New Hampshire provides long-term care resources to seniors through the New Hampshire Department of Health and Human Services (DHHS), Bureau of Elderly and Adult Services. The Bureau oversees New Hampshire ServiceLink, which is the state’s official Aging and Disability Resource Center (ADRC). The ADRC provides information on long-term care resources such as state health care programs for people with Medicare, Caregiver support services, and options counselling – to help determine what types of services and support you or your loved one need for long-term care.

In addition to the resources provided through NH ServiceLink, the state operates a Medicaid waiver program for seniors over 65 who would otherwise require a nursing home level of care but wish to remain in a community setting or their own home.

Medicaid Waiver Program for Assisted Living and In-Home Care

New Hampshire Choices for Independence Medicaid Waiver (NH Choices for Independence Waiver)

The Choices for Independence Program (CFI) is administered by the New Hampshire Department of Health and Human Services, Bureau of Elderly and Adult Services (BEAS). CFI is available to adults who are financially eligible for Medicaid and who medically qualify for the level of care provided in a nursing home. The program provides a wide range of service choices designed to help program participants stay in their own homes and communities.

Services

Services include adult medical care, home health aide, homemaker, personal care, respite, adult family care, adult in-home services, community transition, consolidated services, environmental accessibility, home-delivered meals, non-medical transportation, PERS, residential care facility, skilled nursing, specialized medical equipment, supportive housing services.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care as determined by the Department of Health and Human Services.
  2. Financial: Applicants for the waiver may qualify if they meet certain income and asset limits under the Special Income Limit pathway. For 2022, the income limit for an individual is $2,523, and the asset limit is $2,500 for an individual. If the applicant cannot meet the strict financial income limit, the other pathway for eligibility is through the “medically needy” option. If you choose this route, medical and other remedial care expenses are considered and disregarded from the calculation of your monthly income. The income limit for the “medically needy” pathway is $591, meaning that you must spend down your income on medical-related expenses to that limit before you can be financially eligible. For the non-applicant spouse (or “community spouse”), certain assets and allowances are disregarded for purposes of determining the applicant spouse’s eligibility. For 2022, the community spouse is allowed to keep up to $137,400 in assets, known as the community spouse resource allowance (CSRA).  In addition to the assets, if one spouse is not applying for benefits, the applicant spouse can transfer up to $3,435 in monthly income to the non-applicant spouse.

Practical Considerations

The fact that there is a hard special income limit without the ability to use a Miller Trust means that it is more difficult to qualify if you have too much income. The “medically needy” pathway also is difficult due to the more restrictive income limits that the state has set.

Conclusion

In New Hampshire, it is difficult to receive Medicaid for long-term care in assisted living facilities or in-home care because of their restrictive income limits as a 209(b) state. The spend-down provision of the “medically needy” pathway allows people to spend almost all of their monthly income on medical expenses.

Access all state Medicaid Waiver pages.