New Hampshire Medicaid Spousal Protection: What the Healthy Spouse Can Keep

When one spouse needs nursing home care, the other spouse shouldn't have to spend down the couple's entire life savings to make it happen. Federal and New Hampshire state law both provide explicit financial protections for the healthy spouse — known as the "community spouse" — to prevent impoverishment. But knowing the exact numbers and how to maximize them matters enormously.

The Community Spouse Resource Allowance (CSRA)

When one spouse applies for nursing home Medicaid, the BFA evaluates the couple's total countable assets as of the first day of continuous institutionalization. From that snapshot, the community spouse is entitled to retain a protected share called the Community Spouse Resource Allowance.

In 2026, the CSRA works as follows:

• The community spouse keeps 50% of the couple's joint countable assets, up to a maximum of $162,660
• If 50% of the joint assets falls below $32,532, the community spouse keeps all assets up to that $32,532 floor

Example: A couple has $200,000 in joint countable assets. The community spouse's CSRA is $100,000 (50%). That falls below the $162,660 ceiling, so they keep $100,000. The applicant spouse must spend down the remaining $100,000 to $7,500 before Medicaid activates.

Example with low assets: A couple has $50,000 in joint countable assets. The community spouse's CSRA would be $25,000 (50%), but that's below the $32,532 floor. So the community spouse keeps the full $32,532, and the applicant spouse spends down the remainder to $7,500.

The CSRA protects savings regardless of whose name the accounts are in. The BFA pools all joint assets at the snapshot date, then applies the formula.

The Monthly Maintenance Needs Allowance (MMMNA)

Income protection works differently than asset protection. The community spouse's own income is disregarded entirely — the BFA never looks at it for the applicant's eligibility calculation. The community spouse keeps every dollar of their own Social Security, pension, or employment income.

Where the MMMNA matters is when the community spouse's personal income is below the guaranteed minimum:

• If the community spouse's monthly income is below $2,705 (the Minimum MMMNA, effective July 1, 2026), they are entitled to receive a portion of the nursing home resident's income to bring them up to that level
• The amount redirected is called the spousal income allocation
• The Maximum MMMNA is $4,066.50 per month — the community spouse can claim up to this amount if their housing costs justify it

The path to the higher maximum involves the "excess shelter allowance." If the community spouse's actual monthly housing and utility costs exceed the basic shelter standard of $811.50, they can substitute real costs into the formula using the Standard Utility Allowance of $1,018. This calculation can push the protected income level significantly above the $2,705 baseline — up to the $4,066.50 maximum.

The CFI Waiver Spousal Exception

This is the most significant — and least understood — aspect of spousal protection in New Hampshire.

When a nursing home Medicaid application is filed, a formal joint resource assessment (BFA Form 798A) is mandatory. The couple's joint assets are pooled, split, and the community spouse retains the CSRA. The applicant spouse must spend down their share.

But when one spouse applies for the Choices for Independence (CFI) waiver — the home-based care program — the rules changed fundamentally under House Bill 2 effective January 1, 2024:

A joint resource assessment is no longer required for CFI waiver eligibility. The BFA evaluates only assets held in the applicant spouse's individual name.

This creates a powerful strategy: before the CFI waiver application is filed, a couple can retitle all joint bank accounts and investment portfolios into the community spouse's sole name. Because transfers between spouses are entirely exempt from the 60-month lookback penalty, this can be done immediately — even in a care crisis. Once the retitling is complete, the applicant spouse holds no countable joint assets. The $7,500 effective limit applies only to whatever is in the applicant's individual name. The community spouse retains unlimited assets.

This strategy is unavailable for nursing home applications (which require the joint resource assessment) but can be decisive for couples where home-based care is feasible.

Requesting a CSRA Increase

The standard CSRA formula produces a maximum of $162,660. But for couples with substantial assets — $300,000 to $500,000 or more — a New Hampshire elder law attorney can seek a court-ordered CSRA increase that protects a larger share for the community spouse.

This typically involves demonstrating that the community spouse's income needs, projected over their life expectancy, justify protecting additional assets. The court can authorize a CSRA above the standard $162,660 maximum. This is not a routine strategy and requires attorney involvement, but it can protect significantly more wealth than the standard formula allows.

When to Act

The asset protection window for spousal Medicaid planning is short. Once the nursing home is billing at $13,000 per month, every day of delay costs the couple money they could have retained.

The New Hampshire Medicaid Long-Term Care & Asset Protection Guide includes CSRA and MMMNA calculation worksheets, a step-by-step guide to the joint resource assessment process, and an explanation of the CFI waiver spousal exception — including the retitling steps and timeline.

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