Written by a parent, not a doctor. Nothing here is medical advice.

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New Hampshire program

Spend-down coverage for a period of huge bills (In and Out)

A way to get NH Medicaid for a period of high medical bills [In and Out].

What it is

A way to get NH Medicaid for a period of high medical bills [In and Out].

When ordinary Medicaid does not fit, the district office can check whether an eligible category and qualifying medical expenses allow In and Out coverage. A work plan’s out-of-pocket maximum does not tell us whether you meet the spend-down. The office must check your actual bills, income, assistance group and other rules.

Eligibility rules
  • Resource limits depend on the eligible category and assistance group. The district office confirms whose resources count and which exclusions apply.
  • In and Out Medicaid requires an eligible Medicaid category as well as its income, resource and medical-bill tests. The assistance group may differ from everyone living in the home. DHHS must identify the child’s category, whose money counts, the applicable resource exclusions and the current protected-income amount before a spend-down figure is shown.
What you get
  • NH Medicaid for a qualifying one-month or six-month period after the medical-bill target is met.
What the help covers
  • DHHS sets the protected-income amount for the assistance group and period in your case. The office confirms the current table before calculating your medical-bill target.
If you decide to apply
  1. Ask the district office about In and Out on NH EASY, with help from the hospital financial counselor.
  2. Bring itemized medical bills, income records and savings balances for the office’s calculation.

NH Department of Health and Human Services, Bureau of Family Assistance · 1-844-275-3447 · Official page ↗

After you apply
  • The Bureau of Family Assistance sets the protected amount and the medical-bill target for the chosen period.
  • The district office must confirm which medical expenses count, including older or already-paid bills, whether another insurer is responsible, and the date coverage could begin. The bills used to meet a spend-down are not automatically bills Medicaid will pay. The social worker can help check the written calculation before you rely on it.
Good to know

DHHS checks the assistance group, financial rules and which bills count. Work insurance alone does not rule out this route.

Other details
  • A bill large enough to meet the target does not waive the other eligibility conditions.

Federal background: medically needy Medicaid.

Official sources
Ask your social worker

“Could our medical bills open In and Out coverage? What would we still owe, and could you help us work through the target before we decide?”

Why I’m asking: I want to know whether a period of large bills could open coverage and what costs would remain.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for In and Out by name, choose the period and hand in every bill.

Your social worker

The hospital's financial counsellor gathers the itemised bills for the target.

The care team

Records and letters when the application asks for them.

Who decides
The Bureau of Family Assistance sets the protected level and the target.
Ask your social worker
“Can we apply for In and Out spend-down for this admission, and can the billing office give us itemised bills for the target?”

How to apply

First step: Ask the district office for In and Out medically needy assistance and bring every bill, including old unpaid ones.

  1. Ask for In and Out by name and choose the six-month period if bills will keep coming.
  2. Bring every bill, including old ones you still owe.

Official application / program page ↗

Where it starts: Ask for In and Out medically needy assistance on the NH EASY application or at the district office, and bring the bills.

What to gather

  • Itemised hospital bills
  • Older unpaid medical bills
  • This month's income
  • Savings balances

How long: No published decision standard was found. Ask the office when you file.

What a yes looks like

A notice naming the period and the amount of bills to be met first.

What a no looks like, and the next move

A no on savings or on a category rule. Ask which, and whether the severe-disability category fits better.

Watch out

  • The protected level is for an assistance group, which is not always everyone at home.
  • Savings are capped at $2,500 for one person and $4,000 for two.
  • Being over the children's income line is not enough on its own: the other category rules still apply.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

NH Medicaid for a one-month or six-month period once bills above the protected income level are met. Protected levels run from $1,033 for a group of 2 to $1,611 for a group of 6.

  • $1,033/month — Protected monthly income level, assistance group of 2
  • $1,177/month — Protected monthly income level, assistance group of 3
  • $1,311/month — Protected monthly income level, assistance group of 4
  • $1,444/month — Protected monthly income level, assistance group of 5
  • $1,611/month — Protected monthly income level, assistance group of 6
  • $2,500 — Countable savings ceiling, one person
  • $4,000 — Countable savings ceiling, two people
  • $100 — Added savings allowance for each further group member

Covers: Everything NH Medicaid covers, for the period that is met

Legal protection: Earlier medical debts that are still unpaid and owed can count towards the target · A one-month or a six-month period can be chosen, subject to the rule's conditions

What it costs the family: The bills above the protected level are the family's own; the programme pays after that.

The eligibility facts, as published

Income
income above the protected level for the assistance group is spent down on medical bills
Resources
$2,500 for one, $4,000 for two, plus $100 per additional group member, subject to category exceptions
Period
one month or six months
Household method
assistance group as the office defines it
Note
the current child-specific assistance-group mapping and any 2026 table were not published

The trap: The protected level is set for an assistance group, which is not always everyone under your roof. The office decides who is in it, so do not work the sum out at the kitchen table and give up.

Where I read this

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