How Medicaid Planning Works When One Spouse Needs a Nursing Home in New Hampshire

When one spouse needs nursing home care, the financial questions hit fast. How much does the other spouse get to keep? Will they have to sell the house? What happens to their income? These are not hypothetical concerns.

In New Hampshire, nursing home care can cost over $10,000 a month, and without a plan in place, a family’s savings can disappear quickly.

The good news is that federal and state law includes specific protections for the spouse who stays home. Understanding them is the first step.

The Community Spouse Resource Allowance

When one spouse enters a Medicaid-funded nursing home, the other spouse (called the community spouse) is not left with nothing. New Hampshire follows federal spousal impoverishment rules that allow the community spouse to keep a portion of the couple’s combined assets, known as the Community Spouse Resource Allowance (CSRA).

New Hampshire is a 50% state, meaning the community spouse keeps half of the couple’s combined countable assets up to a federally set maximum that adjusts each year. The nursing home spouse must spend down their share to a minimum threshold, typically between $1,500 and $2,500 depending on individual circumstances, before 

Medicaid eligibility kicks in. An elder law attorney can calculate the exact figures that apply to your situation at the time of application.

Assets like the primary home, one vehicle, and personal belongings are generally not counted toward either limit.

Income Protections for the Spouse at Home

Assets are only part of the picture. Income is the other.

New Hampshire allows the community spouse to keep enough monthly income to cover basic living expenses, under a rule called the Minimum Monthly Maintenance Needs Allowance (MMMNA). If the community spouse’s own income falls below that threshold, they may be entitled to receive a portion of the nursing home spouse’s income to make up the difference.

This prevents a situation where one spouse is in a facility while the other cannot afford to keep the lights on.

The Medicaid Look-Back Period

Medicaid does not simply evaluate a couple’s finances on the day of application. It looks back five years at any asset transfers or gifts made during that period. If assets were given away or sold below market value, Medicaid can impose a penalty period during which it will not cover nursing home costs.

This is why planning ahead matters so much. Strategies that are perfectly legal well in advance of a nursing home stay can become costly mistakes if initiated too close to the application date.

What “Spending Down” Actually Means

Many families hear “spend down” and assume they have no options. That is not accurate. There are legitimate strategies for restructuring assets before a Medicaid application that protect the community spouse without violating the look-back rules. These include:

• Converting countable assets into exempt ones
• Purchasing an annuity that converts assets into income for the community spouse
• Making home improvements to the primary residence
• Paying off debts

None of these strategies is one-size-fits-all, and the rules are specific enough that getting them wrong can delay or disqualify an application.

The Time to Plan Is Before the Crisis

Medicaid applications are among the most document-intensive legal processes a family will go through, and they come at an already overwhelming time. 

Families who have worked with an elder law attorney in advance are in a significantly better position than those who are scrambling after a diagnosis or a fall.