Nursing Homes in New Hampshire
Nursing homes provide essential care for seniors with complex medical needs that can't be managed at home. For example, a senior with a chronic health condition, such as diabetes or arthritis, will receive 24/7 care from licensed health care professionals, while other staff will ensure their living spaces are clean and meals freshly prepared every day. The facility will also have a social program that includes mentally and physically stimulating activities to aid recuperation while also encouraging friendships among residents.
Although about a third of the 65+ age group will never need long-term care, approximately 20% will require 5+ years of assistance, with 35% likely to spend at least a year in a nursing facility. New Hampshire's population is close to 1.4 million, 19.3% of whom are aged 65 and older. The latest figures reveal 5,479 of them currently reside in the state's 73 nursing homes, which is just over 2% of New Hampshire's seniors.
This guide discusses if and how Medicaid pays for nursing home care in New Hampshire. It also considers how Medicare and other financial assistance options can help, and it explains the state's laws and regulations regarding nursing homes.
Popular Cities in New Hampshire
Cost of New Hampshire Nursing Homes
The average cost of nursing homes in New Hampshire is $316 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in New Hampshire?
Medicaid can pay for nursing home care in New Hampshire, where it's known as NH Medicaid (Medical Assistance). Almost 249,000 people are enrolled in the state's Medicaid and CHIP programs. For those who need it to pay for nursing home care, it can cover their medical expenses and room and board, as well as transportation for medical purposes. NH Medicaid is an entitlement program, so those who qualify can get assistance almost immediately. Seniors who qualify for Medicaid but can be cared for safely at home or in the community may be eligible for the Choices for Independence Program or Personal Care Attendant Services. As these are waivers and not entitlement programs, there may be a waiting list.
Eligibility for Medicaid in New Hampshire
Families applying for NH Medicaid to cover nursing home costs for a single person can do so if the senior's annual income doesn't exceed $32,904 and their assets $2,500. If the application is for one adult living in a two-person household, the applicant's limits are also $32,904 and $2,500. As one spouse will be remaining at home, the Spousal Impoverishment Act allows the nonapplicant to keep up to $148,620 in assets. Most income, including pension payments, counts when calculating the person's limit. An exception is VA Aid and Attendance pension payments. Countable assets include stocks and bonds and a second home, but the person's personal belongings, one car and their primary home (in most cases) aren't countable assets.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,500 |
| Two-Person Household | $16,464 | $2,500 (applicant)$148,620 (nonapplicant) |
*Per year
Note: Adults whose incomes can't cover their medical bills but also disqualify them from Medicaid may find a solution with In and Out Medical Assistance. It provides them with a spend down, which will allow Medicaid to help pay their costs once their medical bills reach the spend down amount.
In addition to their income and assets assessments, applicants must also satisfy some other important criteria. These include being:
- A U.S. citizen or legal immigrant
- Aged 65 or older
- A New Hampshire resident
- Recognized by a health care professional as medically in need of skilled nursing care
Applying for Medicaid in New Hampshire
There are several options for applying for Medicaid in New Hampshire, each designed to suit people with different communication preferences. However, families should know the online portal is the fastest route, as the others may incur processing delays.
- Online: The fastest way to apply for one or more state government benefits in New Hampshire, including Medicaid, is to visit NH Easy.
- Mail: Families can download and complete a paper application form and send it to the local DHHS District Office.
- Fax: Seniors can fax a completed paper copy of the application form to (603) 271-5621.
- Phone: Families can call the Bureau of Family Assistance at (800) 852-3345.
Information You Will Need
New Hampshire's DHHS will require applicants to provide evidence to support their claims for NH Medicaid. All documents must be original and come from either a government agency or recognized financial institution. Common forms of documentation include the following:
- A birth certificate or other proof of age
- Evidence of U.S. citizenship or legal residency, such as a passport or Permanent Resident Card
- Proof of residency in New Hampshire, such as a driver's license
- A Social Security card
- Proof of all income, such as tax returns
- Proof of all assets, such as bank statements
- The policy numbers of health insurance for every household member, including Medicare
Additional Medicaid Support & Resources in New Hampshire
Seniors in New Hampshire and their families can access several free resources that can help in matters concerning Medicaid. These include online information seniors can review in their own time and assistance from DHHS staff. There's also a right to redress for seniors who have been denied Medicaid or seen their payments limited or canceled.
