Discharge to Assisted Living in New Hampshire

Your parent's hospital case manager just said the words "assisted living placement," and now you're trying to figure out what that actually means in New Hampshire — who pays, how much, and whether Medicaid covers any of it. The short answer: Medicare covers zero of the room and board, and the funding landscape is more complicated than most families expect.

What Medicare Does and Does Not Cover

Medicare never pays for assisted living room and board. This catches families off guard because Medicare does cover skilled nursing facility stays after a qualifying three-night inpatient admission. But Medicare does not cover the room-and-board or custodial-care costs of assisted living, so families need another way to pay the facility charge.

If your parent needs short-term rehabilitation after a hospital stay, a skilled nursing facility is the Medicare-covered path. Assisted living only enters the picture when the goal is long-term residential support — help with meals, medications, bathing, and daily routines — rather than intensive medical rehabilitation.

How the CFI Waiver Works in Assisted Living

New Hampshire's Choices for Independence waiver can fund care services delivered inside a residential care facility, but it does not cover the room and board portion. The distinction matters: if your parent qualifies for the CFI waiver and moves into an assisted living community that accepts waiver participants, Medicaid can pay for personal care assistance, medication management, and nursing oversight. The monthly facility charge for housing and meals remains a private-pay expense.

To qualify for CFI waiver services, your parent must meet both clinical and financial thresholds. The clinical standard requires needing hands-on help with at least two activities of daily living. The financial criteria include a monthly income cap of $2,982 and an effective countable asset limit of $7,500 (the base $2,500 limit plus New Hampshire's $5,000 resource disregard under House Bill 2).

Contact your local ServiceLink ADRC to start the application. ServiceLink Options Counselors handle intake, preliminary financial screening, and coordination between the Bureau of Family Assistance and the Bureau of Adult and Aging Services.

What Assisted Living Costs in New Hampshire

Assisted-living costs vary significantly by region and level of care. The Concord/Manchester area averages around $7,560 per month. Memory-care pricing is a separate consideration and may be higher depending on the community and level of care.

For families paying entirely out of pocket, that's roughly $90,000 per year before any additional care fees. This is why understanding whether CFI waiver services can offset eligible care costs matters — coverage of personal care services can reduce the amount the family pays privately.

Choosing a Facility During a Hospital Discharge

Hospital discharge planners often hand families a list of nearby facilities and a tight timeline. Before signing an admission agreement, ask these questions:

• Does the facility accept CFI waiver participants? Not all assisted living communities in New Hampshire participate in the waiver program. Confirm this directly with the facility's admissions coordinator.
• What triggers additional care charges? Many communities use tiered pricing based on the resident's care level. A parent who needs help with three or four ADLs may be placed in a higher tier that adds $500 to $2,000 per month.
• What is the facility's policy on Medicaid conversion? If your parent's private funds run out, some facilities allow conversion to Medicaid-funded services through the CFI waiver. Others require discharge. Get this in writing before admission.
• What are the discharge and transfer policies? Ask the community for its written discharge and transfer policies before signing, and understand the process it follows for an involuntary discharge.

Review the facility's most recent state inspection reports through the NH DHHS website and check staffing ratios, complaint history, and any enforcement actions.

When Assisted Living Is Not the Right Step

If your parent needs skilled medical care — wound management, IV medications, ventilator support, or intensive physical rehabilitation — assisted living is not equipped to provide it. A skilled nursing facility or inpatient rehabilitation hospital is the appropriate setting, and Medicare Part A covers those stays when clinical criteria are met.

If your parent's primary need is help at home rather than facility-based care, the CFI waiver can fund in-home personal care, home-delivered meals, emergency response systems, and home modifications. For many families, keeping a parent at home with waiver-funded services is both less expensive and more aligned with the parent's preferences.

The Hospital-to-Home New Hampshire guide walks through every transition pathway — from discharge appeals through Medicaid applications to facility selection — with the specific forms, deadlines, and dollar figures you need for each step.

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