Medicaid is federally required to cover out-of-state medical emergencies for beneficiaries outside their home state. Examples of medical emergencies include life-threatening medical conditions like severe illness, injury, or intense pain that cannot wait until the beneficiary returns home.
However, most routine care and non-life-threatening care is not covered, except in special circumstances. Examples of non-emergency care include mild flu or sprains. Urgent care facilities generally do not accept out-of-state Medicaid, although in some cases they may accept a prior authorization for care at an out-of-state facility.
Some states, like Missouri, allow a person enrolled in the Medicaid program to receive health care services in bordering states. However, the provider must be in-network with Missouri’s Medicaid health insurance for services to be covered.
When a person presents to an emergency room seeking emergency treatment, they should inform the provider(s) of their out-of-state Medicaid plan, so that Medicaid can provide proper reimbursement to the hospital.
In their home state, a person seeking care must ensure their provider is in-network with their state health insurance plan. If not, their medical care may not be Medicaid covered, even if the service provided is approved by Medicaid.
When relocating to a different state, it is important to complete a new Medicaid application in the new state, as your Medicaid coverage will not transfer. It is also important to keep Medicaid eligibility requirements in mind when moving, as states’ Medicaid rules will vary.
Similarly to Medicaid, Medicare covers out-of-state emergencies, but they also cover general medical services for out-of-state care, provided the provider accepts Medicare.