New Hampshire Medicaid Planning: What Families Need to Know
The state program
New Hampshire long-term-care Medicaid in 2026: a $2,982 income cap, $162,660 spousal maximum, $752,000 home-equity limit, tiered look-back and estate recovery.
Jurisdiction New HampshireLast updated October 9, 2026
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When a parent or spouse in New Hampshire needs nursing-home care, Medicaid can pay for it once the person meets the state's medical, income and asset rules. New Hampshire DHHS decides eligibility. It sets 2026 limits, protects part of a couple's savings for the spouse at home, reviews past gifts and may recover costs from an estate after death.
Most people facing a nursing-home placement in New Hampshire come to these rules in the middle of something hard. A hospital discharge may be coming up. A spouse may no longer be safe at home. The family may be watching private-pay bills use up savings that took a lifetime to build. The questions arrive all at once: whether the family home is at risk, what a wife or husband at home will live on, and whether help a parent gave the grandchildren years ago will count against them now. This page explains how New Hampshire's own program answers those questions, using the state's official figures for 2026.
How New Hampshire Medicaid Works for Long-Term Care
Federal law sets the framework every state follows, and each state runs its own program. Federal spousal rules are in 42 U.S.C. § 1396r-5. Estate-recovery rules are in 42 U.S.C. § 1396p. New Hampshire's Department of Health and Human Services (DHHS) applies these rules through its own manuals and policy releases, and those state rules can differ from another state's.
New Hampshire's long-term-care coverage includes nursing facility (NF) care. It also includes home- and community-based services, which DHHS calls HCBS and Choices for Independence (CFI). A person must qualify on two tracks:
Financial eligibility. According to the DHHS Nursing Home Care page, the application starts through any regional Aging & Disability Resource Center (ADRC). The ADRC can help gather information and schedule an appointment with a family service specialist at the Bureau of Family Assistance.
Medical eligibility. A registered nurse employed or designated by the Bureau of Adult and Aging Services (BAAS) conducts a face-to-face assessment at the applicant's current location. The nurse uses the Medical Eligibility Assessment (MEA) form to decide whether the person meets Nursing Facility Level of Care.
A few terms appear throughout this page:
A countable asset is property Medicaid counts toward the limit.
An exempt asset is property it does not count.
The community spouse is the husband or wife who stays at home.
The look-back period is the window of past transfers the agency reviews.
A penalty period is a stretch of months without long-term-care coverage that results from a gift.
Estate recovery is the state's claim for repayment after the recipient's death.
This page covers Medicaid for long-term care only. It does not cover Medicare, private long-term-care insurance or veterans' benefits.
Income Limits for New Hampshire Long-Term-Care Medicaid
Income is the other half of the financial test. Under DHHS Supervisory Release SR 26-01, the NF CAP that New Hampshire uses to determine NF, HCBS and HCBS-CFI categorically needy services increased to $2,982 a month for 2026. The CMS 2026 bulletin lists the same $2,982 figure as the federal income cap limit (300%) for an individual, effective January 1, 2026.
In plain terms, the cap is the monthly income level DHHS uses for categorically needy long-term-care coverage. New Hampshire also has a medically needy pathway, discussed in the next section, and how an applicant whose income is above the cap is treated depends on the state's current rules.
Asset Limits and What New Hampshire Counts
The asset limit depends on the applicant's situation. New Hampshire's Medical Assistance Manual section 407.03 sets the countable resource limit at $2,500 for a single person. For applicants and recipients of NF, CFI or HCBS who meet the medically needy income limit, DHHS applies a resource disregard so that the effective resource limit is $7,500.
The DHHS Nursing Home Care page says certain assets are excluded or disregarded under federal and state law. It also says higher limits apply when a spouse lives in the community. Whether a particular vehicle, personal belongings, burial funds or other property is exempt depends on New Hampshire's current rules as DHHS applies them.
The home. For 2026, SR 26-01 sets the home-equity limit used in financial eligibility for NF, HCBS and CFI services at $752,000. Federal law generally bars long-term-care coverage for a person whose home equity is above the state's limit. That bar does not apply when a spouse, a child under 21 or a blind or disabled child lives in the home.
Spend-down. Spend-down means reducing countable assets to the limit through permitted spending, such as paying for care or other expenses at fair value. It is different from giving assets away. Gifts fall under the look-back rules described below.
New Hampshire's Look-Back Period and Transfer Penalties
The federal look-back is 60 months for any transfer made on or after February 8, 2006. New Hampshire's Medical Assistance Manual section 415.03 also states that the look-back period for all asset transfers on or after 2/8/06 is 60 months.
