Medicaid Planning in New Hampshire

On Behalf of Sowerby & Moustakis Law

Quick Summary

Medicaid asset protection planning is the legal process of arranging your finances so that if you, or your spouse, ever need long-term nursing home care, Medicaid can help cover the cost without first wiping out everything you’ve built. In New Hampshire, nursing home care can run $12,000 or more per month. Without a plan, that expense can drain a family’s savings, retirement accounts, and even the family home in a matter of years.

The Cost Problem No One Talks About At Family Dinners

Nobody plans to need nursing home care. But around 70% of people over 65 will need some form of long-term care in their lifetime. In New Hampshire, the average cost of a private room in a nursing facility hovers around $11,000 to $13,000 per month. That’s not an emergency fund problem. That’s a financial survival problem.

Picture a retired couple in Amherst. One spouse begins showing signs of cognitive decline. Within 18 months, they need full-time memory care. At $12,000 per month, two years of care costs nearly $300,000. The other spouse is still living in the family home, still paying utilities and insurance, still trying to live a dignified life. Without a plan in place before that crisis hit, Medicaid may look at every asset that couple holds and say: spend that down first.

That’s the problem. And it’s why families who wait until there’s a diagnosis frequently have far fewer options than those who plan five or more years out.

What Is Medicaid Asset Protection Planning?

Medicaid asset protection planning is a category of elder law strategy that helps families in New Hampshire structure their assets so they can qualify for Medicaid long-term care benefits without having to exhaust everything first. It is not a loophole. It is a legal and well-established area of law, and when done correctly, it protects your family while keeping you in compliance with state and federal Medicaid rules.

The most common tools include:

Medicaid Asset Protection Trusts (MAPTs): An irrevocable trust designed to hold your assets, including your home, outside the reach of Medicaid’s asset calculation, provided the transfer happened more than five years before you apply for benefits.

Spousal protection strategies: New Hampshire Medicaid rules allow the community spouse (the one not in the nursing home) to keep a portion of the couple’s assets. An attorney can help maximize what the community spouse retains while making sure the nursing home spouse qualifies.

Exempt asset conversion: Certain assets, like a primary residence, one vehicle, and personal belongings, are treated as exempt under Medicaid rules. Knowing how to use these categories correctly makes a real difference.

Understanding The Five-Year Look-Back Rule In New Hampshire

This is the rule that catches most families off guard. When you apply for New Hampshire Medicaid long-term care benefits, the state reviews all asset transfers made in the five years before your application date. If you gave money to your kids, transferred property to a trust, or made any other gift during that window, Medicaid may count it as an uncompensated transfer and impose a penalty period, a stretch of time during which you’re ineligible for benefits despite needing care.

The look-back rule does not mean asset protection planning is off the table. It means timing is everything. Families in Hillsborough County who begin planning at 60 or 65, while in good health, have the full five-year window to work with. Those who wait until 80, when a health event is already on the horizon, may have much narrower options.

There are also exceptions worth knowing. Transfers to a spouse, transfers to a disabled child, and certain caregiver situations may be exempt from the look-back rule entirely. These nuances require an attorney who knows NH Medicaid rules specifically, not a general estate planning template from another state.

Protecting Your Home: The Asset Most Families Overlook

For most families in southern New Hampshire, the home is their largest asset, and the one they feel most strongly about protecting. NH Medicaid treats the primary residence as an exempt asset while you’re living there. But after you pass away, Medicaid has the right to seek reimbursement from your estate through a process called Medicaid estate recovery.

What this means: if your home passes through your probate estate, New Hampshire’s Medicaid program can file a claim against it to recoup what was spent on your care. A Medicaid Asset Protection Trust, set up well before you need care, can move your home outside your probate estate, cutting off that recovery claim and keeping the property in your family.

If protecting the family home is a priority for you, pairing a MAPT with a broader estate plan is worth a serious conversation with an attorney. For more on the home-specific side of this issue, see our article on how to protect your home from nursing home costs in New Hampshire.

When Should NH Families Start This Planning?

The honest answer: now. Not when a parent gets a diagnosis. Not when a spouse starts forgetting things. Now.

The five-year look-back rule turns time into the most valuable resource in Medicaid planning. Every year you wait is a year less runway. Families in Amherst, Merrimack, Milford, and surrounding Hillsborough County communities who have the conversation early are the ones with the most options when a health crisis eventually arrives.

That said, it’s not hopeless if you’re starting later. Emergency Medicaid planning strategies exist for situations where long-term care is already imminent. They are not as clean as planning done years in advance, but they can still make a meaningful difference. An elder law attorney at Sowerby & Moustakis Law can assess your specific timeline and help you understand what options remain.

How Sowerby & Moustakis Law Approaches This

Sowerby & Moustakis Law is a Nashua-area estate planning and elder law firm serving families throughout southern New Hampshire. Their attorneys understand New Hampshire Medicaid rules, the Hillsborough County probate process, and the specific concerns of families in this region, dual NH/MA coverage, rural properties, blended families, and aging parents who want to stay home as long as possible.

What sets this firm apart is a white-glove approach where family meetings are not an add-on, they are the standard. The attorneys take time to understand your full picture before recommending any strategy. That’s how a real asset protection plan gets built: not from a template, but from your family’s actual circumstances.

If you haven’t looked at your current situation through the lens of long-term care yet, now is a good time to start. For a broader look at your overall estate plan, see what happens if you die without a will in New Hampshire, the gaps in any plan tend to compound.

Contact Sowerby & Moustakis Law To Talk Through Your Options

Medicaid planning is not a one-size-fits-all process. Your family’s assets, health situation, and goals are specific, and your plan should be too.

Call Sowerby & Moustakis Law at (603) 249-5925, email info@smlpllc.com, or visit our contact page.