New Hampshire Revised Statutes
N.H. Rev. Stat. Ann. § 167:18-a (2026)
County Reimbursement of Funds; Limitations on Payments
✓ current as of May 2026
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167:18-a County Reimbursement of Funds; Limitations on Payments. –
I. These expenditures shall in the first instance be made by the state, but each county shall make monthly payments to the state for the amounts due under this section within 45 days from notice thereof.
(a) Counties shall reimburse the state for expenditures for recipients for whom such county is liable who are eligible for nursing home care and are receiving services from a licensed nursing home, or in another New Hampshire setting as an alternative to a licensed nursing home placement and are supported under the Medicaid home and community-based care waiver for the elderly and chronically ill, as such waiver may be amended from time to time, to the extent of 100 percent of the non-federal share of such expenditures. If at any point the Federal Medical Assistance Percentage increases, the counties' portion of the non-federal share shall be reduced by the amount of the increased federal percentage, if allowable under federal law and subject to any conditions on the funding. Expenditures shall not include payments made for skilled care.
(b) Counties shall not be liable for Medicaid recipients in state institutions, the Crotched Mountain Rehabilitation Center, and intermediate care facilities (ICF) approved by the department of health and human services and servicing developmentally impaired persons.
II. (a) The total billings to all counties made pursuant to this section shall not exceed the amounts set forth below for state fiscal years 2024-2025:
(1) State fiscal year 2024, $131,849,659
(2) State fiscal year 2025, $131,849,659;
(b) The caps on total billings for fiscal years after fiscal year 2015 shall be established by the legislature at least on a biennial basis.
III. (a) The cap in total billings shall not exceed an annual increase of 2 percent in any year of the biennium.
(b) The counties shall have an aggregate credit of $5,000,000 against amounts due under this section for each fiscal year beginning July 1, 2008. The credit shall be allocated as follows:
(1) For fiscal year 2009, $4,000,000 shall be allocated among the counties based upon the proportion each paid for such expenditures in the prior fiscal year, and $1,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.
(2) For fiscal year 2010, $2,000,000 shall be allocated among the counties based upon the proportion each paid for such expenditures in the prior fiscal year, and $3,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.
(3) For fiscal year 2011 and for each fiscal year thereafter, $5,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.
(4) For fiscal year 2021, in addition to the $5,000,000 allocated pursuant to subparagraph III(b)(3), a credit of $9,721,305 shall be allocated among the counties based upon their relative proportions of residents aged 65 years of age or older who are Medicaid recipients.
(c) The credit shall be made available as soon as possible after the start of the fiscal year. The department shall adopt county credit criteria in consultation with the county-state finance commission and in accordance with the provisions of RSA 541-A. The total aggregate obligation of the counties shall be reduced by the amount of the credit in each fiscal year.
IV. Budgeted general funds shall be applied to the funding of Medicaid long-term services and supports after the allocation of the credit and prior to any county funds.
V. Notwithstanding the procedures of paragraphs I-III of this section, no county shall be liable for total billings in fiscal year 2009 or fiscal year 2010 in an amount which would be greater than the amount of liability projected for that fiscal year using the methodology for determining county payments in former RSA 167:18-a, 167:18-b, and 167:18-f prior to its repeal together with the amount of liability projected for that fiscal year using the repealed methodology for determining county payments in RSA 169-B, 169-C, and 169-D.
VI. (a) Any shortfall between the state audited Medicaid allowances incurred by the state's county operated nursing homes and amounts otherwise reimbursed by federal 50 percent Medicaid matching funds or other income, shall be certified as a public expenditure and be eligible for additional federal funding match.
(b) The department of health and human services shall seek federal Medicaid assistance match for any state audited county nursing home Medicaid expense which is not fully reimbursed through rates. Any revenue realized through such a match shall be paid to the nursing homes which incurred the unreimbursed expense.
I. These expenditures shall in the first instance be made by the state, but each county shall make monthly payments to the state for the amounts due under this section within 45 days from notice thereof.
(a) Counties shall reimburse the state for expenditures for recipients for whom such county is liable who are eligible for nursing home care and are receiving services from a licensed nursing home, or in another New Hampshire setting as an alternative to a licensed nursing home placement and are supported under the Medicaid home and community-based care waiver for the elderly and chronically ill, as such waiver may be amended from time to time, to the extent of 100 percent of the non-federal share of such expenditures. If at any point the Federal Medical Assistance Percentage increases, the counties' portion of the non-federal share shall be reduced by the amount of the increased federal percentage, if allowable under federal law and subject to any conditions on the funding. Expenditures shall not include payments made for skilled care.
(b) Counties shall not be liable for Medicaid recipients in state institutions, the Crotched Mountain Rehabilitation Center, and intermediate care facilities (ICF) approved by the department of health and human services and servicing developmentally impaired persons.
