Page Reviewed / Updated - Sep. 2017
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.
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.
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.
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 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 Relevant Content
Medicaid eligibility is very complex; the rules change frequently and differ by state.
States’ Medicaid programs titles, descriptions, and eligibility requirements.
Speak with local representative to assist your senior living search.