical Assistance) is administered by the New Hampshire Department of Health and Human Services (DHHS). In addition to care services in nursing homes, adult family 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 live at home. Consulting with a New Hampshire elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $2,982/month. All of a beneficiary's monthly income, with the exception of a $93/month Personal Needs Allowance, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability). Asset limit of $2,500 (single) or $5,000 ($2,500 per spouse, married couple both applying). New Hampshire applies an asset disregard allowing up to $7,500 in assets. When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets. This is an entitlement — anyone who qualifies receives benefits.
• Medicaid Waivers / Home and Community Based Services (HCBS): Income limit of $2,982/month. Asset limit of $2,500 (single) or $5,000 (couple, both applying), with the same $7,500 asset disregard. This is not an entitlement — the number of participant slots is limited and waiting lists may exist.
• Regular Medicaid / Old Age Assistance (OAA): Income limit of $1,008/month (single) or $1,492/month (couple). Asset limit of $1,500 (single or couple). This is an entitlement. While not Long-Term Care Medicaid, some long-term care services such as personal care assistance or adult day care may be available.

New Hampshire applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period — including gifts to family members — can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax exclusion (2026) does NOT apply to Medicaid's look-back rules. The Look-Back Period does not apply to Regular Medicaid. For the full New Hampshire Medicaid eligibility breakdown, see our New Hampshire Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or an HCBS Waiver in New Hampshire, only the applicant spouse's income is counted. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660 (2026). If the non-applicant's share falls below $32,532, up to $32,532 can be retained.

New Hampshire sets the Minimum Monthly Maintenance Needs Allowance (MMMNA) at $2,644 per month (eff. 7/1/25 – 6/30/26). If the non-applicant spouse's income falls below this amount, income can be transferred from the applicant spouse. A non-applicant spouse can increase their Spousal Income Allowance if housing/utility costs exceed a shelter standard of $794/month (eff. 7/1/25 – 6/30/26), up to a maximum of $4,067/month. For Regular Medicaid / Old Age Assistance, both spouses' income is counted and there is no MMMNA or CSRA.

Important NH-specific rule for HCBS Waivers: For HCBS Waivers, the assets of a married couple are NOT considered jointly owned — the non-applicant spouse's assets are not counted towards the applicant's eligibility. However, a resource assessment can be requested and the non-applicant may receive a CSRA.

New Hampshire Medicaid Programs: Choices for Independence and Community-Based Options

New Hampshire offers several Medicaid-funded long-term care programs:

• Choices for Independence Program (CFI): Previously called the Elderly and Chronically Ill Waiver, this waiver is intended for seniors and adults with disabilities who require a Nursing Home Level of Care. Available supports can be received in one's home, assisted living / residential care homes, and adult family care homes. Benefits may include adult day care, home health aides, specialized medical equipment, respite care, home and vehicle modifications, and more. Waiting lists may exist.
• Personal Care Attendant Services (PCAS): Part of New Hampshire's Regular Medicaid program, PCAS is for adults who are physically disabled and mostly rely on wheelchairs for mobility. Personal care attendants provide assistance with daily living activities, and program participants are able to hire the caregiver of their choosing, including relatives such as adult children or spouses.
• Money Follows the Person: A federal program that helps institutionalized persons who are eligible for Medicaid to transition back home or another community setting.

Qualifying When Over the Limits: Medically Needy and Asset Strategies

New Hampshire does not use Qualified Income Trusts (Miller Trusts). Instead, the Medically Needy / Spend-Down program is available for persons over the income limit:

• Medically Needy / Spend-Down Program: The Medically Needy Income Level (MNIL / Protected Income Level) is $939/month for individuals and $1,093/month for couples (eff. 1/1/26). The spend-down amount is the difference between income and the PIL. Medical expenses (private health insurance, unpaid medical bills, expenses Medicaid doesn't cover) can be used to meet the spend-down. A Nursing Home Medicaid beneficiary's income cannot exceed the Medicaid pay rate for the nursing facility. The medically needy asset limit is $2,500 (individual) and $4,000 (couple).
• Asset Spend-Down: Spend excess assets on non-countable items — home modifications (wheelchair ramps, stair lifts), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof Medicaid's look-back rule was not violated.
• Medicaid Planning: Work with a Medicaid Planning Professional to employ legal strategies for eligibility and protect your home from Medicaid's Estate Recovery Program.

