New Hampshire Medicaid Excess Income Rule: You Choose a One-Month or Six-Month Spend-Down

Updated August 27, 2026. Quick answer: New Hampshire does not use the phrase “spend-down state” in its program name. It runs in and out medically needy medical assistance under He-W 878.01, and the rule hands the applicant a decision almost no other state gives: “The client may choose either a one or 6 month spenddown period when the department determines eligibility for in and out medically needy medical assistance, subject to the following provisions:”. The limit the excess is measured against is the protected income level, $888 a month for an assistance group of one.

What New Hampshire requires

How it works in practice

• The choice is the differentiator, and the state is required to price both options for you: “The client shall be given the spenddown amounts for both a one and 6 month spenddown period on their notice of decision;”. So the decision is made with two real numbers in hand, not as a guess.
• The six-month figure is arithmetic, not a separate limit. “When the client has chosen a 6 month spenddown period, the spenddown amount shall be equal to 6 times the difference between monthly income and the protected income level.” A six-month period does not lower the total; it changes when the total has to be met, and how long coverage runs once it is.
• Choosing the one-month period is a door that closes. “Once the client has elected a one month spenddown period and the case has been opened, they shall not have a 6 month spenddown period unless they reapply for assistance.” That is the single most consequential sentence in the rule for anyone deciding quickly, and it is why the rule says the choice need not be made until the expenses are in.
• The choice can wait for the paperwork. New Hampshire does not require the client to elect a period “until they submit verification of medical expenses to the department and the case meets all eligibility criteria”.
• A one-month spend-down freezes once the case opens. “Once a case is opened for a one month period, changes in case circumstances shall not affect the spenddown amount.” A raise, or a change in the protected income level, does not reopen the month.
• Old medical debt is usable and need not be taken in order. “Prior medical debts shall not be prioritized or required to be used in sequential order and shall be prorated at the client’s option over several months if the total amount of the debt exceeds the spenddown amount.” Any single expense, however, “A medical expense or prorated expense described in (d) above shall be used only once to offset the spenddown.”
• The family’s bills count, not only the applicant’s. “Incurred current medical expenses and obligated prior medical debts of individuals of a family, as defined in He-W 601.04(c), or family members, as defined in He-W 601.04(f), who reside in the same living unit as the client or for whom the client is liable, shall be used to satisfy the spenddown amount.”
• Expenses are applied in a set order. Prior debts and uncovered expenses land “on the first day of the month of the in and out period”; insurance premiums land on the first day of the month they are due; covered current expenses come after those and can roll into the next month if still unpaid.
• Nursing-home cases run through the same door. The cap is “The nursing facility cap shall be 300% of the maximum SSI benefit for an eligible individual as determined in accordance with 20 CFR 416.410”, and where net income exceeds the facility’s rate, “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”.

The mechanism itself — why an income cap exists and what the trust must contain — is explained on the income-cap and Miller trust page. This page is the record for New Hampshire.

What this page does not settle

• The $888 is a one-person figure and it is dated. Table 600.11 sets the maximum monthly PIL by assistance group size — $1,033 for two — and He-W 858.04 was last amended by Document #14092, effective 10-4-24.
• This page reads one source: New Hampshire Code of Administrative Rules, He-W 878.01 (In and Out Medically Needy Medical Assistance) and He-W 858.04 (Protected Income Level). It is the state’s own publication on this rule, but no state puts its whole treatment of excess income in a single document, and a detail that decides your case may sit in one this page did not read.
• A spend-down fixes an income problem and nothing else. The resource test, the level-of-care test and the transfer-of-assets look-back are separate hurdles, each decided on your own file, and meeting this rule does not clear any of them.
• Every quotation here was read against the source on August 27, 2026. States revise these rules, and a figure or a section number can move without the page around it changing. Open the source before you rely on a detail.

Eligibility is decided by the state agency on the whole file, not by one rule on one page. Nothing here is legal advice, and no one should move, retitle or assign income on the strength of a web page.

Sources

• New Hampshire Code of Administrative Rules, He-W 878.01 (In and Out Medically Needy Medical Assistance) and He-W 858.04 (Protected Income Level)

The source above was retrieved and read against the state text on August 27, 2026. Every quotation on this page was checked against those bytes.