For transfers on or after 1/1/24, the same section describes how deeply DHHS reviews records, in three tiers:
Tier 1: one month. This applies to people who have received assistance from DHHS for three or more years. Their assets were already verified, so they provide only current information.
Tier 2: 36 months. This applies to people who are not in Tier 1 or Tier 3. If nothing questionable appears in those 36 months, DHHS does not need to search months 37 through 60.
Tier 3: 60 months. This applies to people who have stocks, bonds or CDs, an annuity, a trust, or an IRA or other retirement account, or who transferred real property. If a person owns real property that was not transferred, the 36-month review applies.
DHHS also reviews transfers of other valuable assets made within 60 months of application. Examples include a time share, a life estate, a boat or an RV.
How New Hampshire calculates the penalty. Under Adult Assistance Manual section 415.23, the penalty period is the total uncompensated value of the transfers divided by the statewide average monthly nursing facility private pay rate. That rate is listed in Appendix A of the Medical Assistance Manual. The calculation can produce a partial month. The same section sets these rules:
The penalty is based solely on the value of the assets transferred.
For transfers on or after 2/8/06, DHHS adds together all transfers made during the look-back period.
A new penalty does not begin until an existing penalty period ends.
When a spouse's transfer causes a penalty, the penalty is apportioned between the spouses.
When a penalty begins. Federally, a penalty starts on the later of two dates: the month of the transfer, or the date the person is eligible and would otherwise be receiving institutional-level care. Because of this rule, a gift made inside the look-back is penalized the same way whether it was made last month or four years ago.
Exceptions. Federal law lists exceptions to transfer penalties. One of them is that a transfer to the person's spouse carries no penalty. Whether another exception applies depends on the facts and on New Hampshire's current rules. A fuller explanation of how penalties start in a crisis is available elsewhere on this site.
Planning for Long-Term Care?
Medi-Cal and Medicaid rules are complicated, and the stakes for your family are real. Reach out, and we'll listen to your situation and help you understand your options.
A married couple's savings are treated under special federal rules when one spouse enters long-term care. Under 42 U.S.C. § 1396r-5:
When an institutionalized spouse applies, the resources held by either spouse are generally treated as available to that spouse, except for the amount protected for the community spouse.
The state computes the couple's total resources as of the start of the first continuous period of institutionalization. Either spouse may ask for that assessment.
After eligibility is established, the community spouse's resources are not counted against the spouse receiving care.
The amount protected for the spouse at home is called the community spouse resource allowance (CSRA). Under SR 26-01, New Hampshire's 2026 figures, effective January 1, 2026, are:
Minimum CSRA: $32,532, up from $31,584.
Maximum CSRA: $162,660, up from $157,920.
Section 407.03 adds that an institutionalized person with a community spouse may keep $2,500 plus the community spouse's protected share. That allowance runs from the date of application until one year later.
Income for the spouse at home. The minimum monthly maintenance needs allowance (MMMNA) is the monthly income floor protected for the community spouse. Federally, it changes each July 1, according to the CMS 2026 bulletin. For 2026, New Hampshire raised its maximum monthly maintenance needs allowance from $3,948.00 to $4,066.50. New Hampshire's minimum figure depends on the state's current rules.
Income of the spouse receiving care. After eligibility is established, most of that person's income goes toward the cost of care. They keep a $93 monthly personal needs allowance, and income may be allocated to the community spouse.
For couples, the hardest worry is often whether the spouse at home can stay in their own life. These figures are where that answer begins.
Liens on the home. If a person lives in a nursing home and the house or land is not occupied by their spouse, minor or disabled child, or a sibling with an equity interest, the State will file a lien. The lien is to recover Medicaid received after age 55. Before filing, the State must give notice of its intent and an opportunity for a hearing. If the property is jointly owned, the State collects only up to the recipient's ownership share.
What counts as the estate. For recovery, New Hampshire's definition of the estate is broad. It includes assets that pass through probate and assets that pass outside it. It also includes property held alone or jointly on the date of death, which can include joint tenancy, life estates and living trusts.
When a claim is filed. The State files a claim if the person received medical assistance after age 55 and, at death, was unmarried or widowed and had no minor or disabled children. In most cases, there is no recovery for medical assistance received before age 55.
Federal protections. Under 42 U.S.C. § 1396p(b)(2), recovery may be made only after the surviving spouse has died, and only when there is no surviving child under 21 or blind or disabled child. That rule postpones the claim; it does not cancel it. Under 42 U.S.C. § 1396p(b)(3), states must also have procedures to waive recovery when it would work an undue hardship.
Families who think of the house as the one thing to pass on often find this section the most sobering. The protections above show where the rules make room.
