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Clients frequently ask us: If I have Medicaid from another state, will I be covered in a Florida hospital? Or, conversely, will my Florida Medicaid cover me if I am injured in another state? Medicaid is a federal program, so it stands to reason that it would apply across state lines. Unfortunately, the answer is more complex. Below, we discuss how out-of-state Medicaid is treated in Florida healthcare facilities. Call an experienced West Palm Beach Medicaid and asset protection attorney with any questions or for help obtaining medical coverage in Florida.
Part of the confusion surrounding Medicaid coverage is the federal nature of the program. While Medicaid is funded by the federal government, the program operates as a joint partnership with the states. Each state is responsible for setting its own Medicaid guidelines, including eligibility, covered services, service waivers, and other factors. As a result, possessing Medicaid through one state in no way guarantees that you will be covered when traveling to another state.
Instead, each state sets its own rules about when out-of-state services will be covered. It will be up to the state that provides your Medicaid to determine what services will be covered out of state and under what circumstances. For example, if you are a Florida resident covered by Florida Medicaid, you can obtain coverage for an out-of-state medical visit so long as you obtain a referral from your Florida physician. The out-of-state provider, in turn, must be willing to accept Florida Medicaid payment. You might also need to obtain prior authorization before the treatment.
There’s an important exception to the general rule: If a person has Medicaid from another state but becomes seriously ill or injured in Florida, the Florida hospital must agree to treat the patient. The federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires any hospital with an emergency department to stabilize and treat any patient who arrives with an emergency medical condition, regardless of the patient’s insurance status or ability to pay. The purpose of EMTALA is to prevent hospitals from “dumping” patients with no insurance or with Medicaid onto public hospitals without at the very least ensuring that they are stable enough to transfer. Hospitals that refuse treatment are subject to severe fines.
Although you can obtain emergency medical treatment in Florida, you might still wind up on the hook for the bill. It depends on the Medicaid rules in your home state. Florida, for example, will cover the costs of emergency visits out of state so long as (a) the injury or illness occurred out of state, and (b) the recipient’s health would be endangered if their healthcare was delayed until the patient returns to Florida.
A skilled West Palm Beach long-term care planning attorney can help you and your family plan appropriately to maximize your chances to qualify for Medicaid and other needs-based governmental programs without going broke in the process. If you are in need of a professional and talented Florida Medicare planning and elder law attorney, contact the experienced and effective West Palm Beach trust and estates attorneys Shalloway & Shalloway at 561-686-6200.