Medicaid Nursing Home Rates by State

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New Hampshire

Medicaid nursing facility payment · Hybrid · researched October 2026

New Hampshire’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Hybrid

Case-mix level

Facility average

Classification

PDPM

Rate updates

Twice a year

Managed care (LTC)

No

Quality program

MQIP supplement

Paid outside the rate

Large

Bed hold

Leave only

Published rates

Rates only

Assisted living

Covered

Personal needs allowance

$93 / month

Overview

• New Hampshire sets one rate per home from five cost components taken from audited Medicaid cost reports.
• Patient care is the lower of the home's own acuity-adjusted cost or the statewide median; administrative, other support and plant maintenance are paid at the statewide median; capital is the home's actual cost capped at the 85th percentile.
• The sum is cut by a budget adjustment factor (28.76% in the state plan), and money left in the nursing facility account after year-end is paid back to homes each July by share of Medicaid days.
• County-owned homes also get a separate cost-shortfall payment (Proportionate Share Incentive Adjustment 2).

What matters in New Hampshire

• Every computed rate is cut 28.76%, but a quarterly MQIP supplement adds about $72-80 per Medicaid day outside the posted rate.
• County-owned homes get a separate payment up to their full Medicaid cost shortfall (ProShare 2, since 7/1/2023); private homes do not.
• Only patient care follows the home's own costs; administrative, support and plant costs are paid at the statewide median for all homes.
• Case mix moved from RUG-IV to the PDPM nursing component on 7/1/2024; the rate changes every January 1 and July 1.
• The nursing facility quality assessment is 5.5% of net patient revenue, paid quarterly; there is no discount for high-Medicaid homes.
• Nursing home care is carved out of Medicaid managed care; the state pays homes directly. Posted July 2026 rates run about $243 to $343 a day.

Frequently asked

Does New Hampshire cut computed nursing facility Medicaid rates by a budget factor?

Yes. The state plan reduces each computed rate by a budget adjustment factor of 28.76%. Money left in the nursing facility account after the fiscal year is paid to homes each July by share of Medicaid days.

Do New Hampshire county nursing homes get Medicaid payments that private homes do not?

Yes. Non-State governmental (county) homes receive Proportionate Share Incentive Adjustment 2 each year, capped at the gap between their Medicaid costs and Medicaid payments, with a final cost reconciliation.

Does New Hampshire Medicaid managed care pay for nursing home stays?

No. DHHS states that nursing home care stays under regular Medicaid, not the three health plans, which cover other medical services for nursing home residents.

How much is paid outside the posted rate in New Hampshire?

Large: the quarterly MQIP supplement adds about $72-80 per Medicaid day, roughly 30% on top of base per diem spending.

What does New Hampshire Medicaid pay on Medicare coinsurance days?

Lesser-of: Medicaid pays coinsurance only up to its own rate minus Medicare's payment, usually $0.

Does New Hampshire require a minimum share of spending on care?

None found in the rule, the state plan sections read, or the assessment statute.

How is the New Hampshire nursing home provider tax charged?

5.5% of net patient services revenue, paid quarterly; no high-Medicaid or size discount found.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

New Hampshire Medicaid Annual Cost Report (He-E 806.30). For the county-home ProShare 2 payment, nursing facility costs come from Medicare 2540 Worksheet A transferred onto the NH Medicaid cost report (Schedule A, Column 2). Allowability follows the Medicare Provider Reimbursement Manual (He-E 806.34).

Base year and rebasing

Rates use the most recently desk-reviewed or field-audited cost reports. The department must rebase at least every 5 years (SPA 9999.8 item 11; He-E 806.31(l)). The year of the last rebase was not found.

Components

Component	Method	Notes
patient care (direct care)	Lower of the home's case-mix-adjusted direct care cost per day or the statewide median. Cost is divided by the home's all-payor case-mix index, then arrayed to find the median.	Includes RN/LPN/aide pay, nursing supplies, ancillaries and therapy. Therapy cost is subject to a ceiling set at the 85th percentile of the Oct 1, 1998 therapy portion of rates, inflated to Aug 1, 2006. Atypical-resident costs are removed first.
administrative	Statewide median of home cost per day (price).	Includes owner, administrator and consultant pay, management fees, accounting, legal.
other support	Statewide median of home cost per day (price).	Housekeeping, laundry, dietary, central supply, pharmacy, medical records, social service, recreation.
plant maintenance	Statewide median of home cost per day (price).	Maintenance pay, supplies, utilities, property taxes.
capital	Home's actual depreciation and interest, subject to an aggregate 85th percentile ceiling.	Not inflated; divided by the greater of actual days or 85% of certified beds.

