Can I Use Washington Medicaid Out Of State

Paul Gonzalez
• Friday, 04 December, 2020
• 7 min read

Technically, there’s no formal program or option that allows you to transfer your Medicaid coverage from one state to another. The good news is that you’re allowed to apply for Medicaid in your new state immediately after relocating, and doing so can help you avoid a lapse in benefits.

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(Source: source.wustl.edu)


It generally takes anywhere from 15 to 90 days to receive a letter of approval once you apply for Medicaid, and you can usually submit your application online. However, you may be forced to pay for healthcare services out of pocket until that retroactive coverage kicks in and renders you eligible for reimbursement.

To this end, make sure to retain copies of all medical receipts for services received during your coverage gap. Level of care requirements, on the other hand, are more open to interpretation, so while you may qualify for Medicaid based on medical need in one state, that won’t necessarily hold true in another.

That said, sometimes, pre-approved treatment at an out -of- state facility is covered by Medicaid, but only when proper authorization is obtained. Again, you must make sure Medicaid will cover such care before pursuing it, or you risk getting stuck with the associated bills.

Marie Beckman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.

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.

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(Source: www.chcs.org)

Further complicating matters is the fact that someone cannot be eligible for Medicaid in two states at the same time. Therefore, most senior readers should not be alarmed by a potential coverage gap.

For example, in February 2019, Florida eliminated 3-month retroactive coverage for all adults except for pregnant women. Having given these warnings, it should be mentioned that while this process of transferring Medicaid coverage is difficult, it is not impossible.

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 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. Therefore, it is strongly suggested that the Medicaid level of care requirement be thoroughly researched in both states prior to beginning the process.

(Source: www.commonwealthfund.org)

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.

Therefore, applicants should find affordable care in their new state of residence before making the move. 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.

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. Individuals on Medicaid Waivers need to think very carefully about making a move from one state to another.

However, within those parameters, each of the fifty states operates their Medicaid program differently. In addition, an individual cannot receive Medicaid benefits simultaneously in two states.

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 vary between states, generally there is not a big difference between income and asset limits.

(Source: isu.edu)

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 in that state.

For long-term care, there is also a functional (medical) requirement in order to receive Medicaid benefits. For most states, one must 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.

Prior to moving, call the local Medicaid office in the area in which one is relocating for information. One can also view state by state Medicaid financial eligibility criteria here.

Do this prior to canceling one’s Medicaid benefits in one’s current state of residence. 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.

(Source: isu.edu)

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. On a good note, the Medicaid application process generally does not take long.

The process of canceling Medicaid in one state and reapplying in another state can be complicated, but it is definitely not impossible. That said, it is advisable one speak with a Medicaid planning professional to ensure the transition goes as smoothly as possible.

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 most likely require nursing home placement. Unlike state Medicaid plans, Medicaid waivers are not entitlement programs.

Those currently receiving services from a Medicaid waiver must proceed with caution. A Warning for Medicaid Beneficiaries Traveling Out of Stateless to affordable health care through the Medicaid program is one of the great benefits afforded to most recipients of Supplemental Security Income (SSI).

However, many Medicaid recipients don't realize that their health insurance coverage may not provide a full set of benefits should they require care while out of state. In these situations, a caregiver or other family member is often required to sign an agreement to pay for the services before the person with special needs can receive care.

(Source: isu.edu)

Investing the time now could save you thousands of dollars in medical bills down the road. Residency depends on a person's intent or purpose in coming to Washington state at the time of application and renewal.

A person is not considered a resident of Washington if he or she enters the state only for medical care. Person just moved to Washington without a job commitment and is not looking for work, but does not intend to stay.

When questionable, one way in which tourist/visitor visa holders may show they intend to reside in Washington is to apply for adjustment with the United States Citizenship and Immigration Services/Department of Homeland Security (USCIS). However, they must demonstrate intent to continue to reside in Washington after purpose for leaving the state is completed.

Intent can be shown by a current lease agreement or utility bill. Apple Health eligibility continues for a Washington resident who is absent temporarily and will return.

She is planning to return to live with her parents when the job ends, which may be in about 3 to 6 months. She is still a resident of WashingtonState because she plans to return to Washington after her temporary job ends.

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(Source: www.nap.edu)

However, if the other state refuses to provide medical services in Washington, then the person can be approved for Apple Health. The person needs to contact the Social Security Administration at 1-800-772-1213 to change their address.

The child moves out of the parents' house and in with a friend and applies for Apple Health. The parents intend to return to their home country when they finish with school, but the child says that she is staying.

The family will be here for a minimum of six months and could possibly be longer depending on the progress the child makes from the treatment. Since the family entered the state for medical care, and they plan to return home, they are not considered residents.

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