By Marc Gilman
(603) 493-1394 |
Medicare itself doesn’t involve trusts — it’s a federal health insurance program funded through the national Medicare Trust Funds. But when a New Hampshire family starts planning for nursing home or long-term care costs, Medicaid enters the picture, and Medicaid has strict financial limits that trusts are often used to navigate. If you or a loved one may need long-term care in the next few years, understanding how these tools fit together — and where the boundaries of insurance planning stop and legal planning starts — can save a lot of confusion later.
Key Takeaways
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New Hampshire’s Nursing Home Medicaid asset limit is $2,500 for a single applicant, with a monthly income limit of $2,982.
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New Hampshire enforces a 60-month (5-year) look-back period on asset transfers, including transfers into most trusts.
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A Medicaid Asset Protection Trust (MAPT) can shield a home or savings from countable assets, but only if it’s set up well before care is needed.
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A Qualified Income Trust (Miller Trust) is for applicants whose income is too high to qualify, not their assets.
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New Hampshire’s estate recovery reaches further than probate assets alone — a revocable living trust or joint ownership doesn’t automatically shield a home the way it might in other states.
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Trusts are legal instruments drafted by an elder law attorney — Gilman Agency helps coordinate the insurance and Medicare side of the plan, not the trust document itself.
What Are New Hampshire’s Current Medicaid Income and Asset Limits?
As of 2026, a single applicant for New Hampshire Nursing Home Medicaid must have $2,500 or less in countable assets and monthly income under $2,982. Countable assets include bank accounts, retirement accounts, stocks, bonds, and CDs — a primary home is generally excluded up to an equity limit, and personal belongings, one vehicle, and Irrevocable Funeral Trusts are also non-countable.
For married couples where only one spouse is applying, the non-applicant “community spouse” can keep between roughly $32,532 and $162,660 in assets under the Community Spouse Resource Allowance (CSRA), depending on the couple’s total resources at the start of care. The applicant spouse is still held to the $2,500 individual limit. A resident approved for nursing home Medicaid keeps only a $90/month personal needs allowance; the rest of their income goes toward the cost of care.
These figures are adjusted annually, so it’s worth confirming current numbers before making any planning decisions.
What Is a Medicaid Asset Protection Trust (MAPT)?
A MAPT is an irrevocable trust that holds assets — most commonly a home — outside the applicant’s name and control. Because the applicant no longer legally owns what’s in the trust, those assets don’t count against the $2,500 limit once the trust has been in place long enough.
That last part is the catch: New Hampshire enforces a 60-month look-back period. DHHS reviews financial transactions from the five years preceding a Medicaid application, and transfers made during that window — including funding a MAPT — can trigger a penalty period during which Medicaid won’t pay for care. Importantly, that penalty period doesn’t start on the date of the transfer — it generally doesn’t begin until the applicant is otherwise eligible for Medicaid and has actually applied, which means an ill-timed transfer can leave a family covering care costs out of pocket for longer than they expect. The penalty is calculated by dividing the value of the disqualifying transfer by the average monthly cost of nursing home care in New Hampshire, which runs roughly $150,000–$160,000 a year (about $13,000–$13,500/month) as of 2026. A $200,000 transfer made inside the look-back window, for example, would trigger a penalty period of roughly 15 months — a stretch during which the applicant is on the hook for the full cost of care out of pocket, with no Medicaid coverage.
MAPTs work best as an early, proactive step, not a last-minute reaction to a health crisis.
What Is a Qualified Income Trust (Miller Trust), and Who Needs One?
A Qualified Income Trust (QIT), also called a Miller Trust, solves a different problem: income, not assets. If an applicant’s monthly income exceeds New Hampshire’s $2,982 cap but they still can’t afford the cost of care, excess income can be redirected into a QIT each month so it isn’t counted toward the eligibility limit. Unlike a MAPT, a QIT doesn’t require years of advance planning — it can typically be set up close to the time of application, which makes it one of the more commonly used tools for people who didn’t plan ahead.
What Is a Special Needs Trust, and How Is It Different?
A Special Needs Trust (SNT) serves a different population: individuals with disabilities who need to preserve eligibility for government benefits like Medicaid or SSI while still having access to funds for supplemental needs — items and services Medicaid doesn’t cover. A first-party SNT (funded with the beneficiary’s own assets, such as a settlement or inheritance) is subject to a Medicaid payback provision, meaning the state must be reimbursed from remaining trust funds after the beneficiary passes away, up to the amount of benefits paid. Third-party SNTs, funded by a family member, don’t carry that same payback requirement.
What Happens to a Home or Estate After a Medicaid Recipient Passes Away?
New Hampshire’s annual nursing home costs now average more than $150,000, and Medicaid eventually becomes the only realistic payment option for many families. But qualifying for Medicaid isn’t the end of the story — New Hampshire’s DHHS Estate Recovery Unit can seek reimbursement from a deceased recipient’s estate for long-term care benefits paid, and the state’s recovery authority is broader than many people expect.
Some states limit estate recovery to assets that pass through probate, so property transferred outside probate — through beneficiary designations, joint ownership, or certain trusts — is out of reach. New Hampshire doesn’t work that way. Its expanded definition of recoverable property can extend to assets held as joint tenancy or tenancy in common, certain life estate interests, and property held in a living trust established on or after July 1, 2005. In practice, this means an ordinary revocable living trust set up mainly to avoid probate does not automatically protect a home from Medicaid estate recovery in New Hampshire — only a properly structured, irrevocable MAPT funded well outside the five-year look-back window offers that protection.
Recovery isn’t automatic in every case, though. New Hampshire generally won’t pursue recovery against a surviving spouse’s estate while that spouse is still alive, and the state won’t displace certain protected family members living in the home, including a surviving spouse, a child under 21, a child of any age who is blind or disabled, or a qualifying sibling with an ownership interest who meets residency requirements.
Where Does Insurance Planning Fit In?
Trusts themselves are legal instruments — they need to be drafted and funded by an elder law or estate planning attorney, not an insurance agency. Where Gilman Agency comes in is the surrounding picture: making sure Medicare, Medicare Advantage, or dual-eligible coverage is coordinated correctly with a Medicaid application, reviewing whether a Hospital Indemnity Plan (HIP) or long-term care (LTC) rider makes sense as a supplement, and helping clients understand how their insurance decisions interact with the financial planning their attorney is handling. We work alongside — not in place of — the legal side of this process.
What To Do Next
If long-term care could be on the horizon for you or a family member, timing is the single biggest factor in how much of a MAPT — or estate recovery protection — is available to you. Start by talking to an elder law attorney about trust options, and reach out to Gilman Agency to make sure your Medicare and insurance coverage is coordinated with whatever plan they put in place.
Call (603) 493-1394 or (800) 927-9326, or email to talk through your situation. TTY: 711.
By Marc Gilman, Gilman Agency