Inflation

CMS SNF PPS input price index by expense category, applied to patient care, administrative, other support and plant maintenance costs from the cost report midpoint to the midpoint of the rate period (He-E 806.31(g)). Depreciation and interest are not inflated.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

The state plan pays 'a single facility-wide prospective rate'; each resident's rate is computed from their PDPM nursing class on a picture date, then summed and divided by the number of residents so every Medicaid resident in the home gets the same per diem (SPA 9999.8 items 4(a), 8(a); He-E 806.31(k)).

Classification

PDPM nursing component only, described as 'State of New Hampshire Acuity Group Classifications', using the federal PDPM relative weights published each year in the Federal Register. Before 7/1/2024 the state used RUG-IV 48 groups (2019 MACPAC baseline).

Applies to

Patient care component only. The home's all-payor case-mix index also normalizes its direct care cost before the median test. Atypical-care residents are excluded.

Acuity measured from

All residents (all-payor case-mix index) for cost normalization, synchronized with the cost report year. Rate acuity uses MDS 3.0 assessments (OBRA and PPS) as of a picture date of the last day of the 5th month before the rate date. Facilities must transmit assessments by the 20th of the month after the picture date.

Updated

semi-annual (July 1 and January 1)

Move to PDPM

State plan amendment 24-0024 (effective 7/1/2024, approved 10/15/2024) replaced RUG-IV with the PDPM nursing component; He-E 806.31(e) was readopted 7/10/2024 and again 12/12/2024. A phase-in or budget-neutrality step was not found. Sources: https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documen… ; https://www.gencourt.state.nh.us/rules/state_agencies/he-e800…

Verified October 11, 2026

Low-acuity residents

None found. The state plan pages read (4.19-D pages 1-2 and 29-45) and He-E 806 describe no reduced or flat rate for low-acuity residents; low acuity lowers the home's average PDPM index and so its patient care rate. About 20 of the 64 pages were not read, so this is not a full check.

Verified October 11, 2026

Capital

Actual cost: the home's depreciation and interest from its audited cost report, subject to an aggregate 85th percentile ceiling (not fair rental value). Not inflated. Divided by the greater of actual days or 85% of certified bed capacity (He-E 806.31(i)(2)e; 806.35(c)(2)). Return on equity is not recognized (SPA 9999.8 item 13).

Verified October 11, 2026

Budget adjustment factor

28.76% reduction of the summed rate components (SPA 9999.8 item 8(b), TN 24-0024 effective 7/1/2024; kept at 28.76% for SFY2026 by TN 25-0021, effective 7/1/2025, approved 12/19/2025). He-E 806.31(k)(3) as readopted 12/12/2024 still says 25%, and the 2018 plan said 26.82%, so the rule text and plan disagree. After each state fiscal year, money left in the nursing facility account (class line 504) after the factor is reconciled is paid in July to homes by their share of Medicaid fee-for-service per diem spending; the budget for that line was $287,877,714 total computable for SFY2025 and $303,355,759 for SFY2026 (TN 25-0021).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

large

Estimate

About 30-33% of base from the MQIP supplement alone: quarterly pools of $23.2-27.1 million (about $95-100 million a year, $72-80 per Medicaid day) against a SFY2026 nursing facility account (class line 504) budget of $303.4 million total computable, which funds the base per diems. The July reconciliation and ProShare 2 come on top and were not sized.

Components

Quarterly MQIP supplement to all homes by Medicaid paid days (about $95-100 million a year); July reconciliation of class line 504 to all homes (not sized); ProShare 2 to county homes, up to their Medicaid cost shortfall (not sized).

Source

https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0010.pdf ; https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0021.pdf ; https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documen…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

Only non-State governmental (county) homes receive ProShare 2, up to the difference between their allowable Medicaid fee-for-service cost and Medicaid payments, with reconciliation to audited cost within the service period. State-owned and operated homes are paid an interim cost-based rate, reconciled to actual cost within 24 months. Private homes have neither. How many county homes qualify was not counted; the July 2026 rate list names several county homes (e.g. Belknap, Coos, Grafton).

Funding

Not stated in the pages read. County homes certify expenditures for ProShare 2 ('all qualifying nursing facilities shall certify expenditures'), which points to a certified public expenditure or IGT basis; that was not confirmed.