| Contact | Service | |
|---|---|---|
| American Council on Aging | Online Only | This online resource is written and maintained by Medicaid experts who have extensive knowledge about the program in each state. It's a useful resource for families who prefer doing their own research. The site includes helpful tools, such as a spend down calculator and a Medicaid eligibility test. |
| Medicaid Fair Hearings | (603) 271-4292 | New Hampshire seniors who have been denied Medicaid or have had their payments reduced or canceled are entitled to a fair hearing from DHHS. Seniors can appeal the decision before the department in person, or they can attend with a representative, such as an attorney. |
| NH Medicaid Care Management Program | (844) 275-3447 | NH Medicaid's hotline is available during normal business hours Mondays through Fridays. Seniors and their families can call with any questions or concerns they have about Medicaid. They can also email DHHS staff, who can respond to most questions, including those about waiver programs and where to get help completing Medicaid applications. |
Can You Use Medicare to Pay for Nursing Home Care in New Hampshire?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in New Hampshire
New Hampshire's seniors can access a wealth of support programs, most of which are free of charge. The following table includes three of them, each of which can help with varying needs. These include helping seniors understand Medicare, apply for the state program, detect Medicare fraud and report errors or abuse.
| Contact | Service | |
|---|---|---|
| State Commission on Aging | (603) 271-0527 | The New Hampshire State Commission on Aging aims to create a more age-integrated state by advising the governor and general court on matters concerning aging. It provides numerous resources for seniors, including links to nonprofits dedicated to helping New Hampshire's older residents. |
| Department of Health and Human Services | (603) 271-9700 | The department oversees the State Committee on Aging, New Hampshire's Medicaid program and the Medicare Savings Program. It's responsible for the state's resources that promote the health and well-being of seniors. |
| ServiceLink | (866) 634-9412 | ServiceLink is a statewide network of community-based resource centers serving seniors. They include New Hampshire's State Health Insurance Assistance Program (SHIP) and its Senior Medicare Patrol (SMP). |
| New Hampshire Bureau of Elderly and Adult Services | (603) 271-9203 | The bureau provides support to New Hampshire residents aged 60 and older who have a chronic illness or disability but want to live independently at home for as long as possible. It manages a range of services to make this happen, including home-delivered meals and home care services. |
Other Financial Assistance Options for Nursing Home Care in New Hampshire
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in New Hampshire
| Licensing Requirements | The Health Facility Licensing Unit, a division of the Department of Health and Human Services, licenses and regulates New Hampshire's nursing homes. Facilities must meet all state requirements related to fire safety, building regulations, health and safety and patient care. |
| Staffing Requirements | A registered nurse must be on duty for 8 hours every day of the week, with at least one on duty for every shift. There must also be sufficient licensed practice nurses on-site 24/7, supported around the clock by nursing assistants. |
| Staff Training Requirements | All personnel must be trained for their roles and able to demonstrate competency. Facilities are required to train all staff on policies and procedures, and certified nursing assistants must complete at least 100 hours of state-approved training. All staff must also receive annual refresher training. |
| Admission Restrictions | New Hampshire's nursing homes can't admit persons under 18 years unless they have appropriate accommodation for their age group and sex. They can also refuse people with a history of violence or criminal behavior and those with behavioral issues the facility can't treat. |
| Care Planning Requirements | An initial needs assessment must happen within 48 hours of the senior's admission, and a comprehensive assessment must occur within 14 days. A detailed medical exam is required at least every 30 days for the first 90 days of a senior's residency and once every 60 days thereafter. |
| Dietary and Nutritional Services Requirements | Three nutritionally balanced meals must be served daily, with dietary needs catered to if ordered by a health care professional. Menus must be posted in advance, and records must be kept that document residents' nutritional intake, including compliance with special diets. |
| Specialized Rehabilitative Services | Nursing homes must provide specialized rehabilitative services delivered by qualified therapists in purposely designed rooms. Each resident receiving care must have a personalized care plan developed by a licensed health care professional, and the nursing home must keep records of its monitoring of the resident's progress. |
| Medication and Pharmaceutical Services | Under the direction of a qualified practitioner, New Hampshire's nursing homes must provide all the medications their residents require, including over-the-counter drugs. Medications must be provided within 24 hours of the order, and the facility must comply with labeling, tracking and dispensing medication regulations. |
| Activities Requirements | Nursing home residents must have access to mentally and physically stimulating activities that promote socialization, physical well-being and cognitive functionality. The facility is required to have a written activity program and sufficient staff to supervise each session. |
| Infection Control Requirements | Facilities must have a written infection prevention and control plan that also covers monitoring and reporting outbreaks to the Department of Health and Services. Staff must adhere to hand hygiene rules and the use of personal protective equipment, such as gowns and masks. |
| Medicaid Coverage | NH Medicaid will pay all costs, including room and board, for seniors who satisfy the qualifying criteria. This is on the condition the senior resides in a licensed facility approved for Medicaid payments. |
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