Medicaid Pending at a Nursing Home in New Hampshire

What "Medicaid Pending" Means

Medicaid Pending is the status your parent's application holds between the day it's submitted to New Hampshire DHHS and the day the state issues a formal approval or denial. During this period, the state is verifying financial documents, conducting the Medical Eligibility Assessment (MEA), reviewing the 60-month lookback period for asset transfers, and determining the monthly patient liability.

In New Hampshire, Medicaid processing times for long-term care applications often extend to several months due to administrative backlogs at the Bureau of Family Assistance. Complex cases — those involving asset transfers within the lookback window, multiple bank accounts, or spousal impoverishment calculations — can take even longer.

This timeline creates a gap. Your parent is already in the nursing home receiving care, but Medicaid hasn't approved coverage yet. Someone has to pay during that gap, and families face intense pressure from facility billing departments to cover the difference.

The Eviction Protection You Need to Know

Under federal and New Hampshire state nursing home regulations, a facility generally cannot transfer or discharge a resident solely because a Medicaid eligibility determination is pending. The facility may still bill for services while the application is pending, so confirm in writing what amount it expects the resident or representative to pay.

This protection exists because Medicaid status has not been decided. It does not erase the bill while the application is pending: a facility may seek payment under its agreement, but it cannot use the pending application itself as the reason for discharge.

If a nursing home threatens eviction during the pending period:

1. Ask for the threat in writing. Verbal pressure from a billing coordinator carries no legal weight. A formal Notice of Transfer or Discharge must be in writing and must specify one of the six federally permitted reasons for involuntary transfer.

2. Contact the New Hampshire Long-Term Care Ombudsman at (603) 271-4375. The Ombudsman is an independent advocate for nursing home residents' rights and can intervene in discharge disputes.

3. Confirm what payment the facility expects. The facility may bill or seek payment under its agreement while Medicaid is pending, but it cannot require a family member to personally guarantee the bill or threaten discharge solely because the eligibility decision is still pending.

Who Pays During the Pending Period

The financial structure during Medicaid Pending depends on the patient's income and assets:

Patient liability (share of cost): This is the portion of your parent's monthly income that goes directly to the nursing home. Almost all of the applicant's income — Social Security, pension, any other recurring income — is paid to the facility, minus New Hampshire's applicable personal-needs allowance and any spousal income allocation. The family is responsible for ensuring this payment reaches the facility each month.

The gap between patient liability and the facility's daily rate: This is the amount Medicaid will cover once approved. During the pending period, this gap goes unpaid unless the family privately funds it. Most New Hampshire nursing facilities accept Medicaid-pending residents with the understanding that once Medicaid is approved, the state reimburses the facility retroactively to the date of eligibility.

Do not sign a personal financial guarantee. Nursing home billing departments sometimes pressure family members to sign documents guaranteeing payment for the full private-pay rate. Federal law prohibits a nursing home from requiring a third-party personal guarantee as a condition of admission or continued stay. A representative may agree to pay from the resident's available resources without becoming personally liable; read any agreement carefully. If the facility insists on a personal guarantee, push back and document the request.

Speeding Up the Application

The most common cause of processing delays is incomplete documentation. When submitting the Medicaid application (Form 800) through NH EASY or the local DHHS district office, include:

• Five years of bank statements for every account the applicant or their spouse holds
• Documentation of all asset transfers during the 60-month lookback period
• The completed Reimbursement Agreement (Form 770), which must be notarized
• Current income verification (Social Security award letter, pension statements)
• Medical Eligibility Assessment results (coordinated through the Bureau of Adult and Aging Services)

Missing even one document can stall the entire review. Follow up with the assigned eligibility worker every two weeks to confirm no additional documentation is needed.

Navigating the Medicaid application alongside a nursing home admission while managing the financial pressure of the pending period is one of the most stressful parts of elder care transitions. The New Hampshire Hospital Discharge Guide includes an asset inventory worksheet and a Medicaid application document checklist designed to minimize processing delays.

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