Meghann Mendez of Ocala, Fla., thought everything was in place for her 14-month-old son Shae’s surgery scheduled for early January. But then last December, just weeks before his critical procedure, she learned that Shae’s Medicaid coverage through the Florida Department of Children and Families (DCF) ended on November 30.
The reason? Shae has been receiving specialty treatment at Children’s Hospital of Philadelphia since May 2025. According to Mendez, DCF informed her that her son had been out of Florida “too long.” As WFTV Action 9 reports, she was told she had to apply for Medicaid in Pennsylvania, even though she and her husband remained Florida residents.
“It just leaves me stranded and I can’t be stranded because my son’s life depends on it,” Mendez told the news station.
What happened to Shae wasn’t a rare clerical error, but it highlights a rule that catches many families off guard: Medicaid eligibility is tied to state residency. Which means coverage doesn’t always automatically follow families when they cross state lines, even temporarily for medical care.
This differs fundamentally from private health insurance. When you move with private insurance in the health insurance marketplace or through an employer plan, you usually qualify for a special enrollment period to select a new plan (6). Although you will need a new policy in your new state, the process is simpler and coverage can often begin quickly.
However, with Medicaid, there is no transfer option because each state administers its own program with unique rules. As HealthInsurance.org explains, “because each state has its own Medicaid eligibility requirements, you cannot simply transfer coverage from one state to another, nor can you use your Medicaid coverage when you are temporarily visiting another state, unless you need emergency medical care (3).”
That said, states are required to provide Medicaid to their residents, including those who are temporarily absent under certain circumstances. And Medicaid allows states to establish interstate agreements to prevent low-income children who rely on the program from losing coverage or experiencing gaps in their continuity of care. This coordination may be especially necessary in situations where children would otherwise lose coverage due to family migration due to natural disasters, emergency evacuations, educational needs, public health emergencies, or other similar circumstances (2).
More than 77.9 million Americans rely on Medicaid and the Children’s Health Insurance Program for health coverage (4). Many parents assume that if their child has Medicaid, coverage will follow them wherever they need to go for care.
This assumption can be dangerous. While Medicaid typically covers pre-approved out-of-state treatment — as Shae initially did — extended absences from your home state can trigger residency questions that jeopardize coverage.
The consequences can be devastating. Shae was born with a FOXP3 mutation, which her mother described as a “one in a million” genetic syndrome that causes a severe, life-threatening autoimmune disorder.
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After unsuccessful treatments at Nemours Children’s Hospital in Orlando, specialists found him a bed at Children’s Hospital of Philadelphia for specialized care he could not receive in Florida.
For families seeking health care out of state, the challenge is determining when a “temporary absence” becomes a change of residency. States have flexibility in defining these terms, and the rules are not always clear or applied consistently.
After Mendez contacted Florida Congresswoman Kat Cammack and WFTV Action 9, Shae’s coverage was resumed, keeping her transplant on the schedule. However, DCF has not publicly explained why coverage was initially cut or later reinstated.
Parents planning to move interstate or seeking medical care that requires extended out-of-state stays should understand a few critical points:
Medicaid does not automatically transfer. You must close coverage in your old state and reapply in your new state as a new applicant, according to Medicaid Planning Assistance (5). Each state has different income limits, asset limits, and coverage rules.
You can’t have Medicaid in two states. You are not legally allowed to have Medicaid coverage in two states at the same time. If you try to maintain benefits in multiple states, you risk voiding coverage and potential reimbursement obligations.
Residency rules vary by state. According to federal regulations cited by Medicaid, a person is considered a resident if they live in a state with the intention of remaining or if they entered with a commitment to work. For children, residence is usually where the child lives or where their parent lives (2).
Pre-approved out-of-state care should be documented. When seeking medical treatment in another state, make sure you have written authorization from your current state’s Medicaid program that the care will be covered. Keep copies of all communications.
The move requires immediate action. If you’re moving permanently, contact both your current state’s Medicaid office to report the move and the new state’s office to start the application process right away. Don’t assume there will be perfect coverage during the transition.
Retroactive coverage may be available. According to official Medicaid policy, benefits may be covered retroactively up to three months prior to the month of application if the individual would have been eligible during that period (4). However, not all states offer this option.
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(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 construed as advice. Offered without warranty of any kind.
