N.H. Code Admin. R. He-W 876.01
Financial Eligibility for Nursing Facilities
Effective Aug 28, 2025(See Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91; ss by #5565, eff 2-8-93; ss by #6955, eff 3-3-99; ss by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; ss by #8903, eff 6-28-07; ss by #10895, eff 7-22-15 (See Revision Note at Part heading for He-W 876); ss by #14359, eff 8-28-25, EXPIRES: 8-28-35Former Division of Human Services
(a) The department shall provide medical assistance for all the dates for which payment is requested when the following criteria have been met:
- (1) The individual has been determined eligible for categorically or medically needy medical assistance;
- (2) The individual has been determined eligible for a medical service for all dates for which medical payment is requested;
- (3) The individual has satisfied all procedural requirements; and
- (4) The individual has been physically placed at the proper level of care.
- (b) Each individual applying for or in nursing facility care shall be treated as an assistance group of one.
- (c) If the individual's net income, as defined in He-W 801.05, is greater than the rate of the nursing facility, the individual shall be eligible for in and out medically needy medical assistance, as defined in He-W 801.05, and the cost of the nursing facility care shall be an allowable expense for spending down to the protected income level, as defined in He-W 801.06.
- (d) Nursing care payments shall be made only on behalf of individuals in licensed, certified nursing facilities.
- (e) Individuals in licensed but uncertified nursing facilities shall be considered to be residing in an independent living arrangement.
- (f) The nursing facility rate used in determining eligibility shall remain in effect until the next eligibility determination.
- (g) The veteran’s affairs aid and attendance allowance shall be used in full to offset the cost of nursing facility care.
- (h) A deduction for the cost of health insurance shall be allowed regardless of whether the expense is mandatory or voluntary.
- (i) Whenever health insurance premiums are due more frequently than monthly, the cost shall be converted to a monthly amount in accordance with He-W 852.05.
- (j) Whenever health insurance premiums are due less frequently than monthly, the cost shall be averaged over the period it is intended to cover in order to obtain a monthly amount.
Source. (See Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91; ss by #5565, eff 2-8-93; ss by #6955, eff 3-3-99; ss by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; ss by #8903, eff 6-28-07; ss by #10895, eff 7-22-15 (See Revision Note at Part heading for He-W 876); ss by #14359, eff 8-28-25, EXPIRES: 8-28-35