Asset Rules: What Counts and What Doesn't

Countable assets in New Hampshire include cash, stocks, bonds, investments, promissory notes, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside. In New Hampshire, IRAs / 401Ks are counted as assets. Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, a burial plot, burial funds (up to $1,500), and generally one's primary home.

New Hampshire's asset limit is $2,500 for an individual and $5,000 for a married couple (both applying). However, New Hampshire applies an asset disregard which allows one to have up to $7,500 in assets. For Nursing Home Medicaid and Regular Medicaid, all assets of a married couple are considered jointly owned. For HCBS Waivers, spousal assets are NOT considered jointly owned. The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (minimum $32,532). There is no CSRA for Regular Medicaid. In New Hampshire, the VA Aid & Attendance Allowance (above and beyond the Basic VA Pension) does not count as income. Nationally, Holocaust restitution payments are not counted as income.

Veterans and Long-Term Care in New Hampshire

New Hampshire has a proud veteran population, with facilities including the Manchester VA Medical Center, VA clinics in Portsmouth, Conway, Somersworth, and Tilton, and the New Hampshire Veterans Home in Tilton.

Notably, New Hampshire does not count VA Aid & Attendance as income for Medicaid eligibility purposes — making it one of the more favorable states for veterans applying for Medicaid while receiving VA benefits. Veterans should factor this advantage into their long-term care planning strategy. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in New Hampshire

Understanding how to pay for nursing home care in New Hampshire — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $12,243/month (28% above the national average), a 60-month look-back period, and a $2,500 asset limit (with $7,500 disregard), advance planning is essential. New Hampshire long-term care insurance policies, personal savings, veterans benefits, and Medicaid each play a role. Key steps include:

• Understanding your current financial position relative to New Hampshire Medicaid eligibility thresholds
• Knowing that New Hampshire's $2,500 asset limit includes a $7,500 disregard — above the national standard of $2,000 — but IRAs/401Ks are counted as assets
• Taking advantage of the PCAS program's option to hire family members, including spouses, as paid caregivers
• Leveraging New Hampshire's MMMNA ($2,644) and the shelter cost exception (up to $4,067) to protect the non-applicant spouse's income
• Recognizing that New Hampshire does not count VA Aid & Attendance as income — a significant advantage for veteran families
• Understanding New Hampshire's Medically Needy program with its $939/month MNIL as an alternative to Miller Trusts
• Noting that after 6 months, even with Intent to Return, a single Medicaid beneficiary might be required to sell their home
• Consulting with a New Hampshire elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in New Hampshire

New Hampshire operates a Medicaid Estate Recovery Program (MERP), which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Medicaid. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $730,000 (in 2026). If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. However, after 6 months, even with Intent to Return, a single Medicaid beneficiary might be required to sell their home — a unique New Hampshire rule that makes early planning critical. There is no home equity interest limit for Regular Medicaid. The home is NOT exempt from estate recovery — families should consult a New Hampshire elder law attorney to explore legal protections.

Regional Cost Variations Across New Hampshire

Long-term care costs in New Hampshire vary by region. Manchester and Nashua (the state's two largest cities in southern Hillsborough County) typically see the highest costs due to proximity to the Boston metro area. Concord (the state capital), Dover, and Portsmouth (Seacoast region) represent mid-to-high-range markets. In contrast, northern New Hampshire (Berlin, Littleton, Colebrook) and the Upper Valley (Lebanon, Hanover) generally have lower costs, though availability of providers is more limited — particularly for home care and specialized memory care services. Keene, Laconia, and the Lakes Region offer mid-range options.

Application Timeline and Process

New Hampshire Medicaid applications can be submitted through several channels:

• Apply online at NHEasy Gateway to Services (nheasy.nh.gov)
• Mail a completed 'Application for Assistance (Form 800)' to a local DHHS office
• Call DHHS Customer Service Center at 844-275-3447 (844-ASK-DHHS) for program questions and application assistance

It is extremely important that all eligibility requirements are met prior to beginning the application process. Not meeting criteria can result in a denial or delay of benefits. Medicaid planning is highly suggested for those uncertain of eligibility or over the limits. Processing times vary but typically take 45–90 days.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including New Hampshire's Choices for Independence Program, Personal Care Attendant Services, and Money Follows the Person — are likely targets for cuts. This law is still facing legal challenges. Families relying on or planning to use HCBS should monitor developments and consider applying early.

Last updated: September 2026. Data sources: New Hampshire Department of Health and Human Services (DHHS), CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.