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There are three sets of requirements - general, financial and medical that are evaluated to make an eligibility determination for Medicaid. While there are requirements that are generally the same for each set of services, there are some differences - for example, an application for services under the Aid to the Needy Blind program requires an individual to have a medical necessity determination of legally blind. Specific details regarding all eligibility requirements are explained for each service.

General Requirements

All or most of the general requirements below must be met to be eligible for Medicaid services. When an item below is not required for a program, a DHHS District Office worker will inform you at the time of application.

  • Citizenship Status/Immigration: You must be either a US citizen or an eligible qualified alien. There are limited emergency medical services available for some non-qualified aliens. Contact a DHHS District Office for more information;
  • Residency: You must be a current resident of NH but do not need to live here for a specified length of time;
  • Age: You must meet any program age requirements; and
  • Social Security Number: For most Medicaid programs the law requires that each individual requesting assistance furnish a social security number or verify that an application for a social security number was filed (if one has never been issued or you cannot provide the number).

Financial Requirements

Financial requirements are broken into two components: income and resources. Although every program examines income to determine eligibility, not every program counts resources. If a program counts resources, you must meet the program's resource requirements as well as the income requirements to be eligible for the program.

  • Household Income: Available income for all household members is counted when eligibility is determined. However, certain expenses are subtracted. Please refer to the Net Monthly Income Limits Adobe Acrobat Reader Symbol for the specific income requirements for the various programs;
  • If Household Resources Are Counted: Resources owned by all household members are considered to determine eligibility. Examples of resources are cash, bank accounts, stocks, bonds, some vehicles, permanently unoccupied real estate, and some trusts. We do not count certain resources such as the home you live in, your furniture and some vehicles. Please refer to the Program Fact Sheet for the specific resource requirements for the various programs.
  • Potential Income: Individuals who apply for some Medicaid programs must be prepared to explore and develop all potential sources of income. For example, if you are potentially eligible for any of the following (or additional benefits not listed), a DHHS District Office worker will tell you if you must apply for them:
    • Social Security Benefits
    • Retirement Benefits or Pensions
    • Unemployment or Worker's Compensation
    • Third-Party Medical Coverage
    • VA Benefits (including Aid and Attendance)
    • Contributions from any Liable Third Party

Medical Requirements

Certain Medicaid service categories require a determination of medical eligibility in addition to general and financial requirements.

Determining that an applicant is medically eligible for Medicaid services involves an assessment of an applicant's medical condition, made by a DHHS medical review team. This review is based on an applicant's medical records and other medical documentation specifically related to an applicant's medical condition, keeping in mind access, quality, choice, and cost effectiveness. The DHHS medical review team consists of professional individuals including nurses, medical physicians, psychiatrists and clinical psychologists, as well as para-professionals and administrative staff.

The length of time required to complete the medical determination process depends on the clarity of information received from an applicant, the responsiveness of an applicant's healthcare provider to return information requested by the medical review team, the volume and comprehensiveness of information received, and the need for an applicant to have additional examinations or testing.

Next Steps: When a determination of medical eligibility is completed, an applicant is notified in writing. If an applicant also meets all general requirements and is found eligible financially, then the applicant will begin receiving the appropriate Medicaid services. If an applicant is found not to meet all the relevant eligibility requirements, the applicant is notified of his or her right to a Fair Hearing.

How to Apply for NH Medicaid

If you think you meet the eligibility requirements find out more about how to apply for Medicaid.

Right to an Administrative Appeal Hearing

If you disagree with a decision made about your case, you may request an Administrative Appeals hearing.

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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852

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