New Hampshire Medicaid Income Limit for Long-Term Care

Most families assume that if their parent's Social Security and pension income exceeds the Medicaid limit, they're automatically out of luck. In New Hampshire, that's wrong — and understanding how the state handles over-income applicants can make or break a care plan.

The 2026 Income Cap: $2,982 per Month

New Hampshire's gross monthly income limit for long-term care Medicaid is $2,982 for a single applicant. This equals 300% of the Federal Benefit Rate (FBR) and is adjusted annually in January.

All sources count toward this ceiling: Social Security retirement and disability income, pension payments, annuity distributions, rental income, and interest. Veterans benefits count if they exceed specific threshold amounts.

If your parent's income is under $2,982, they satisfy the income test. Approval puts them on patient liability — meaning their income, minus deductions, goes directly to the nursing facility each month.

What Happens When Income Exceeds $2,982

Here's the critical New Hampshire distinction: the state does not use Qualified Income Trusts (QITs) or Miller Trusts.

In about 30 states, applicants whose income exceeds the cap must establish a QIT — a bank account governed by a formal trust document — to funnel excess income and maintain eligibility. Not in New Hampshire.

Instead, the state uses a Medically Needy Spend-Down pathway. This system treats excess income like an insurance deductible:

1. The state establishes a Protected Income Limit (PIL) of $916 per month for a single individual.
2. The applicant's monthly spend-down obligation equals their gross income minus $916.
3. Once the applicant documents incurred medical and care expenses equal to that monthly obligation, Medicaid activates for the rest of that calendar month.

Example: If your parent receives $3,500 per month in Social Security and pension income, their spend-down obligation is $3,500 − $916 = $2,584. Once they incur and document $2,584 in medical bills, prescriptions, health insurance premiums, or care fees in a given month, Medicaid covers remaining costs for that month.

The problem: for community-dwelling seniors, $916 left over after paying $2,584 in medical expenses doesn't cover rent, food, and utilities in New Hampshire's economy. This is one reason families often pursue nursing home placement rather than home-based care when income is high.

What You Can Deduct as Spend-Down Expenses

The state accepts documented medical and care-related expenses:

• Medicare Part B, Medigap, and Part D premium payments
• Prescription drug costs not covered by insurance
• Doctor, dentist, and specialist co-pays
• Medical equipment and supplies
• Long-term care costs such as home health aide fees, adult day program charges, and personal care services
• Health insurance premiums

You must keep receipts and submit documentation monthly. There is no carryover — unspent deductibles do not accumulate from month to month.

Asset Spend-Down: A Different Process

"Spend-down" also refers to reducing countable assets to qualify for Medicaid — this is separate from the income spend-down pathway above.

When your parent has countable assets above the $7,500 effective limit, they must convert those assets into something non-countable before Medicaid will approve the application. Legitimate asset spend-down strategies include:

• Paying off existing debt. Mortgage balances, credit card debt, car loans — paying these reduces a countable asset (cash) without triggering a transfer penalty.
• Home modifications. Installing a wheelchair ramp, stair lift, grab bars, or widening doorways reduces countable cash and improves care capacity.
• Prepaying funeral and burial expenses. Funding an irrevocable prepaid funeral trust or purchasing a burial space converts cash into an exempt asset with no cap.
• Purchasing care services. Paying for home health aides at fair market value, with a written personal care agreement signed before services begin.

What you cannot do: gift cash to an adult child, pay for a grandchild's college tuition, or transfer a home without receiving fair market value. These trigger the 60-month lookback and produce a penalty period — the state calculates how many months of Medicaid coverage is denied based on the transfer value divided by $13,000 (the state's average private-pay nursing home rate).

Patient Liability: What Happens After Approval

Once your parent is approved for nursing home Medicaid, nearly all of their monthly income flows to the facility as "patient liability." The deductions allowed before calculating patient liability are:

• The $93 monthly Personal Needs Allowance — this is the resident's share to keep for personal items like haircuts, clothing, or phone service. It cannot be withheld or redirected.
• Health insurance premiums — Medicare Part B and Medigap premiums are deducted.
• Spousal income allocation — if a community spouse's income falls below $2,705 per month, the nursing home resident can redirect part of their income to their spouse.

The $93 Personal Needs Allowance is set by the state legislature under RSA 167:27-a and adjusts annually. It is deposited into a resident trust account managed by the facility. Accumulated PNA funds count toward the $7,500 asset limit — if a resident doesn't spend the $93 each month, the balance can push them over the limit.

The New Hampshire Medicaid Long-Term Care & Asset Protection Guide includes tracking worksheets for documenting monthly spend-down expenses and a patient liability calculation template.

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