Medicaid Senior Care for Southern New Hampshire

Navigating healthcare coverage during the senior years often involves understanding Medicaid—a vital resource for many older adults in Southern New Hampshire. For families managing the costs of senior care, Medicaid programs can provide essential support, but understanding eligibility requirements and available services requires careful attention to New Hampshire’s specific regulations.

What is Medicaid and How Does It Differ from Medicare?

While many seniors are familiar with Medicare, the federal health insurance program primarily for those 65 and older, Medicaid serves a different purpose. Medicaid is a joint federal and state program that covers medical costs for eligible individuals with limited income and resources.

The key difference: Medicare is primarily age-based health insurance, while Medicaid is needs-based assistance. Many seniors actually qualify for both programs, which is known as being “dual eligible.”

In New Hampshire, the Medicaid program for seniors and people with disabilities is administered by the Department of Health and Human Services (DHHS).

New Hampshire Medicaid Eligibility for Seniors (2025)

Qualifying for Medicaid in New Hampshire requires meeting both financial and non-financial requirements. For seniors seeking long-term care coverage, the eligibility criteria include:

Financial Requirements:

• Income Limits: Individual applicants generally cannot exceed monthly income limits set by the state. As of 2025, the income limit for an individual is $2,901 per month for nursing home and waiver services (subject to annual adjustments).
• Asset Limits: For a single applicant, countable assets cannot exceed $2,500. For married couples with one spouse applying, the community spouse (the one not requiring care) can retain a higher amount of assets—up to $157,920, depending on circumstances.

Non-Financial Requirements:

• Age or Disability Status: Applicants must be 65 years or older or have a qualifying disability.
• Residency: Must be a New Hampshire resident.
• Citizenship: Must be a U.S. citizen or have qualified immigration status.
• Need for Care: Must meet the nursing home level of care requirement for certain programs.

Eligibility limits are subject to change. Always verify current information through New Hampshire DHHS at dhhs.nh.gov.

Types of Medicaid Programs Available to New Hampshire Seniors

New Hampshire offers several Medicaid programs designed specifically for seniors:

Nursing Home Medicaid

This program covers care in nursing homes for those who require 24-hour skilled nursing care and meet the nursing home level of care criteria. Services typically covered include:

• Room and board
• Nursing care
• Medical supplies and equipment
• Rehabilitation services
• Personal care assistance
• Medication management

Participants usually contribute most of their monthly income toward their care costs, retaining only a small personal needs allowance.

Home and Community-Based Services (HCBS) Waiver

New Hampshire offers the Choices for Independence (CFI) Waiver, which helps seniors receive care while remaining in their homes or community settings rather than entering a nursing facility. Services may include:

• Personal care assistance
• Home health aide services
• Adult day health services
• Home-delivered meals
• Environmental modifications
• Respite care
• Medical transportation

This program requires meeting the same level of care criteria needed for nursing home placement but allows for care in less restrictive environments.

Medicaid Spend Down (Medically Needy Program)

For seniors whose income exceeds Medicaid limits but who face substantial medical costs, the Medicaid Spend Down program may provide a pathway to coverage. This program allows individuals to “spend down” their excess income on medical expenses until they reach the eligibility threshold.

Understanding the Application Process

Applying for Medicaid in New Hampshire requires certain documentation and involves several steps:

Required Documentation:

• Proof of identity and citizenship​
• Social Security card​
• Proof of New Hampshire residency​
• Financial statements (bank accounts, investments, property)​
• Income verification​
• Insurance cards and policies​
• Medical records demonstrating level of care needs​

Application Methods:

• Online: Through NH EASY (nheasy.nh.gov)​
• In Person: At your local DHHS office​
• By Mail: Using downloadable forms from the DHHS website​
• By Phone: Call 1-844-275-3447​

Assessment:

• An in-person, face-to-face assessment by a registered nurse will be conducted to determine medical eligibility for long-term care services. ​

Processing Time:

• The processing time typically ranges from 45 to 90 days, depending on the complexity of the case and the type of coverage requested. ​

Navigating Asset Rules and Spend-Down Requirements

Understanding Medicaid’s approach to assets is crucial for proper planning:

Countable vs. Exempt Assets

Medicaid distinguishes between countable and exempt assets:

Countable assets (those that affect eligibility) typically include:

