What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through “Medicaid Waivers,” which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Waiver Description
This program provides support to help New Hampshire residents live at home or in assisted living communities instead of nursing homes.
The Choices for Independence Waiver is designed to help the elderly and adults with chronic illnesses. It does so by providing services and support for individuals that are clinically eligible for nursing home placement, but choose to remain living in the community or at home. The definition of “community” under this waiver is broad and includes many types of non-nursing home care, such as Residential Care Homes (Assisted Living), Adult Foster Care, and other types of Supportive Housing.
Services and support are provided to individuals at these places of residence, provided the costs of services do not exceed a certain percentage of what the costs would otherwise be if they were provided in a nursing home. A complete list of possible services is located further down this page. Most popular among them are personal care and support for home modifications to increase the participant’s independence.
Choices For Independence offers participants a degree of consumer-direction, or self-direction, in which they are able to choose some of their care service providers. This applies largely to unskilled or custodial care services. Participants are able to hire family members, including spouses in some cases, as care providers.
Eligibility Guidelines
New Hampshire has complicated and frequently changing eligibility guidelines. Some of these requirements change depending on the age, level of impairment, or marital status of the applicant. What follows is current for the year 2024.
General Requirements
- Age – In absolute terms, applicants must be at least 18 years of age. However, persons between the ages of 18 and 64 must be officially designated as disabled by Social Security. Disability is not a requirement for those 65 and older.
- Level of Impairment – Applicants must be disabled if under 65, or require nursing home level care if 65 or older.
Financial Requirements
Income Limits
For single applicants, there is a hard income limit of $2,829 a month. For married applicants with both spouses applying, the monthly income limit is $5,658.
When only one spouse of a married couple is applying, only the income of the applicant spouse is considered. Furthermore, in some cases, the applicant spouse can transfer as much as $3,853.50 a month to his or her non-applicant spouse. This is known as a monthly maintenance needs allowance. It is intended to prevent impoverishment of the non-applicant spouse, and also lowers an applicant’s countable income. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted.
For applicants who still have income over the limit, the state offers a Medically Needy Pathway to eligibility. This means both income and monthly medical and care expenses are taken into consideration. Simply stated, if these expenses lower one’s income to the medically needy income limit, which is $888 a month for a single applicant, he or she will be income eligible.
Asset Limits
Single applicants must have less than $2,500 in countable resources (assets). An owner-occupied home with home equity valued up to $713,000 can be excluded from countable, assets as well as home furnishings, personal items, and a single vehicle.
When only one spouse of a married couple is applying, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140 (as of 2024). If the couple’s assets are under $30,828, the non-applicant spouse can keep all of the assets, up to this amount. This is called the Community Spouse Resource Allowance.
Over the Financial Limits?
It is possible to exceed these limits and still gain Medicaid eligibility. Professional Medicaid planners can help families in this situation. Learn more.
Benefits and Services
Under Choices for Independence, a large number of supports, services, and assistance are available. The purchase of some of the following goods and services can be self-directed.
- Adult Day Health Care – supervision, assistance with daily living activities, and social activities during daytime hours
- Adult In-Home Care – meal preparation, laundry, light housekeeping, and shopping for essentials
- Adult Family Care – personal care provided in a certified residence with 1-2 care recipients
- Case Management
- Community Transition Assistance – to help nursing home residents return to living at home
- Environmental Accessibility for Homes and Vehicles
- Home Delivered Meals
- Home Health Services
- Homemaker Services
- Non-Medical Transportation
- Personal Care Assistance
- Personal Emergency Response Service – abbreviated as PERS, and more commonly referred to as Medical Alert Services
- Residential Care Services (Assisted Living Services)
- Respite Care for the Caregiver
- Skilled Nursing
- Specialized Durable Medical Equipment
- Supported Employment
How to Apply / Learn More
To begin the application process, one can call ServiceLink (the Aging & Disability Resource Center) at 1-866-634-9412, apply online, or contact their local area agency on aging.
There is a cap on enrollment, so a wait list may exist.
One can also download a brochure or view limited information on the NH Department of Health and Human Services website.