Source

https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documen…

Verified October 11, 2026

Quality program

Active

Yes

Program

Supplemental Medicaid Nursing Home Payment, called the Medicaid Quality Incentive Program (MQIP) in CMS approvals; Attachment 4.19-D page 31(d.8), 9999.8 f(1)

Funding

Not stated on the plan page. Its stated purpose is to close the gap between each home's allowable Medicaid cost and the per diem after the budget adjustment factor, paid quarterly, which matches the RSA 151-E:14-15 nursing facility trust fund fed by the 5.5% quality assessment.

Size

Quarterly pools: $23,227,084 for Jan-Mar 2025 (314,606 Medicaid days, TN 25-0007), $27,117,123 for Apr-Jun 2025 (336,967 days, TN 25-0008), $24,147,472 for Oct-Dec 2025 (334,033 days, TN 25-0010, approved 3/17/2026). That is about $72-80 per paid Medicaid day, roughly $95-100 million a year.

Paid as

Quarterly lump-sum supplemental payment, paid in the quarter after the service quarter.

Payment formula

Pro rata: each home's share of total Medicaid paid nursing home days (MMIS) times the quarterly pool. No quality scoring.

Eligibility

All licensed Medicaid nursing facilities, private and county-operated.

Cadence

Quarterly; a new SPA sets each quarter's pool and day count.

Scores published

No; each home gets a calculation exhibit before payment.

Notes

Despite its name, MQIP has no quality measures; it is a Medicaid-days supplement. Pages 31(b), 31(c), 31(d) and 31(d.5)-31(d.7) are reserved (TN 23-002), but page 31(d.8) still carries the payment, and CMS approved new quarterly pools through Oct-Dec 2025. Sources: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0010.pdf ; https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0008.pdf ; https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0007.pdf

Verified October 11, 2026

Provider tax

Charged

% of net patient revenue

Standard amount

5.5% of net patient services revenue (revenue net of bad debts, charity care and payer discounts), assessed per patient day, due quarterly (RSA 84-C:2, 84-C:3).

Tiers

Who	Test	Amount
Facilities licensed as specialty hospitals and certified as nursing facilities	hospital_based	same 5.5%, but deposited to the general fund rather than the nursing facility trust fund (RSA 84-C:5-a)

Lower for high-Medicaid homes

no

Returned in the rate

Through the nursing facility trust fund (RSA 151-E:14 and 151-E:15): the money funds the state share of the gap between allowable Medicaid cost and the budgeted rate, and any leftover is paid out by raising the rate system and the July reconciliation. No separate per diem add-on amount was found.

Source

https://www.gencourt.state.nh.us/rsa/html/V/84-C/84-C-mrg.htm ; https://www.gencourt.state.nh.us/rsa/html/XI/151-E/151-E-mrg.htm

Verified October 11, 2026

Provider tax notes

Nursing Facility Quality Assessment, RSA 84-C: 5.5% of net patient services revenue, assessed per patient day, quarterly (return by the 10th and payment by the 15th of the month after each quarter). Proceeds go to the nursing facility trust fund, which pays out at least quarterly to close the gap between allowable Medicaid cost and the budgeted rate (RSA 151-E:14, 151-E:15). Specialty-hospital nursing facilities pay into the general fund (RSA 84-C:5-a). The tax is void if Medicaid nursing facility funding falls below its Feb 1, 2003 level plus trust fund spending (RSA 84-C:11).

Verified October 11, 2026

Supplemental payments

(1) Proportionate Share Incentive Adjustment 2 (ProShare 2) to non-State governmental (county) homes, effective 7/1/2023, one interim payment by the end of each state fiscal year, capped at allowable Medicaid fee-for-service cost minus Medicaid payments, then reconciled to audited cost (TN 23-0002; amended TN 25-0022 effective 7/1/2025, approved 4/10/2026). (2) The July reconciliation of the nursing facility account, paid to all homes by Medicaid days. (3) State-owned and operated homes are paid an interim rate reconciled to actual cost with settlement within 24 months. (4) The quarterly Supplemental Medicaid Nursing Home Payment (MQIP, page 31(d.8)) to all licensed Medicaid homes, private and county, split by Medicaid paid days: $23,227,084 for Jan-Mar 2025 (TN 25-0007), $27,117,123 for Apr-Jun 2025 (TN 25-0008) and $24,147,472 for Oct-Dec 2025 (TN 25-0010, approved 3/17/2026). Amounts of ProShare 2 and the July payment were not found.

