Medicaid Long-Term Care Guide in New Hampshire
Long-term care eligibility, benefits, and how to apply through the New Hampshire Department of Health and Human Services (DHHS).
What makes New Hampshire Medicaid different
Medicaid in New Hampshire is also called Medical Assistance. While jointly funded by the state and federal government, it is state administered by the 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.
Administered by the New Hampshire Department of Health and Human Services (DHHS).
Program Types
Institutional / Nursing Home Medicaid
An entitlement; anyone who meets the requirements will receive assistance. Benefits are provided in Medicaid-certified nursing home facilities.
Level of care: Nursing Home
Medicaid Waivers / Home and Community Based Services (HCBS)
Not an entitlement; there are a limited number of participant enrollment slots and waiting 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.
Level of care: Nursing Home
Regular Medicaid / Old Age Assistance (OAA)
An entitlement; if eligibility requirements are met, one will receive assistance. While Regular Medicaid is not Long-Term Care Medicaid, some long-term care services, such as personal care assistance or adult day care, may be available.
Level of care: Help with ADLs
2026 New Hampshire Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid*
Medicaid Waivers / Home and Community Based Services‡
Regular Medicaid / Old Age Assistance
*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $93.00 / month, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs. This is called a Patient Liability.
†While the applicant asset limit is $2,500, New Hampshire applies an asset disregard, which allows one to have up to $7,500 in assets.
‡Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.
Explore New Hampshire Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to New Hampshire.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — New Hampshire
How the main LTC programs available in New Hampshire compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $16–19/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in New Hampshire | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
New Hampshire Medicaid programs
Choices for Independence Waiver
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in New Hampshire
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in New HampshireHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: DHHS · dhhs.nh.gov
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in New Hampshire
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in New Hampshire. The process typically takes 45–90 days from application to first paycheck.
Apply in New Hampshire: DHHS · dhhs.nh.gov
Medicaid Eligibility Screener — New Hampshire
Answer 7 quick questions — we'll check the financial and care requirements for New Hampshire and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly any income from any source is counted towards Medicaid's income limit, including employment wages, alimony, pension payments, SSDI, SSI, IRA withdrawals, and stock dividends.
- Nationally, Holocaust restitution payments are not counted as income.
- In NH, the VA Aid & Attendance Allowance, which is above and beyond the Basic VA Pension, does not count.
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,644 (eff. 7/1/25 – 6/30/26). If a non-applicant spouse's income falls under 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 MMMNA of $4,067 / month.
- For Regular Medicaid / Old Age Assistance, both spouses' income is counted. There is no MMMNA for a non-applicant spouse.
- Countable assets 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.
- For Nursing Home Medicaid and Regular Medicaid, all assets of a married couple are considered jointly owned.
- 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.
- The 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 is under $32,532, up to $32,532 can be retained.
- There is no CSRA for Regular Medicaid.
- The 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 this is not the case, there is a home equity interest limit of $730,000 (in 2026).
- Home equity is the value of the home minus any outstanding debt. Equity interest is the amount of equity owned by the applicant.
- If neither the applicant nor qualifying family live in the home, the applicant must have Intent to Return. After 6 months, even with Intent to Return, a single Medicaid beneficiary might be required to sell their home.
- There is no home equity interest limit for Regular Medicaid.
- The home is NOT exempt from Medicaid's Estate Recovery Program. After a beneficiary's death, New Hampshire's Medicaid agency attempts reimbursement of care costs through the deceased's estate.
- New Hampshire has a 60-month (5-year) Look-Back Period for Nursing Home Medicaid and Medicaid Waiver applications.
- Medicaid checks all asset transfers to ensure none were gifted or sold for less than fair market value, including transfers by a spouse.
- Violations, even unintentional ones, result in a Penalty Period of Medicaid ineligibility.
- The Look-Back Rule does not apply to Regular Medicaid.
- The U.S. Federal Gift Tax Rule ($19,000 per recipient in 2026) does not extend to Medicaid eligibility — gifting under this rule still violates the Look-Back Period.
- MMMNA: $2,644 · CSRA: $162,660 · CSRA Min: $32,532
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,644 (eff. 7/1/25 – 6/30/26). Income can be transferred from the applicant spouse if the non-applicant's income is below this level.
- A non-applicant can increase their Spousal Income Allowance if housing/utility costs exceed the shelter standard of $794 / month, up to a maximum of $4,067 / month.
- The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (min $32,532) in 2026.
- For HCBS Waivers, spousal assets are NOT considered jointly owned, but a CSRA may still apply upon resource assessment.
- For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.
- Medically Needy Pathway — New Hampshire has a Spend-Down Program. The MNIL (protected income level / PIL) is $939 / month for an individual and $1,093 / month for a couple (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. 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 such as home modifications (wheelchair ramps, stair lifts), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof the Look-Back Rule was not violated.
- Medicaid Planning — Work with a Medicaid Planning Professional to employ strategies to become eligible and protect your home from Medicaid's Estate Recovery Program.
New Hampshire does not use Qualified Income Trusts (Miller Trusts). The Medically Needy / Spend-Down program is available for persons over the income limit.
New Hampshire Medicaid 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.
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 one's adult child or spouse.
Money Follows the Person
A federal program that helps institutionalized persons who are eligible for Medicaid to transition back home or another community setting.
How to Apply
- Apply online at NHEasy Gateway to Services
- 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.
More New Hampshire Long-Term Care Resources
New Hampshire Long-Term Care Costs
Compare assisted living, home care, and nursing home costs.
New Hampshire Senior Services Directory
Find local aging agencies, support programs, and community resources.
Veterans Long-Term Care Benefits
Aid & Attendance, caregiver programs, and VA nursing home coverage.
Take the Next Step for New Hampshire Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- New Hampshire Department of Health and Human Services (DHHS) — New Hampshire Medicaid — Official site