Medicaid — not Medicare — is the primary payer of long-term care in the United States. Medicare covers short rehab stays after a hospital admission, then stops. The bill for ongoing nursing-home care, memory care, or in-home support past that window has to be paid by someone — and for the majority of US seniors, that someone is the state Medicaid program. In New Hampshire, that program runs through the Bureau of Elderly and Adult Services (BEAS) within the Department of Health and Human Services.1

NH delivers Medicaid long-term care through two main paths: institutional Medicaid (nursing-home coverage) and the Choices for Independence (CFI) waiver, which is the Home and Community-Based Services waiver covering care at home, in assisted living, or in adult family-care homes. Both apply the same financial-eligibility rules. What differs is where care is delivered and the availability of waiver slots.

Three eligibility tests, in order

1. Medical eligibility

Before the financial analysis matters, your parent has to meet a medical level-of-care standard. NH uses a functional assessment that scores the applicant on activities of daily living, instrumental activities of daily living, and cognitive status. Meeting nursing-home level of care is required for both institutional placement and CFI enrollment.

Schedule the assessment early — wait times can run several weeks. Once eligibility is established, CFI slot availability becomes the next question; the program is a capped waiver, and waiting lists periodically open.

2. Income

NH applies the federal categorical income standard for Medicaid LTC: gross monthly income at or below 300% of the federal benefit rate (approximately $2,829/month in 2026). If your parent’s gross income from all sources exceeds this, they aren’t automatically disqualified — a Qualified Income Trust (QIT), sometimes called a Miller trust, allows above-cap income to be diverted and not count toward eligibility.2

3. Assets

This is where families lose months and tens of thousands of dollars to misinformation. The applicant’s countable assets must be at or below the applicable limit ($2,500 in NH) at the moment of application. A number of categories are not counted.

Not counted (in most cases):

Counted:

The five-year look-back, in plain English

NH (like every state) reviews any transfer of assets for less than fair market value made during the 60 months before the Medicaid application. Uncompensated transfers trigger a penalty period— a window during which your parent is otherwise eligible but Medicaid won’t pay.

The penalty math is straightforward: the value of the transfer divided by NH’s penalty divisor (approximately $11,000/ month). A $50,000 gift produces roughly a 4.5-month penalty. The penalty clock does not start until your parent is otherwise eligible— meaning they’ve spent down and are in care. So the penalty hits precisely when the family most needs Medicaid to pay.

Choices for Independence (CFI): the HCBS waiver

Most older adults prefer to receive care at home, in assisted living, or in adult family-care homes rather than in a nursing facility. NH’s Choices for Independence waiver pays for those services for eligible Medicaid recipients.3 CFI covers:

CFI slots are capped, and waiting lists are common when the waiver is at capacity. If your parent might benefit from CFI rather than nursing-home placement, start the application process early.

The community-spouse situation

If one spouse needs care and the other doesn’t, federal spousal-protection rules apply. The well spouse (the “community spouse”) keeps:

Most one-spouse-needs-care situations can be planned to a non-catastrophic outcome with 12–24 months of lead time. Talk to a NH elder-law attorney before doing anything unilateral — the DIY approach in this scenario is where we’ve seen the most expensive mistakes.

When to start planning

The honest answer: as soon as you see meaningful cognitive or physical decline. The look-back math — spend-down on exempt assets, certain trust structures, spousal allowance optimization — works well at the five-year mark and progressively worse as you get closer to application. That doesn’t mean it’s ever too late — plenty of families plan in the final 12–18 months and still improve the outcome. But the toolkit narrows.

What to do this month

For the broader Medicaid context, see our Medicaid pillar overview. For NH estate planning that intersects with Medicaid, see Legal & Financial in NH.