Medicaid State-to-State Transfer Rules

Medicaid eligibility professionals Long IslandMany Medicaid recipients believe that since Medicaid is a federally funded program that their Medicaid coverage and benefits will automatically switch from one state to another. This assumption is inaccurate. While Medicaid is a federal program, it is also a state program. Therefore, each state has its own eligibility requirements which may make it difficult for a recipient to easily switch their Medicaid coverage to a new state.


The first step in switching Medicaid coverage to a new state is knowing that a recipient cannot be enrolled in Medicaid funding in two states at once. Therefore, a recipient must cancel their Medicaid coverage in their old state before applying to Medicaid in their new state. This may cause a lot of uneasiness for Medicaid recipients who need the Medicaid funding to pay for daily medical services, however, Medicaid offers retroactive coverage. For example, Jessica canceled her Medicaid funding in New Jersey on December 29, 2017. She moved to New York where her Medicaid funding was accepted in New York on January 15, 2018. Jessica, unfortunately, needed to have a procedure on January 10, 2018, but couldn’t pay for the health services. Medicaid will pay for those services that Jessica received on January 10, 2018, even though she was not enrolled in Medicaid funding during that time.


Additionally, while a recipient will receive retroactive coverage, they will also be provided coverage by their old state for the month in which the move is reported and the month after. Medicaid coverage will then be established in the new state of residence effective the first day of the second month following the month the move was reported.


While this process may seem complicated, it is not too difficult to become accepted into Medicaid in a different state. In fact, many states have very similar eligibility requirements, making it relatively easy to move state to state. Additionally, the whole process is rather quick. Depending on the state, it will typically take between 15 and 90 days to receive a letter of approval. Furthermore, under federal law, a Medicaid recipient transferring states will not have to meet any residency requirement. For example, it is unlawful for New York to deny Jessica Medicaid funding because she has not lived in New York for a certain amount of time. Residency requirements are illegal to impose.


The main concern of a Medicaid recipient should be the new state’s level of care requirements. Medicaid level of care requirements can vary state to state, as well as the definitions of certain terms. For example, Jessica may have met the requirement for “nursing home level care” in New Jersey, but New York may have a much stricter definition of “nursing home level care.” Therefore, it is important that Jessica understands what level of care she falls under before deciding to move states.


If you or a loved one has the option to move, but you are unsure whether Medicaid will cover you in your new state, speak to an experienced Medicaid professional. The consultants at P&P Medicaid Consulting can help to ensure that your move goes as smoothly as possible while still retaining your Medicaid benefits. Call P&P Medicaid Consulting at (516) 541-4770 to discuss your questions and concerns about your long-term care coverage.

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