Verified October 11, 2026

Other add-ons

None found beyond ProShare 2 and the July reconciliation. The 2020 and 2021 state plan text noted a 3.1% rate increase on 1/1/2020 and 1/1/2021 (page 29, item 1(d)); no current add-ons were found.

Verified October 11, 2026

Units paid separately

Atypical care (He-E 806.36; SPA 9999.8c): a facility or distinct part devoted to highly specialized care (children with severe disabilities, brain and spinal injury, ventilator-dependent, other) is paid on its documented cost for routine, ancillary and capital care, exempt from cost and occupancy limits, with an access adjustment. Each home's regular cost components are reduced by an atypical factor. State-owned homes: interim rate reconciled to cost. Swing beds: 75% of the statewide average budget-adjusted nursing facility per diem as of Jan 1 of the prior year. Out-of-state homes: that state's Medicaid rate.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

Nursing home care is carved out of Medicaid Care Management (AmeriHealth Caritas NH, NH Healthy Families, WellSense). DHHS FAQ: 'Services still covered by regular Medicaid include children's dental care, Long Term Care (LTC), and waiver services.' Source: https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-c…

Verified October 11, 2026

Who pays

fee_for_service. DHHS says nursing home care, home and community-based care and children's dental stay under regular Medicaid; the three Medicaid Care Management health plans (AmeriHealth Caritas NH, NH Healthy Families, WellSense) cover other medical services, including some for nursing home residents. The state pays the per diem directly.

Verified October 11, 2026

Managed care rate floor

Not applicable for the per diem: homes are paid by DHHS fee-for-service. Whether the health plans' contract sets a floor for the other medical services they cover for nursing home residents was not checked.

Verified October 11, 2026

Included in the daily rate

Allowable costs for services and items directly related to resident care are in the per diem, including therapy, nursing supplies and ancillaries, unless the service is billable to Medicare or covered by the drug rebate program (He-E 806; MACPAC 2019 quote). During reserved bed days the department pays nothing separately for services already in the facility rate (He-E 802.15(d)(5)). A full list of items paid separately was not found.

Verified October 11, 2026

Bed hold

Hospital stays

Not paid by Medicaid. Absences for hospitalization or transfer cannot be billed as reserved bed days; the home must offer the resident or representative a written option to pay for the hold, at no more than the Medicaid rate, and readmit to the next available bed after absences over 10 days (He-E 802.15).

Leave days

Paid at 100% of the facility's Medicaid per diem, up to 30 days per recipient per state fiscal year, if the days are in the plan of care with continuity-of-care provisions (SPA 4.19-C TN 23-0016, effective 5/30/2023; He-E 802.15(d)).

Occupancy rule

None found.

Notes

Reserved bed days count in actual days when the per diem is computed (He-E 806.35(c)).

Source

https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documen… ; https://www.gencourt.state.nh.us/rules/state_agencies/he-e800…

Verified October 11, 2026

Personal needs allowance

Per month

93

Effective

2026 (DHHS page, no date shown; RSA 167:27-a amended eff. 2026-01-01)

Notes

DHHS: 'A monthly personal needs allowance (PNA) of $93 is retained by the individual.' RSA 167:27-a sets a floor of $56 and requires a yearly Social Security COLA adjustment (2025 amendment effective 1/1/2026).

Source

https://www.dhhs.nh.gov/programs-services/adult-aging-care/nu… ; https://www.gencourt.state.nh.us/rsa/html/XII/167/167-27-a.htm

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

State plan Supplement 1 to Attachment 4.19-B, page 2 (TN 99-04, effective 1/1/1999), marks Part A and Part B deductibles and coinsurance 'SP' for QMBs, other Medicaid recipients and dual eligibles (QMB Plus). Page 1 defines SP: 'Payments are limited to State plan rates and payment methodologies.' Page 3, where exceptions would be listed, is blank, so nursing facility Part A coinsurance days are paid only up to the Medicaid rate less Medicare's payment. A footnote adds that for mental health claims under Medicare's 37.5% reduction, NH also does not pay the 37.5%. No separate rule for Medicare Advantage cost sharing was found.

Effect

Medicare's day 21-100 SNF payment is usually far above the home's Medicaid per diem (about $243-$343 in July 2026), so NH Medicaid usually pays $0 of the coinsurance.

Source

https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documen… (read from the web.archive.org copy; dhhs.nh.gov returns 403 to scripts)

Verified October 11, 2026

Required care spending

Applies

no

Rule

None found in He-E 806, the state plan pages read or RSA 84-C and 151-E.