• Cash and bank accounts
• Investments and retirement accounts
• Additional properties beyond the primary residence
• Certain life insurance policies with cash value

Exempt assets (those not counted toward the eligibility limit) generally include:

• Primary residence (with equity limits)
• One vehicle
• Personal belongings and household items
• Burial plots and prepaid funeral contracts
• Certain life insurance policies

Look-Back Period and Transfer Penalties

New Hampshire Medicaid imposes a 5-year “look-back period” on asset transfers. This means:

• Medicaid reviews all financial transactions in the 5 years before application
• Gifts or assets sold below fair market value may trigger penalties
• Penalties result in periods of Medicaid ineligibility

The penalty period is calculated based on the value of transferred assets divided by the average monthly cost of nursing home care in New Hampshire.

Spousal Impoverishment Protections

When one spouse requires long-term care while the other remains in the community, New Hampshire Medicaid provides protections for the community spouse:

• The community spouse can retain a Monthly Maintenance Needs Allowance from the institutionalized spouse’s income
• The community spouse can keep the primary residence, one vehicle, and personal possessions
• The Community Spouse Resource Allowance permits the at-home spouse to retain a portion of the couple’s joint assets

Working with Medicaid at Maple Leaf Health Care Center

Maple Leaf Health Care Center works with Medicaid-eligible residents to ensure they receive appropriate care while navigating the complexities of coverage. Our approach includes:

• Assistance with determining potential eligibility. While we cannot provide definitive eligibility determinations, our administrative team can help families understand general requirements.
• Coordination with Medicaid case managers to ensure covered services are properly authorized and documented.
• Regular communication with residents and families about any changes in Medicaid coverage or requirements that might affect care.
• Support during the annual Medicaid recertification process to help maintain continuous coverage.

Common Challenges and How to Address Them

Families often encounter challenges when navigating Medicaid for senior care:

Income Over the Limits

For seniors whose income exceeds Medicaid limits but falls short of covering care costs, options include:

• Qualified Income Trusts (Miller Trusts) in some circumstances
• The Medicaid Spend Down program
• Exploring alternative financial assistance programs

Asset Spend-Down Concerns

When asset levels exceed limits, families often worry about appropriate spend-down strategies. Consider:

• Paying for legitimate medical care and services
• Making home modifications for accessibility
• Paying off debts
• Purchasing exempt assets when appropriate

Always consult with an elder law attorney before making significant financial decisions related to Medicaid planning.

Denial of Benefits

If your Medicaid application is denied:

• Review the denial notice carefully to understand the reasons
• Gather documentation to address the identified issues
• File an appeal within the specified timeframe (usually 30 days)
• Consider seeking assistance from a legal aid organization or elder law attorney

Resources for Additional Help

Navigating Medicaid can be complex, but numerous resources exist to assist New Hampshire families:

• ServiceLink Resource Centers: New Hampshire’s aging and disability resource centers provide free information and assistance with Medicare and Medicaid questions. Call 1-866-634-9412 to find your local office. ​
• New Hampshire Legal Assistance (NHLA): Offers legal services for seniors on healthcare access issues. Visit www.nhla.org or call 1-800-562-3174.
• DHHS Bureau of Elderly and Adult Services: Provides information on various assistance programs for seniors. Call 1-800-351-1888.​
• NH Medicaid Client Services: Answers questions about Medicaid benefits and eligibility. Call 1-800-852-3345, extension 4344.​

Planning Ahead Makes a Difference

The complexity of Medicaid rules makes advance planning crucial. Ideally, families should begin considering long-term care options and potential Medicaid eligibility well before the need becomes urgent.

Working with a qualified elder law attorney who specializes in Medicaid planning can help families develop strategies that preserve assets while ensuring access to necessary care. Many attorneys offer initial consultations to outline potential approaches.

Get Expert Guidance at Maple Leaf Health Care Center

Understanding Medicaid coverage for senior care involves navigating complex regulations and requirements. At Maple Leaf Health Care Center, we’re committed to helping families understand their options for quality care.

Our administrative team works closely with residents and families to provide information about potential coverage options and connect them with appropriate resources. While we don’t provide legal or financial advice, we can help guide you through the process of accessing care.

For questions about Medicaid coverage at our facility or to learn more about our services for seniors in Southern New Hampshire, call us at 603-669-1660. Our team is ready to help you understand your options for quality care in our Manchester community.