How to Transfer Your Autism Medicaid Waiver to Another State

For families relying on Home and Community-Based Services (HCBS) Medicaid Waivers for their autistic child's care, the prospect of moving to a new state is terrifying.

HCBS Waivers fund critical lifelines: respite care, in-home nursing, day programs, and group home placements. Unfortunately, due to how the Medicaid system is structured in the United States, waivers are not portable.

The Harsh Reality: Starting Over

Medicaid is a joint federal-state program. While the federal government provides funding and sets broad guidelines, each state designs and runs its own waiver programs.

Because waivers are not entitlements, states are allowed to cap the number of people who receive them. This results in waitlists. If you move from a state where you currently hold a waiver (like New York) to a new state (like Texas), you cannot bring your waiver with you.

When you establish residency in the new state, you must apply to their specific waiver program. In almost all cases, you will be placed at the absolute bottom of the waitlist—a waitlist that in some states is over 15 years long.

The Danger of "Testing the Waters"

If you leave your current state to try living somewhere else, you will lose your active waiver in your home state. If you decide to move back, you will not get your old spot back; you will go to the bottom of the waitlist in your home state.

Warning

Exceptions and Strategies

There are very few ways around this systemic issue, but families should be aware of a few nuances:

1. Entitlement States: A few states (most notably California, through the Lanterman Act) do not have waitlists for developmental disability services. If you move to California and establish residency, you are legally entitled to services through the Regional Center system, bypassing the traditional waiver waitlist problem.
2. Military Families: The federal government provides some protections and specific programs (like ECHO) for active-duty military families who are forced to move across state lines due to PCS orders, though gaps in care still frequently occur.
3. Crisis Exceptions: Some states have "crisis" or "emergency" waiver slots for individuals in immediate danger of institutionalization or homelessness. However, proving a crisis is incredibly difficult and usually requires severe behavioral or medical emergencies.

If your family relies on an HCBS waiver, you must treat your current state residency as a highly valuable asset. Moving should only be considered if the new state is an entitlement state or if you can afford to pay out-of-pocket for services for several years while waiting on a new list.