Source

https://www.gencourt.state.nh.us/rules/state_agencies/he-e800…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

Capital: allowable capital cost is divided by the greater of actual days (including reserved bed days) or resident days computed at 85% of certified bed capacity (He-E 806.35(c)). Other components use actual days. No rate cut for low occupancy was found. Atypical care homes are exempt from occupancy limits.

Source

https://www.gencourt.state.nh.us/rules/state_agencies/he-e800…

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

semiannual

When

July 1 and January 1: acuity-based rates are reviewed every six months from validated MDS data (SPA 9999.8 item 10). Cost components are updated at rebasing (at least every 5 years) and, in between, inflated by the CMS SNF price index. The July reconciliation payment follows each state fiscal year.

Verified October 11, 2026

When rates change

July 1 and January 1 each year (acuity updates); July 1 posted rate list dated 7/2026. Picture date: last day of the 5th month before the rate date. ProShare 2 interim payment by the end of each state fiscal year (June 30); July reconciliation payment.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://www.dhhs.nh.gov/programs-services/adult-aging-care/nu… (link 'Nursing Facility Rates')

Format

pdf (4 pages; 'Appendix A, Nursing Facility Rates', dated 7/2026)

Cadence

At least annually; the file is dated 7/2026 and shows 7/1/2026 effective dates. Whether a January list is posted was not checked.

History

Only the current list was seen on the page.

Home identifier

Medicaid provider identifier (7-digit, e.g. 3125647) plus facility name and town; no NPI or CCN.

Verified October 11, 2026

Rate build-ups

Published

No

Where

Not posted. SPA 9999.8 item 1(e): rate calculation work sheets are maintained by the department and available for inspection at its premises.

What they show

The posted PDF shows only the per diem, monthly rate (per diem x 30.42), provider identifier, level-of-care code (L1/L2) and effective date, plus a statewide average private-pay rate ($423.82).

Format

pdf

Example file

https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documen…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Choices for Independence (CFI) HCBS 1915(c) waiver, He-E 801. Residential care facility = 'assisted living residence-residential care' or 'assisted living-supported residential health care' facility licensed under RSA 151 (He-E 801.02).

What is paid

Waiver services only; payment excludes room and board except for respite in a residential care facility (He-E 801.12(b)). Participants' income is applied toward care after a maintenance allowance of 300% of the SSI benefit and medical deductions (He-E 801 post-eligibility rules).

Limits

Participants must meet nursing facility level of care and Medicaid financial rules. Participant-directed services are not available for residential care facility services. Enrollment caps or a waitlist were not checked.

Source

https://www.gencourt.state.nh.us/rules/state_agencies/he-e800…

Verified October 11, 2026

Sources

1. NH Medicaid State Plan Attachment 4.19-D (TNs 24-0024, 23-0002, 25-0022; Nursing Facility Reimbursement, 64 pp) · state plan
2. NH Medicaid State Plan Attachment 4.19-C (Reserved Bed Days, TN 23-0016) · state plan
3. NH Administrative Rules He-E 800 series (He-E 801 CFI, 802.15 bed holds, 806 nursing facility reimbursement), gencourt.state.nh.us · regulation
4. RSA 84-C Nursing Facility Quality Assessment · statute
5. RSA 151-E (151-E:14, 151-E:15 nursing facility trust fund) · statute
6. RSA 167:27-a Personal Needs Allowance of Residents of Nursing Homes · statute
7. DHHS Nursing Home Care page (PNA $93, rates link) · agency page
8. DHHS Appendix A, Nursing Facility Rates (7/2026) · rate file
9. DHHS Medicaid Care Management page (nursing home care stays fee-for-service) · agency page
10. CMS approval of NH SPA 18-0017 (MQIP continuation through 9/30/2018) · state plan
11. NH Medicaid State Plan Attachment 4.19-B, Supplement 1 (Payment of Medicare Part A and Part B Deductible/Coinsurance, TN 99-04) · state plan
12. CMS approvals of NH SPAs 25-0007, 25-0008 and 25-0010 (Nursing Facility MQIP quarterly pools, Attachment 4.19-D page 31(d.8)) · state plan
13. CMS approval of NH SPA 25-0021 (Budget adjustment factor 28.76% and SFY2026 class line 504 budget, Attachment 4.19-D page 29(f)) · state plan
14. MACPAC 2019 nursing facility payment policies, NH tab (baseline only) · secondary

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