Moving out of state and maintaining Medicaid coverage is a burden. That’s because Medicaid beneficiaries can not transfer their coverage from state to state, and they can’t be covered in two states at once. Instead, they have to re-apply after moving to their new state of residence. There is no waiting period to re-apply, but the process still comes with its own difficulties. First and foremost, Medicaid’s eligibility requirements can vary by state, so a senior can be eligible in one state but ineligible in another. Maybe their monthly income met the eligibility limit in their old state, but their new state has a lower income limit. Or their new state of residence could have a different method of counting assets that pushes the senior over their asset limit. And the challenges will only multiply if the Medicaid beneficiary owned a home in their old state and sold it before moving.
Not only can Medicaid’s financial eligibility criteria change depending on the state, the medical criteria can also vary. Most Medicaid long-term care programs require applicants to need a Nursing Facility Level of Care (NFLOC), which means the kind of constant care and supervision associated with nursing homes. But how a NFLOC is defined and measured can change from state to state. Needing help with two of the five Activities of Daily Living (mobility, bathing, dressing, eating, toileting) might constitute a NFLOC in one state, while another state might define a NFLOC as needing help with three of the five activities. Most states will perform an in-person evaluation to determine a NFLOC, but how they perform it can change, and some states may put more weight on caregivers’ assessments than in-person evaluations.
What Medicaid covers in nursing homes is consistent across states, but that’s not true when it comes to in-home care. Most Medicaid beneficiaries who need a NFLOC but live at home will be covered via a Home and Community Bases Services (HCBS) Waivers. These HCBS Waivers have different names and benefits in every state. The number of enrollment spots can also vary depending on the HCBS Waiver, and some of them have waitlists. So, a senior who is new to the state and re-applying for Medicaid may have to wait for the in-home benefits they were receiving via a HCBS Waiver in their previous state of residence.
Our team of professionals at Eldercare Resource Planning is uniquely qualified to help relocating seniors make a smooth transition with their Medicaid coverage. That’s because we have a comprehensive knowledge of Medicaid’s rules, eligibility requirements and benefits across all 50 states and the District of Columbia. We know which HCBS Waivers have waitlists and how long they might be. We are experts when it comes to Medicaid applications, so we can streamline the process for our clients and make sure they start receiving benefits as soon as possible in their new state.
Our Benefits Consultation can help you decide if moving out of state is the best option, what it will require and how long it might take. If you do decide to move, our team can help you navigate the transition in order to minimize any lapses in coverage and out-of-pocket expenses.