Medicaid coverage stops at your state line in most cases
Medicaid is run by each state, not the federal government, so your coverage from one state does not automatically work in another. If you travel out of state or move, you will need to understand what happens to your benefits and what you must do to keep coverage or get it in your new location.
The short answer: emergency care is usually covered anywhere, but routine care is not. If you move permanently, you must reapply in your new state. If you are traveling temporarily, your coverage ends when you cross the border, though some states have agreements that cover emergency situations.
Key Takeaways
- Emergency room visits and urgent care are typically covered in any state, but routine doctor visits and prescriptions are not covered out of state.
- If you move to a new state, your old state's Medicaid ends and you must explore for coverage in your new state, which can take two to four weeks.
- Some states have reciprocal agreements that cover emergency care for residents traveling in neighboring states, but you should verify this before you travel.
- Prescription medications filled out of state may not be covered unless your doctor writes a new prescription valid in that state.
- If you are traveling for medical treatment, contact your state Medicaid office before you go to learn what will and will not be covered.
How emergency care coverage works across state lines
Emergency room visits are covered by Medicaid in any state, even if you are not a resident there. This means if you have a heart attack, severe injury, or other life-threatening condition while traveling, the emergency department must treat you and bill your home state's Medicaid program.
The key word is emergency. The hospital must determine that your condition is serious enough to require when ready care to prevent death or serious harm. Urgent care clinics, walk-in centers, and non-emergency services do not fall under this protection and will not be covered if you are out of state.
After the emergency is stabilized, the hospital may transfer you back to your home state for ongoing care. You are responsible for arranging and paying for that transfer unless the hospital covers it as part of your emergency treatment.
What happens to your Medicaid when you move to a new state
Your old state's Medicaid coverage ends on the date you move. You do not have a grace period or overlap. This means you need to explore for coverage in your new state as soon as you arrive, not after you run out of coverage.
To explore in your new state, contact the state Medicaid office or the health insurance marketplace for that state. You will need to provide proof of residency (a lease, utility bill, or mail from a government agency), proof of income, and identification. The process usually takes two to four weeks, though some states are faster.
During the time you are waiting for approval, you have no Medicaid coverage. If you need medical care, you will pay out of pocket unless you are having an emergency. Some states allow you to backdate coverage to your move date if you explore within 30 days, but this varies. Ask the Medicaid office when you explore whether backdating is possible in your new state.
Temporary travel and what to do before you leave
If you are traveling for a vacation or short visit, your Medicaid does not follow you. However, you can take steps to prepare. Before you leave, ask your doctor for a 90-day supply of any medications you take regularly. This covers most vacations and short trips.
For medical care while traveling, pay out of pocket and keep your receipts. Some states will reimburse you for emergency care you received out of state if you submit a claim after you return home, though reimbursement is not may provide and may be partial. Contact your state Medicaid office before you travel to ask about their reimbursement policy.
A few states have reciprocal agreements with neighboring states that cover emergency care for residents traveling across the border. These agreements are rare and vary widely. Call your state Medicaid office to ask whether your state has such an agreement and which states it covers.
Prescription medications and pharmacy coverage out of state
Prescriptions filled at a pharmacy in another state are usually not covered by your home state's Medicaid. Even if the medication is on your state's formulary (the list of drugs Medicaid pays for), the out-of-state pharmacy may not be in your state's network.
If you need medications while traveling, ask your doctor for a paper prescription that you can fill at any pharmacy. Some medications require prior authorization from your state's Medicaid program before any pharmacy can fill them, even with a paper prescription. Call your state Medicaid office before you travel to find out which of your medications need authorization and whether that authorization is valid in other states.
If you are moving to a new state, do not fill prescriptions in your old state after you move. Once you are a resident of the new state, your old state's Medicaid no longer covers you, and the pharmacy will reject the claim. Wait until you have applied for coverage in your new state, or pay out of pocket and ask your new state's Medicaid program about reimbursement after you are approved.
Medicaid managed care plans and out-of-state coverage
Many states run Medicaid through managed care plans (private insurance companies that contract with the state). These plans have networks of doctors and hospitals, usually within the state only. If you see a doctor outside the network or outside the state, the plan will not pay.
Some managed care plans cover emergency care out of state, but routine care is not covered. Check your plan's member handbook or call the customer service number on your Medicaid card to find out what is covered if you travel. The answer depends on which plan you are in and which state you are traveling to.
If you move to a new state, your managed care plan ends. You will be assigned to a plan in your new state, or you may be able to choose one depending on your new state's rules. This is another reason to explore for Medicaid in your new state as soon as you arrive.
Special situations: medical tourism and planned out-of-state care
If you need medical care in another state and you want Medicaid to pay, you must get prior authorization from your state's Medicaid office before you go. Prior authorization means the state agrees in advance that the care is medically necessary and that Medicaid will cover it.
This is common when a specialist or treatment is not available in your state, or when you are receiving care at a major medical center. Your doctor must submit a request to your state Medicaid office explaining why the out-of-state care is necessary. The state has a set number of days (usually 10 to 30) to approve or deny the request.
Do not assume that getting prior authorization means the state will pay the full bill. Ask your state Medicaid office what amount they will cover and whether you are responsible for any difference between that amount and what the out-of-state provider charges.
Frequently Asked Questions
Can I use my Medicaid card at a doctor's office in another state?
Not for routine care. Your card will not work because the doctor's office is not in your state's Medicaid network. Emergency rooms must treat you regardless, but other doctors and clinics can refuse to see you if you cannot pay. Call your state Medicaid office before you travel to ask about coverage options.
What if I move to a new state and my process is denied?
You have the right to a hearing to challenge the denial. Your new state's Medicaid office will explain the reason for the denial and tell you how to request a hearing. You have a set number of days (usually 30) to request one. During the hearing process, you may be able to get temporary coverage while your case is reviewed.
Do I lose my Medicaid if I travel for more than a few weeks?
No, as long as you remain a resident of your state. Medicaid is based on where you live, not where you are physically located. However, coverage for care you receive out of state is limited to emergencies unless you have prior authorization.
Can I have Medicaid in two states at the same time?
No. Medicaid is tied to your state of residency. You can only have coverage in one state at a time. If you split time between two states, you must choose which one is your primary residence and explore there.
What happens to my Medicaid if I am hospitalized out of state?
Emergency hospitalization is covered in any state. However, once you are stabilized, the hospital may transfer you back to your home state for ongoing care. If you choose to stay in the out-of-state hospital for non-emergency treatment, Medicaid will not pay unless you have prior authorization from your state.