Medicaid State Transfer Rules Overview
Much to the surprise and dismay of many, Medicaid coverage and benefits cannot simply 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 in the majority of the states.
Therefore, most senior readers should not be alarmed by a potential coverage gap. Simply put, retroactive
coverage allows a Medicaid applicant to receive Medicaid coverage for as many as three months prior to the date
of one’s application.
However, as mentioned above, not all states allow this type of coverage for seniors. For
example, in February 2019, Florida eliminated 3-month retroactive coverage for all adults except for pregnant
women. Therefore, it is crucial one research if retroactive coverage exists (and for which coverage groups) in
the state in which one wishes to relocate. Read more about retroactive
eligibility.
The process of transferring between states is difficult, but not impossible.
Having given these warnings, it should be mentioned that while this process of transferring Medicaid coverage is
difficult, it is not impossible. In addition, there is good news. Even though each state has different
eligibility requirements for Medicaid, usually their income and asset limits are very similar. Most people who
are financially eligible in one state can generally qualify in their new state with little to no re-structuring
of their finances.
More good news is that 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).
Aside from states having different financial requirements for Medicaid, they may 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, it is determined they do not
require a high enough level of care to be eligible. Therefore, it is 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,” it 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 will not be eligible.
Consider having a loved one assessed medically in the new state before giving up the old state’s
coverage.
2) If it is determined that a loved one 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 before
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 before
making the move. Often, they can be reimbursed by Medicaid but know that the Medicaid reimbursement
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 moving to the new state.
Transferring Medicaid when on HCBS or 1915(c) 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 oftentimes 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, adult foster care homes, 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 and some states do not have adult foster care.
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.
