Megan Mendez from Ocala, Florida, was preparing for her 14-month-old son, Shay, to have a crucial surgery in January. However, just weeks before the procedure, she discovered that Shay’s Medicaid coverage through the Florida Department of Children and Families (DCF) had expired on November 30th.
The reason for this abrupt loss of coverage was that Shay had been receiving specialized care at Children’s Hospital of Philadelphia since May 2025. Mendez reported that DCF informed her that her son had been out of Florida for “too long.” According to WFTV Action 9, she was instructed to apply for Medicaid in Pennsylvania, despite the fact that she and her husband are still residents of Florida.
“They’re just keeping me stuck. I can’t stay stuck because my son’s life is at stake,” Mendez expressed to the news station.
What happened to Shay highlights a less-familiar rule that can leave many families in a tough spot. Medicaid eligibility is linked to state residency, which means that crossing state lines, even for a short time, can complicate or jeopardize coverage.
This contrasts sharply with private health insurance. Generally, when you switch to private insurance through the Health Insurance Marketplace or an employer, you usually have a special enrollment period to select a new plan. While new states will necessitate new insurance, it’s often a smoother process, allowing coverage to begin more quickly.
In contrast, Medicaid doesn’t allow for an easy transition because each state runs its own program with unique regulations. Per health insurance sources, “Because each state has its own Medicaid eligibility requirements, you cannot transfer your insurance from one state to another, and you cannot use your Medicaid insurance to temporarily visit another state unless you need emergency medical care.”
States are, however, mandated to provide Medicaid coverage to their residents, including those who are temporarily absent, under specific conditions. Medicaid allows for interstate agreements to ensure low-income children who rely on the program don’t lose coverage or face gaps in care continuity. This is particularly important in instances where children might lose insurance due to family relocations related to natural disasters or other urgent circumstances.
Over 77.9 million Americans depend on Medicaid and the Children’s Health Insurance Program for their healthcare needs. Many parents might assume that if their child is covered by Medicaid, that coverage will apply no matter where care is given.
This assumption can carry serious risks. Although Medicaid often covers pre-approved treatments out of state, an extended absence can raise residency issues and jeopardize coverage, as seen in Shay’s case.
The stakes are high: Shay was born with the FOXP3 mutation, a rare genetic syndrome leading to a severe and potentially fatal autoimmune disorder.
After the treatment at Nemours Children’s Hospital in Orlando didn’t succeed, Mendez was able to find a place for Shay at Children’s Hospital of Philadelphia, where specialized care was available that Florida could not provide.
For families needing medical care out of state, defining what constitutes a “temporary absence” versus a change of residence can be confusing. Each state can interpret these terms differently, and the rules might not always be clear or consistently applied.
Following Mendez’s outreach to Representative Kat Cammack and WFTV Action 9, Shay’s coverage was reinstated, allowing the transplant to proceed as planned. However, DCF has yet to clarify why there was a reduction in coverage initially.
For parents thinking about moving to another state or seeking healthcare that requires being out of state for a while, it’s crucial to keep a few points in mind.
Medicaid does not automatically transfer. When moving, you need to end your coverage in your previous state and reapply in your new state, which can have different rules and requirements.
You cannot have Medicaid in two states. It’s illegal to receive Medicaid benefits in both states simultaneously. Trying to maintain benefits across states can lead to losing coverage altogether.
Residency rules differ by state. According to federal guidelines, individuals are deemed residents if they plan to stay in a state or come there under the promise of employment. For children, this typically means residing where their parents do.
Out-of-state care must be pre-approved. If you need treatment in another state, obtain written authorization to ensure coverage under your current Medicaid program, and keep records of all communications.
Moving demands quick action. If you are permanently relocating, you should promptly notify your current Medicaid office about the move and reach out to the new state’s office to start the application process. Don’t expect a seamless transition.
Retroactive coverage might be an option. Medicaid policies allow for some benefits to be retroactively covered up to three months before the application, provided the individual was eligible during that time, although not all states have this policy.
