Medicaid State-to-State Transfer Rules

Page Reviewed / Updated - Sep. 2017

Medicaid State Transfer Rules Overview

Much to the surprise and dismay of many, Medicaid coverage and benefits cannot be simply switched from one state to another. While Medicaid is often thought of as a federal program, each state is given the flexibility to set their own eligibility requirements. Therefore, each state evaluates its applicants independently from each other state. Those wishing to transfer their coverage must re-apply for Medicaid in the new state.

Further complicating matters is the fact that someone cannot be eligible for Medicaid in two states at the same time. Therefore, in order to be accepted by Medicaid in a new state, the individual must first close out their Medicaid coverage with the old state.  However, retroactive coverage exists, and therefore readers should not be alarmed by a potential coverage gap.

 The process of transferring between states is difficult, but not impossible.

Having given these warnings, it should be mentioned that while this process is difficult, it is not impossible and there is good news. Even though each state has different eligibility requirements for Medicaid, usually their income and assets limits are very similar. Most people who are financially eligible in one state can qualify in their new state with little or no re-structuring of their finances. More good news is the Medicaid application review and approval process is fairly quick. Depending on the state, it will usually take between 15 - 90 days to receive a letter of approval.  Also, states are prohibited by federal law from having a length of residency requirement; this means one can be eligible immediately upon moving to their new state (or becoming a resident of the new state).  Finally, Medicaid coverage can be made retroactive to the date of application. Read more about retroactive eligibility.

Aside from states having different financial requirements for Medicaid, they can also have different “level of care” requirements.  This applies mostly for the elderly and for long term care.  It is entirely possible that an applicant is medically-eligible in one state and when applying in the new state, that they be found to not require a high enough level of care to be eligible.  It is therefore, strongly suggested that the Medicaid level of care requirement be thoroughly researched in both states prior to beginning the process.  Note also that just because both states say applicants “must require nursing home level care” does not mean that both states have the same definition of what “nursing home level care” means.

Did You Know? There are Medicaid planners who are familiar with the rules in all 50 states. These professionals can help facilitate the re-application process. Learn more.  


Recommended Process for Transferring Medicaid

To limit the challenges associated with moving from one state to another while under Medicaid coverage (elderly, disabled or low income adult), the following steps are recommended. 

1) Research both the old state’s and the new state’s Medicaid level of care requirements. Since some states have a higher level of care need, it may be possible that your loved one cannot be eligible. Consider having a loved one assessed medically in the new state prior to giving up the old state’s coverage.

2) If it is determined, a loved will be medically eligible, then research the new state's Medicaid financial eligibility requirements (for your loved one’s coverage group, specifically) well in advance of the move to make sure a loved one is qualified.

3) Work with a Medicaid planning professional to ensure the applicant is eligible in the new state and prepare all the necessary paperwork for application prior to moving.  

4) Be aware that the applicant will very likely have to pay out-of-pocket for their care for several weeks or months.  Therefore, applicants should find affordable care in their new state of residence prior to making the move.  Usually they can be reimbursed by Medicaid but know that the Medicaid reimbursements rates are not high, therefore it is important to find affordable care providers in the new state.

5) Time the move around the end of the month.  In some states, it takes until the end of the month to end Medicaid coverage regardless of the date on which the individual notified their Medicaid office that they will be moving.  Since one cannot be covered by Medicaid in two states concurrently, one's coverage must end in the old state, before the application can be submitted in the new state.

6) Submit the application in the new state immediately upon making the move to the new state.

Transferring Medicaid when on HCBS or 1915 Waivers

While transferring Medicaid from state to state is difficult, it is even more challenging for those individuals who are receiving Home and Community Based Services through a Medicaid Waiver program.  

 Medicaid waivers are different in every state and often times there is not a corresponding waiver between states.

Medicaid Waivers are programs that allow individuals who would typically require nursing home care to receive care services at home, in assisted living residences and in adult day care.  Each state has its own set of Medicaid Waivers and very often these do not align with waivers in other states.  For example, some states do not have assisted living waivers.  Furthermore, Medicaid Waivers are not entitlements.  There are usually a limited number of spaces available for any one waiver and long wait lists or Interest Lists can exist.  Therefore, an individual wishing to transfer from one Medicaid Waiver in one state to a similar program in a new state may find there is no comparative program or may be required to spend months or even years on a waiting list for services.  Again, a Medicaid planner may be able to tell you if there is a compatible Waiver in the new state, if there is a wait list and how prioritization works for the wait list.

Individuals on Medicaid Waivers need to think very carefully about making a move from one state to another.  Furthermore, they should be aware that an extended stay in a nursing home may be necessary as they move from a Medicaid Waiver to regular Medicaid and are wait-listed for the new state's Medicaid Waiver.


Other Medicaid Resources

More on Medicaid
Medicaid Government Website
Assistance Qualifying for Medicaid
Medicaid and Assisted Living
Medicaid and Home Care Medicaid and Adult Day Care
Alternatives to Medicaid

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Help Qualifying for Medicaid in a Different State

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List of All State Medicaid Programs

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