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.
This program provides support to help New Hampshire residents live at home or in assisted living communities instead of nursing homes.
This New Hampshire Medicaid program is designed to help adults with chronic illnesses and the elderly. 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 Assisted Living, Residential Care Homes, 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 is 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. However, unlike many state Medicaid waivers, participants are not able to hire family members as care providers. Self-direction applies to choosing from a limited set of providers such as for adult day care or assisted living services.
This waiver was formerly referred to as the Home and Community Based Care Program for the Elderly and Chronically Ill Waiver or the HCBC-ECI Waiver. This is New Hampshire's sole waiver that specifically targets the elderly population. It is under the administration of the New Hampshire Bureau of Elderly and Adult Services.
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 2019.
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.
Income - For single applicants residing outside of nursing homes, there is a hard income limit of $2,313 / month or $27,756 per year. Married applicants, regardless if one or both spouses are applying, will have their incomes considered separately. However, the state also 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 $591 / month for a single applicant, he or she will be income eligible.
Assets - Single applicants must have less than $2,500 in countable resources. Married applicants, whose husband or wife is not receiving Medicaid, can transfer joint assets to the non-applicant up to a value of $126,420 in 2018. This is called the Community Spouse Resource Allowance. An owner-occupied home with home equity valued up to $585,000 can be excluded from countable assets as well as home furnishings, personal items and a single vehicle.
Persons Exceeding these 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 Care – supervision and social activities during daytime hours
Adult Family Care – personal care provided in a certified residence with 1-2 care recipients
Assistive Technology – devices to help overcome disabilities
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
Medical Day Services
Personal Care Assistance
Personal Emergency Response Service – abbreviated as PERS, and more commonly referred to as Medical Alert Services
Respite Care for the Caregiver
Specialized Durable Medical Equipment
The total value of the services received by a program participant cannot exceed 80% of what those services would otherwise cost were the participant to reside in a Medicaid-funded nursing home.
How to Apply / Learn More
To begin the application process, persons can call 1-866-634-9412, use this online form or contact their local area agency on aging.
The administering body for this waiver is the NH Dpt. of Health and Human Services, Division of Community Based Care Services, Bureau of Elderly and Adult Services (BEAS). The waiver is available statewide and there is no waiting list for services. However, there is a cap on enrollment of approximately 3,700 individuals, which if exceeded will result in a wait list.
One can also download a brochure or view limited information on the NH Department of Health and Human Services website.