New Hampshire Medicaid for Seniors & Long-Term Care

The Choices for Independence (CFI) waiver is New Hampshire's primary 1915(c) HCBS waiver for adults age 18 and over who are at risk of nursing facility placement. CFI allows eligible individuals to receive Medicaid-funded home and community-based services — such as personal care attendants, home modifications, and adult day programs — as an alternative to institutional care.

CFI eligibility requires meeting both financial criteria and a nursing facility level of care assessment. NH DHHS administers CFI through the Bureau of Elderly and Adult Services (BEAS). To apply, contact BEAS or your regional Area Agency on Aging. There may be a waiting list for CFI services; individuals on the waitlist may still qualify for other NH Medicaid services while waiting for a slot.

New Hampshire Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care, typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance, which is $93/month in New Hampshire, well above the $30/month federal minimum. Medicaid covers the gap. If income exceeds the institutional Medicaid limit, New Hampshire may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. Exempt assets are not counted: the primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt. Medicaid has a 60-month (5-year) lookback period for asset transfers; transfers for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income, the minimum monthly maintenance needs allowance (MMMNA). The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility.

New Hampshire operates a Medicaid estate recovery program. The state may seek reimbursement from the estate of a Medicaid member who received nursing facility care or certain long-term services at age 55 or older. NH applies a 60-month look-back period for asset transfers before a long-term care Medicaid application. The primary residence is typically exempt while a surviving spouse, a child under 21, or a disabled or blind child lives there. Consult a New Hampshire-licensed elder law attorney before making asset transfers if nursing facility Medicaid may be needed.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact New Hampshire Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.