Elder Care Index

What Medicaid Actually Covers for Senior Care

Navigating senior care options in New Hampshire can feel overwhelming, but understanding what Medicaid covers is a crucial first step. In our state, you'll primarily encounter two main paths for long-term care through Medicaid, also known as Medical Assistance: Institutional/Nursing Home Medicaid and Home and Community-Based Services (HCBS) Waivers. Institutional Medicaid is designed for those who need a nursing home level of care and covers the full cost of care within a Medicaid-certified facility, including room, board, medical, and non-medical services. For those who wish to remain at home or in a community setting, the key program is the Choices for Independence (CFI) Waiver. This waiver supports services like adult day care, home health aides, specialized medical equipment, respite care, and modifications to your home or vehicle to increase independence. However, it's important to know that while CFI helps pay for these crucial care services, it generally does not cover "room and board" expenses such as rent, mortgage payments, utility bills, or food costs if your loved one lives at home or in an assisted living facility.

Do You Qualify?

Understanding the eligibility picture for 2026 is vital. For a single senior applying for Nursing Home Medicaid or an HCBS Waiver in New Hampshire, the income limit is typically $2,982 per month, and the asset limit is $2,500. If your parent's income is higher than this, New Hampshire has a "Medically Needy Pathway" or Spend-Down Program. This allows them to qualify by spending their excess income on approved medical expenses, effectively reducing their countable income to the Medically Needy Income Limit, which is $939 per month for an individual. When considering assets, a primary home is generally exempt, provided its equity interest is below $752,000 in 2026, especially if a spouse, minor child, or disabled child lives there, or if your parent expresses an "Intent to Return" to the home. However, be aware that the state may seek reimbursement from the home's value after your parent's death through estate recovery. Pension payments are usually counted as income. New Hampshire also has a 60-month (five-year) "Look-Back Period" for asset transfers, meaning any assets gifted or sold for less than fair market value during this time could result in a penalty period of Medicaid ineligibility. For married couples where only one spouse needs care, spousal impoverishment rules allow the non-applicant spouse to keep a Community Spouse Resource Allowance (CSRA) of up to $162,660 in assets and a Minimum Monthly Maintenance Needs Allowance (MMMNA) of $2,644 per month from the applicant spouse's income to prevent financial hardship.

Waitlists & How to Apply

The reality of waitlists can be a significant concern. Institutional/Nursing Home Medicaid is considered an entitlement, meaning anyone who meets the eligibility requirements is guaranteed assistance without a waitlist, though securing a bed in a specific facility might depend on availability. However, Home and Community-Based Services Waivers, like the Choices for Independence Program, are not entitlements and have a limited number of enrollment slots, which means waitlists may exist. To apply, you have a few options: the easiest way is often online through the NH EASY Gateway to Services portal. You can also mail a completed "Application for Assistance (Form 800)" to your local Department of Health and Human Services (DHHS) office, or call the DHHS Customer Service Center at 1-844-ASK-DHHS (1-844-275-3447) for assistance or to request a paper application. You'll need to gather documents such as proof of income, Social Security numbers, and identification. Once submitted, you can generally expect a decision on your application within 45 days.

Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.