Medicaid Planning Tools Available Under New Hampshire Law
The tools used in planning are described here, not recommended. Each one depends on dates, ownership and how DHHS applies its rules.
Irrevocable trusts. Section 415.23 treats transfers to an irrevocable trust, where the principal is not available to the person, as transfers subject to penalty rules. A trust also places an application in Tier 3 of the look-back review. A trust does not always protect assets. The result depends on its terms and timing.
Annuities. An annuity also triggers the 60-month review. Whether it affects eligibility depends on its structure and New Hampshire's current rules. An annuity does not always protect assets.
Spouse-to-spouse transfers. Federal law allows the spouse receiving care to transfer the CSRA amount to the community spouse. Transfers between spouses carry no transfer penalty.
Spend-down purchases. Spending at fair value is not a gift. Whether a specific purchase is treated as exempt depends on the state's current rules.
Power of attorney. If a parent can no longer sign, the agent's authority comes only from the document itself. The scope of that document matters.
Every transfer, trust and account must be reported fully on the application. Nothing here guarantees eligibility or a result. For background on planning before a nursing-home stay, this site has a separate overview.
What a New Hampshire Elder-Law Attorney Does in Medicaid Planning
An elder-law attorney's work in this area includes:
Analyzing a family's assets, income and transfer history against New Hampshire's rules.
Explaining which planning options the rules allow.
Preparing documents such as trusts and powers of attorney.
Assisting with applications.
Handling appeals.
Appeal deadlines. Under the DHHS Administrative Appeals page, an appeal must generally be filed within 30 days of the date on the Notice of Decision. The notice itself states the exact time limit. If the appeal is filed within 15 days, benefits may sometimes continue at the same level until a decision is issued. Those benefits must be repaid if the Department's action is upheld. A person who cannot complete the form or write a letter may start an appeal by telling a DHHS representative.
What this page does not cover. This page also does not address divorce or real-estate closings.
Discussing Medicaid Planning in New Hampshire
New Hampshire's rules turn on details. They include how many months of records DHHS reviews, how a trust or annuity changes that review, and how the 2026 income and spousal figures apply to a particular couple. A consultation can cover the family's assets and how each is titled, the dates and amounts of past transfers, the care setting, and whether a spouse or child lives in the home.
To talk through a situation like this with an attorney, request a consultation about your family's Medicaid and long-term-care options through Medicaid Asset Protection Group.
Planning for Long-Term Care?
Medi-Cal and Medicaid rules are complicated, and the stakes for your family are real. Reach out, and we'll listen to your situation and help you understand your options.
What kind of lawyer can help with Medicaid planning in New Hampshire?
Elder-law attorneys are the lawyers who usually handle long-term-care Medicaid planning. Because DHHS applies New Hampshire's own manuals and 2026 figures, an attorney familiar with the state's rules is the usual point of reference. The attorney's tasks are listed in the section above.
How far back does New Hampshire look at asset transfers?
For transfers on or after February 8, 2006, New Hampshire's look-back period is 60 months. For transfers on or after January 1, 2024, DHHS reviews one, 36 or 60 months of records, depending on the applicant's assistance history and assets. Applicants with an annuity, a trust, stocks, a retirement account or a transfer of real property get the full 60-month review.
Can a New Hampshire Medicaid applicant keep the family home?
The home can be kept during life, but the 2026 home-equity limit for NF, HCBS and CFI services is $752,000. Federal law bars coverage above the limit unless a spouse, a child under 21 or a blind or disabled child lives in the home. The State may file a lien on the home and may file an estate claim after death.
What does the community spouse get to keep under New Hampshire Medicaid?
For 2026, the community spouse resource allowance ranges from $32,532 to $162,660. New Hampshire's maximum monthly maintenance needs allowance is $4,066.50. The state's minimum income figure depends on its current rules.
Does New Hampshire recover Medicaid costs from a recipient's estate?
Yes. New Hampshire recovers for medical assistance received after age 55, and its definition of the estate includes both probate and non-probate assets. Federal law postpones recovery while a surviving spouse, a child under 21 or a blind or disabled child survives, but that does not cancel the claim. Hardship waivers are also available.
What is a Medicaid penalty period and how is it calculated?
A penalty period is a stretch of months without long-term-care coverage caused by a gift made within the look-back. New Hampshire calculates it by dividing the total uncompensated value of the transfers by the statewide average monthly nursing facility private pay rate. Federally, the penalty starts on the later of the transfer month or the date the person is otherwise eligible for care.
Are transfers to a spouse penalized under Medicaid?
No. Under federal law, a transfer of assets to the person's spouse carries no transfer penalty. Federal law also lists other exceptions. Whether one of those applies depends on the facts and New Hampshire's current rules.
