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 then last December, just weeks before his critical procedure, she learned that Shae’s Medicaid coverage through Florida’s Department of Children and Families (DCF) had ended on November 30.

The reason? Shae had been receiving specialized treatment at the 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 needed to apply for Medicaid in Pennsylvania, even though she and her husband remained Florida residents.

“They’re just leaving me stuck, and I can’t be stuck because my son’s life is depending on it, (1)” Mendez told the news station.

What happened to Shae wasn’t a rare clerical error, but 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 through the health insurance market or an employer plan, you typically qualify for a special enrollment period to select a new plan (6). While you’ll still need a new policy in your new state, the process is more straightforward and coverage can often begin quickly.

However, with Medicaid, there’s no transfer option as each state administers its own program with unique rules. As HealthInsurance.org explains, “because each state has its own Medicaid eligibility requirements, you can’t just transfer coverage from one state to another, nor can you use your Medicaid coverage when you’re temporarily visiting another state, unless you need emergency health care (3).”

That being said, states are required to provide Medicaid to their residents, including those temporarily absent under certain circumstances. And Medicaid allows for states to establish interstate agreements to prevent low-income children who rely on the program from losing coverage or experiencing gaps in the continuity of their care. That coordination may be necessary especially in situations where children would otherwise lose their coverage due to family migration as a result of natural disasters, emergency evacuations, educational needs, public health emergencies or other similar circumstances (2).

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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.

That assumption can be dangerous. While Medicaid typically covers pre-approved out-of-state treatment — as Shae’s initially was — prolonged 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 his 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 the Children’s Hospital of Philadelphia for specialized care he couldn’t receive in Florida.

For families seeking medical care out of state, the challenge is determining when a “temporary absence” becomes a change in residency. States have flexibility in defining these terms, and the rules aren’t always clear or consistently applied.

After Mendez contacted Florida Congresswoman Kat Cammack and WFTV Action 9, Shae’s coverage was reinstated, keeping his transplant on schedule. However, DCF hasn’t publicly explained why coverage was initially cut or subsequently restored.

Parents planning to move between states, or seeking medical care requiring extended out-of-state stays, should understand several critical points:

Medicaid doesn’t transfer automatically. 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. It’s not legally permissible to have Medicaid coverage in two states simultaneously. If you attempt to maintain benefits in multiple states, you risk termination of coverage and potential repayment obligations.

Residency rules vary by state. According to federal regulations cited by Medicaid, an individual is considered a resident if they’re living in a state with the intention to remain or if they entered with a job commitment. For children, residency is typically where the child lives or where their parent resides (2).

Pre-approved out-of-state care should be documented. When seeking medical treatment in another state, ensure you have written authorization from your current state’s Medicaid program confirming that care will be covered. Keep copies of all communications.

Moving requires immediate action. If you’re relocating permanently, contact both your current state’s Medicaid office to report the move and your new state’s office to begin the application process immediately. Don’t assume there will be seamless coverage during the transition.

Retroactive coverage may be available. According to official Medicaid policy, benefits may be covered retroactively for 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. It is provided without warranty of any kind.