Meghann Mendez of Ocala, Florida, thought everything was in place for her 14-month-old son Shae’s potentially life-saving surgery scheduled for early January. But last December, just weeks before Shea underwent critical surgery, she learned that his Medicaid benefits through the Florida Department of Children and Families (DCF) had ended on November 30.
What’s the reason? Since May 2025, Shay has been receiving specialized treatment at the Children’s Hospital of Philadelphia. Mendez said DCF told her her son had been away from Florida “for too long.” Although she and her husband are still Florida residents, she was told she needed to apply for Medicaid in Pennsylvania, WFTV Action 9 reported.
“They’re just putting me in trouble, but I can’t put myself in trouble because my son’s life depends on it,(1)” Mendez told the news station.
What happened to Shae was not an uncommon clerical error, but it highlights a rule that has caught many families off guard: Medicaid eligibility is tied to state residency. That means when families cross state lines, insurance doesn’t always automatically follow them, even for temporary medical care.
This is fundamentally different from private health insurance. When you purchase private insurance through the health insurance marketplace or an employer plan, you often qualify for a special enrollment period to choose a new plan (6). While you’ll still need a new policy in your new state, the process is simpler and coverage can often start quickly.
However, with Medicaid, there is no transfer option because each state governs its own program with unique rules. As HealthInsurance.org explains, “Because each state has its own Medicaid eligibility requirements, you cannot transfer coverage from one state to another or use your Medicaid coverage during a temporary visit to another state unless you need emergency medical care(3).”
That being said, states are required to provide Medicaid to their residents, including those who are temporarily absent under certain circumstances. Medicaid allows states to establish interstate agreements to prevent low-income children who rely on the program from losing coverage or experiencing gaps in continuity of care. Such coordination may be necessary, particularly if a child loses coverage due to family emigration due to a natural disaster, emergency evacuation, educational needs, public health emergency, or other similar circumstances (2).
More than 77.9 million Americans rely on Medicaid and the Children’s Health Insurance Program for health insurance (4). Many parents believe that if their child has Medicaid, the insurance will follow them no matter where they need to seek care.
This assumption can be dangerous. While Medicaid typically covers pre-approved out-of-state treatment (as was Shea’s original situation), being away from home for an extended period of time can raise residency issues that jeopardize coverage.
The consequences can be devastating. Shae was born with a FOXP3 mutation, which his mother describes as a “one in a million” genetic syndrome that causes severe, life-threatening autoimmune disease.
Read more: The average American net worth is a surprising $620,654. But that makes almost no sense. Here are the numbers that matter (and how to make them soar)
After treatment failed at Nemours Children’s Hospital in Orlando, experts found him a bed at Children’s Hospital of Philadelphia to receive specialized care he couldn’t get in Florida.
For families seeking medical care out of state, the challenge is determining when “temporary absence” becomes a change of residence. States have flexibility in defining these terms, and the rules are not always clear or consistently applied.
Shae’s coverage was restored after Mendez contacted Florida Congresswoman Kat Cammack and WFTV Action 9, keeping his transplant on schedule. However, DCF has not publicly explained why it initially cut coverage or subsequently restored it.
Parents planning to move between states or seeking medical care that requires an extended stay out of state should know several key points:
Medicaid does not transfer automatically. Under Medicaid Planning Assistance (5), you must close coverage in your original state and reapply as a new applicant in the new state. Each state has different income limits, asset limits and insurance coverage rules.
You can’t have Medicaid in two states. The law does not allow for Medicaid coverage in two states at the same time. If you try to maintain benefits in multiple states, you run the risk of coverage termination and potential repayment obligations.
Residency rules vary by state. Under federal regulations cited by Medicaid, an individual is considered a resident if the person lives in a state with the intention of staying or if they enter the state with a job commitment. For children, the place of residence is usually the place of residence of the child or his or her parents (2).
Pre-approved out-of-state care should be documented. When seeking care in another state, make sure you have written authorization from your current state’s Medicaid program confirming that the care will be covered. Keep copies of all communications.
Moving requires immediate action. If you are moving permanently, contact your current state’s Medicaid office to report the move and contact the office in your new state to begin the application process immediately. Don’t assume there will be seamless coverage during the transition.
Retroactive coverage may be available. Under official Medicaid policy, benefits are retroactive to the three months prior to the month of application if the individual was eligible during that period(4). However, not all states offer this option.
Join more than 200,000 readers and get first access to Moneywise’s best stories and exclusive interviews – curated and delivered with clear insights every week. Subscribe now.
We rely only on vetted sources and reliable third-party reports. For more information, see our Editorial Ethics and Guidelines.
(1) WFTV Action 9, (2, 4) Medicaid.gov, (3, 6) HealthInsurance.org, (5) Medicaid Planning Assistance
This article provides information only and should not be considered advice. It is provided without any warranty of any kind.
