How to Prepare for the Medicaid Assessment in New Hampshire

Why Preparation Matters More Than You Think

The Medical Eligibility Assessment (MEA) is a single visit — roughly 45 minutes — that determines whether your parent qualifies for Medicaid-funded home care in New Hampshire. A registered nurse from the Bureau of Elderly and Adult Services evaluates your parent's functional capacity against the nursing facility level of care standard. The threshold: documented dependency in at least two Activities of Daily Living.

Forty-five minutes isn't much time to capture the reality of daily caregiving. And the biggest threat to an accurate assessment isn't your parent's health — it's their instinct to perform.

The Masking Problem

Parents with cognitive decline or physical frailty routinely present better than their daily baseline during formal evaluations. They sit up straighter, concentrate harder, answer questions more clearly, and minimize their struggles. Psychologists call this "masking" or "staging." Families call it the reason their clearly struggling parent gets assessed as functional.

Masking isn't deceptive — it's a survival reflex. Your parent has spent decades projecting competence, and a formal evaluation triggers that response even when they can barely get dressed without help on a normal morning.

The MEA nurse is experienced enough to look for signs of masking, but they're also constrained by what they observe during the visit and what the medical records document. If the visit goes well and the records are thin, the assessment may not reflect reality.

Your job is to give the nurse the full picture before and during the evaluation.

Start the Functional Log Two Weeks Early

The single most effective preparation tool is a 14-day functional care log — a daily written record of every ADL struggle you observe. This isn't a medical document; it's a specific, dated record of what happened, what help was needed, and what would have happened without your intervention.

For each day, document:

• What ADL was affected (bathing, dressing, eating, toileting, transferring, continence)
• What specifically happened ("Couldn't get out of the bathtub without me lifting her left side" is useful. "Had trouble bathing" is not.)
• What time it occurred (patterns matter — cognitive decline is often worse in the afternoon and evening)
• What help you provided (hands-on physical assistance? Verbal prompting? Complete task completion?)
• Whether a safety risk was present ("Left the stove on twice" or "Fell getting out of bed at 2 AM")

Two weeks of entries establish a pattern that a 45-minute visit can't capture. When the nurse sees a consistent, detailed log showing daily ADL failures across multiple categories, the assessment has context that a snapshot observation alone can't provide.

Assemble Medical Records Before the Visit

The MEA scoring draws on both direct observation and documented medical history. Missing records weaken the clinical picture. Before the scheduled assessment, gather:

• Primary care physician records — recent visit notes documenting functional decline, chronic conditions, and any diagnoses affecting ADL capacity
• Hospital discharge summaries — especially recent hospitalizations related to falls, medication errors, or acute cognitive episodes
• Specialist notes — neurologist reports for dementia or stroke, orthopedic assessments for mobility limitations, psychiatric evaluations for behavioral symptoms
• Physical and occupational therapy records — showing functional limitations and rehabilitation outcomes
• Medication list — complete and current, including any medications affecting alertness, balance, or cognition

Have these organized and ready to hand the nurse during the visit. Don't assume DHHS already has them — records from private physicians and hospitals don't automatically feed into the state assessment system.

How to Participate in the Visit

You have every right to be present during the MEA. More than that — your presence is important because you provide the daily context the nurse needs.

Ground rules for participating effectively:

Don't speak for your parent. Let them answer questions and attempt tasks. The nurse needs to observe their actual capacity, not your description of it.

Do supplement with specific observations. When the nurse asks about bathing, your parent may say "I manage fine." You can add: "She hasn't been able to wash her hair without help since March, and I've been helping her in and out of the shower every morning because she slipped twice in February."

Bring the functional log. Hand it to the nurse at the start of the visit. It establishes that you've been systematically tracking functional decline, not making subjective claims from memory.

Note cognitive fluctuations. If your parent has good days and bad days — common with dementia, Parkinson's, and many chronic conditions — explain the pattern. "Today is a good day. On Thursday she couldn't remember whether she'd eaten breakfast and I found her wearing two pairs of pants."

Don't coach your parent to underperform. This occasionally backfires and undermines the assessment's credibility. The goal isn't to make your parent look worse — it's to ensure the nurse sees an accurate picture by providing context that a single visit can't capture on its own.

After the Assessment

The nurse submits the MEA results to DHHS, which issues a notice of decision. If the assessment confirms nursing facility level of care, the clinical gate is cleared and the application moves to financial eligibility review.

If the assessment comes back negative — your parent didn't meet the two-ADL threshold — you have the right to appeal. Review the denial notice for the specific reasoning. Common grounds for successful appeal:

• Medical records that weren't available during the initial visit (a specialist report completed after the assessment date)
• Documented functional decline that occurred after the assessment
• The 14-day functional log showing a pattern of ADL dependency that a single good-day visit didn't capture

The appeal must be filed within the deadline printed on the notice of decision. Don't let the window close while you're deciding whether to challenge the result.

The Aging in Place in New Hampshire guide includes a printable 14-day functional care log template and the full document preparation checklist for the MEA, designed so you walk into the assessment with everything the nurse needs to make an accurate determination.

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