Home and Community Based Services – Choices for Independence

The New Hampshire Department of Health and Human Services (“DHHS”) Medicaid program offers a number of programs that provide long term supports and services to individuals living in the community.  One such program is the Choices for Independence program or CFI, which provides services to elderly and disabled adults.   To qualify for CFI, applicants must meet certain financial and medical eligibility standards.  Financial eligibility is based on income and resource standards and a review of financial statements during a five year look back period.

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Five-Year Look-Back

CFI eligibility includes a review of five years of financial information to determine whether any assets were deliberately given away or transferred for less than fair market value.  If the applicant is married, the five-year review applies to all assets owned by the married couple, either individually or jointly.  If DHHS determines that assets have been gifted, a period of benefit disqualification is imposed.

Resource Eligibility

The resource limit for a single individual applying for CFI is $2,500.  With respect to married couples, DHHS recently changed its rules for resource eligibility.  Prior to August 2017, DHHS counted only the applicant’s resources, however, beginning in September 2017, DHHS policy changed so that the resources of both spouses are counted to determine a married applicant’s CFI eligibility.  The new CFI resource eligibility policy mirrors DHHS Medicaid nursing facility resource rules.

Medicaid rules protect a portion of a couple’s resources for the non-applicant spouse.  This protected amount is known as the “spousal resource allowance.”  The general rule is that the non-applicant spouse is permitted to retain one-half of the couple’s countable resources, however there is a minimum and a maximum resource allowance.  The applicant is allowed to retain $2,500.  The following chart illustrates the spousal resource allocation as of January 2018:

Spousal Resource Allowance as of January 2018

Resources valued at, or under,

$49,440

Resources valued between

$49,440 and $247,200

Resources valued more than

$247,200

Non-applicant spouse may keep

$24,720

Non-applicant spouse may keep

One-half

Non-applicant spouse may keep

$123,600

 

When an individual applies for CFI, DHHS schedules an initial appointment at the DHHS District Office and after this appointment an in-home appointment is scheduled with a CFI nurse.  A married couple’s resources are valued as of the date of the CFI nurse’s visit, however if the applicant had a prior continuous 30-day period of institutionalization (meaning hospital, skilled or nursing facility care), DHHS may insist on using the first date of institutionalization to value the couple’s resources.  The DHHS valuation of resources is known as a Resource Assessment, and after the Resource Assessment the married couple must spend down excess resources.  A married applicant will not be resource eligible until the assets are spent down below the allowable limit (i.e., the Spousal Resource Allowance plus $2,500 for the applicant).  Resources may be spent on any item or service that benefits either spouse.

Income Eligibility

The monthly income limit for CFI is $2,250 (2017) and only the applicant’s income is counted.  An individual with income above this limit who has significant medical expenses may still qualify for CFI by meeting a monthly spend-down.

 

Understanding NH Medicaid Rules - Updated Jan 2020