II. (a) The total billings to all counties made pursuant to this section shall not exceed the amounts set forth below for state fiscal years 2024-2025:
(1) State fiscal year 2024, $131,849,659
(2) State fiscal year 2025, $131,849,659;
(b) The caps on total billings for fiscal years after fiscal year 2015 shall be established by the legislature at least on a biennial basis.
III. (a) The cap in total billings shall not exceed an annual increase of 2 percent in any year of the biennium.
(b) The counties shall have an aggregate credit of $5,000,000 against amounts due under this section for each fiscal year beginning July 1, 2008. The credit shall be allocated as follows:
(1) For fiscal year 2009, $4,000,000 shall be allocated among the counties based upon the proportion each paid for such expenditures in the prior fiscal year, and $1,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.
(2) For fiscal year 2010, $2,000,000 shall be allocated among the counties based upon the proportion each paid for such expenditures in the prior fiscal year, and $3,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.
(3) For fiscal year 2011 and for each fiscal year thereafter, $5,000,000 shall be allocated among the counties based upon their relative proportions of residents age 65 or older who are Medicaid recipients.
(4) For fiscal year 2021, in addition to the $5,000,000 allocated pursuant to subparagraph III(b)(3), a credit of $9,721,305 shall be allocated among the counties based upon their relative proportions of residents aged 65 years of age or older who are Medicaid recipients.
(c) The credit shall be made available as soon as possible after the start of the fiscal year. The department shall adopt county credit criteria in consultation with the county-state finance commission and in accordance with the provisions of RSA 541-A. The total aggregate obligation of the counties shall be reduced by the amount of the credit in each fiscal year.
IV. Budgeted general funds shall be applied to the funding of Medicaid long-term services and supports after the allocation of the credit and prior to any county funds.
V. Notwithstanding the procedures of paragraphs I-III of this section, no county shall be liable for total billings in fiscal year 2009 or fiscal year 2010 in an amount which would be greater than the amount of liability projected for that fiscal year using the methodology for determining county payments in former RSA 167:18-a, 167:18-b, and 167:18-f prior to its repeal together with the amount of liability projected for that fiscal year using the repealed methodology for determining county payments in RSA 169-B, 169-C, and 169-D.
VI. (a) Any shortfall between the state audited Medicaid allowances incurred by the state's county operated nursing homes and amounts otherwise reimbursed by federal 50 percent Medicaid matching funds or other income, shall be certified as a public expenditure and be eligible for additional federal funding match.
(b) The department of health and human services shall seek federal Medicaid assistance match for any state audited county nursing home Medicaid expense which is not fully reimbursed through rates. Any revenue realized through such a match shall be paid to the nursing homes which incurred the unreimbursed expense.
Source. 1973, 423:6. 1985, 380:33. 2007, 263:17. 2008, 52:10; 296:19, 20. 2009, 144:22. 2011, 224:21, 22. 2013, 144:8, eff. July 1, 2013. 2015, 276:153, eff. July 1, 2015. 2017, 156:84, eff. July 1, 2017. 2019, 346:59, eff. July 1, 2019. 2021, 91:26, eff. July 1, 2021. 2023, 79:219, eff. July 1, 2023.
Notes of Decisions
Cited in 4
cases, 1981–2009 · leading case: New Hampshire Ass'n v. State, 158 N.H. 284 (N.H. 2009).
New Hampshire Ass'n v. State, 158 N.H. 284 (N.H. 2009). “See RSA 167:18-a, :18-b, :18-f (1994). Under SB 409, in addition to these and other required payments, the counties became liable for paying a share of the cost of medical care for those persons eligible for nursing home care, but who receive care under a Home and Community…”
New Hampshire Ass'n of Counties v. Comm'r, New Hampshire Dep't of Health & Human Servs., 930 A.2d 400 (N.H. 2007). “In an objection to the petitioners’ summary judgment motion, the commissioner argued that “even assuming arguendo that the Counties are correct in their contention that they have been improperly billed for the amount of the disputed funds pursuant to RSA 167:18-b, those bills…”
In re Eva S., 435 A.2d 838 (N.H. 1981). “Correspondingly, there are no rights of action by a State or federal governmental unit against a local governmental unit for expenditures made in connection with public assistance, with the exception of those contained in RSA 167:18-a and :18-b. RSA 167:18-a requires that all…”
New Hampshire Ass'n of Counties v. State, 965 A.2d 1012 (N.H. 2009). “See RSA 167:18-a,:18-b,:18-f (1994). Under SB 409, in addition to these and other required payments, the counties became liable for paying a share of the cost of medical care for those persons eligible for nursing home care, but who receive care under a Home and Community Based…”
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