Can Medicaid Benefits be Transferred from State-to-State?
The US federal government establishes parameters for the Medicaid program. Within those parameters, each of the fifty states operates their Medicaid program differently. Therefore, Medicaid eligibility requirements are not consistent across states. Individuals are required to reapply for Medicaid in the state in which they are relocating. In addition, an individual cannot receive Medicaid benefits simultaneously in two states. This means one must close their Medicaid case, and hence their benefits, in their original state before applying for benefits in their new state. Fortunately, when it comes to applying for Medicaid, there are no residency requirements. After relocation, one can immediately apply for Medicaid benefits in their new state.
A common concern is the lapse of benefits between canceling one’s Medicaid plan in their original state and reapplying (and becoming eligible) in the state in which they are relocating. Fortunately, most states allow retroactive Medicaid coverage. This allows up to three months of Medicaid coverage immediately prior to the month of Medicaid application. Once retroactive Medicaid eligibility is established, Medicaid will pay unpaid, qualified medical expenses from this retroactive period.
Variations in State Medicaid Plans
As mentioned above, an individual must reapply for Medicaid benefits in the new state into which they are moving. While eligibility requirements do differ between states, generally there is not a big variance between income and asset limits from state to state. This means that it is likely that those who are financially eligible in one state, will be financially eligible in another state. However, if one does move to a state that is more financially restrictive, it may be necessary to restructure one’s finances to become income and / or asset eligible.
For example, say an elderly person lives in New York, but wants to move to Florida and re-qualify for Medicaid there. In 2021, New York permits a single Medicaid beneficiary to have $15,900 in countable assets, while Florida only allows a beneficiary to have $2,000 for long-term care Medicaid or $5,000 for regular Medicaid. To re-qualify, the candidate would have to “spend down” those additional assets in a Medicaid-acceptable manner.
For long-term care, there is also a functional (medical) requirement in order to receive Medicaid benefits. One must generally require a level of care that is consistent to that which is provided in a nursing home. That said, each state establishes its own definition and criteria as to what constitutes a “nursing home level of care”. A very simplified example might be that one state requires an applicant to need assistance with two activities of daily living, while another state requires assistance with three activities of daily living. If an elderly individual moves to a state that has a higher level of care requirement than the state in which they were residing, they may no longer be functionally eligible for Medicaid.
Due to state variances in Medicaid rules, it is recommended one seek the counsel of a professional Medicaid planner for the best chance of Medicaid acceptance.
How to Relocate and Still Receive Medicaid Benefits
While it can be challenging to relocate from one state to another and get Medicaid coverage in the new state, it can be done.
Do Your Research
Know, in advance, the financial and functional eligibility requirements in the state in which you or your loved one is currently residing and in the state to which one is relocating. Remember, the criteria is not consistent across states, nor is the way a state determines one’s level of care need consistent. Furthermore, retroactive coverage may not be available in all states. Prior to moving, call the local Medicaid office in the area in which one is relocating for information. Please bear in mind, there are many different Medicaid coverage groups and it is vital to enquire about the correct one. Persons can also view state by state Medicaid financial eligibility criteria here.
Have a Functional Assessment Done
It can be extremely helpful to have a functional assessment completed in the state in which one is considering relocating. Do this prior to canceling one’s Medicaid benefits in one’s current state of residence. If one is not functionally eligible in the new state, one may want to reconsider the move or consider relocating to a state with less strict functional requirements.
Seek Assistance from a Professional Medicaid Planner
A professional Medicaid planner can assist in gathering information, restructuring finances (if necessary), and preparing application paperwork for the new state. Medicaid planners are knowledgeable about state Medicaid plans and Medicaid waivers in all 50 states and can prove to be an invaluable resource.
Plan the Move Accordingly
Relocating towards the end of the month may move the Medicaid application process along, as some states won’t close out current coverage until the end of the month. Again, one cannot receive Medicaid coverage in more than one state at the same time. It might be best to cancel coverage in one’s original state at the end of the month, move, and immediately apply for coverage in the new state. Some states, such as Illinois, may require a letter proving cancellation of Medicaid in one’s prior state before opening a new Medicaid case. On a good note, the Medicaid application process generally does not take long. On average, it takes 15 to 90 days for Medicaid eligibility approval.
What about Home and Community Based Services Waivers
For those who are receiving services via a Home and Community Based Services (HCBS) Medicaid waiver, the process of relocating and still receiving the required long-term care benefits is more complicated. Medicaid waivers allow individuals to receive long-term care services in their homes, assisted living residences, adult day care centers, and sometimes, other settings such as adult foster care, and without these services, the individual would require nursing home placement. Unlike state Medicaid plans, Medicaid waivers are not entitlement programs. This means that waivers have a cap on how many participants are able to receive services via any given waiver. Once the allotted slots have been filled, there will be a wait list. Further complicating the transfer of HCBS Medicaid waiver services is the fact that each state has its own Medicaid waivers and the services they provide do not always align. For instance, some states have assisted living waivers, while others do not.
Therefore, one may be receiving services via a Medicaid waiver in one state and there might not be a comparable waiver in the state in which they want to relocate. If there is a comparative waiver, there may be a very long wait list for benefits. Wait lists can be several months to several years.
Those currently receiving services from a Medicaid waiver must proceed with caution. Extensive research should be done to determine if a comparable waiver is available, if there is a waitlist, and if so, how long the waitlist is for benefits. If there is no comparative waiver or the wait time is extensive, one may have to apply for state Medicaid benefits and reside in a nursing home facility until waiver services become available. As with other situations, professional Medicaid planners can be of assistance.