How Does Out of State Medicaid Work?

Christian Worstell
In this article...
  • Out of state Medicaid may be available in special circumstances. Find out more about out of state Medicaid options and learn how to find the Medicaid benefits available in your state and when you travel.

More than 84 million Americans relied on Medicaid for some or all of their health benefits as of November 2023. Medicaid is jointly funded by the federal government and individual states, but it's administered at the state level on behalf of people with limited income. 

What can you do if you're enrolled in Medicaid in one state, but require care in another state? Is there such a thing as out of state Medicaid? Find out more below.

Can I Use My Medicaid Coverage Out of State?

Generally, the answer is no — you can't use Medicaid out of state because each state has its own Medicaid eligibility requirements, coverage can't be transferred from one state to another, nor is coverage provided by one state available while you’re temporarily visiting another state.

Can I transfer Medicaid to another State

If, for example, you move from New Hampshire to Massachusetts, you can't transfer Medicaid coverage. Instead of transferring you have to apply for Medicaid in the state you move to, which in this case is Massachusetts.

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Talk to a licensed agent today to find a plan that fits your needs.

How Medicaid Coverage Works When You Move

You should reapply for Medicaid benefits as soon as you can to avoid a lapse in benefits coverage when you relocate across state lines. While the application process varies by state, you can usually apply online. In most cases, you'll receive a letter of approval (or denial with instructions to appeal) within 15 to 90 days.

Another thing to keep in mind is you can't get Medicaid benefits in two states at the same time. Instead, you have to terminate your old Medicaid coverage in one state and reapply for benefits in your new home state.

Retroactive Coverage

Helpfully, many states offer retroactive Medicaid coverage, which pays for eligible health services you got up to three months prior to the date of your application's approval. 

If you need medical care before your application is approved, you may have to cover the costs out of pocket, and then later request reimbursement. It's helpful to keep copies of all your medical bills and treatment records for the care you get before your benefits are approved.

Traveling Out of State With Medicaid

If you travel outside of your home state and get sick, Medicaid generally doesn’t cover the cost of services you get on your trip. Generally, the care you get must be provided to you in your home state to be eligible for Medicaid coverage.

One major reason for this limitation is the way providers bill Medicaid. As a rule, a medical provider in one state will only be authorized to bill that state’s Medicaid. Thus, an outpatient clinic you visit in Kansas probably can’t collect payment from Medicaid in Texas.

There is one major exception to this rule: out of state Medicaid coverage may be used if you have a life-threatening emergency. This must be an emergency that requires immediate medical care, and there isn’t time for you to return home to receive care from your regular provider.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Other Exceptions

Medicaid sometimes covers non-emergency treatment from an out of state facility, but only when proper authorization is obtained beforehand. This works on a case-by-case basis, though, so check with your Medicaid representative to see if your situation qualifies.

Medicaid coverage might also kick in if you happen to receive medical care at a facility located just across the border from your state. This is most likely to be approved when the out of state location is your regular care provider, and in-state facilities are inconveniently far away from your home address.

Always check with your local Medicaid office to make sure it covers such treatment out of state before seeking non-emergency care across the border. Otherwise, you may be responsible for the medical bills yourself.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@MyHelpAdvisor.com.

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