How Medicaid Nursing Home Transfers Work in Texas and Arkansas

Key Takeaways:

• Medicaid eligibility does not automatically end when a resident moves to another participating nursing facility in the same state.
• The receiving facility must be able to meet the resident’s needs, participate in Medicaid, and agree to admit the resident.
• The sending and receiving facilities must coordinate records, benefit information, admission documents, and required notices.
• Families should confirm the move with the resident’s Medicaid contact or health plan beforehand to reduce administrative or payment problems.

When Medicaid is already paying for a loved one’s nursing home care, moving to another facility can feel risky. Families may worry that the new nursing home will not accept Medicaid, that coverage will lapse, or that the resident will need to reapply.

A same-state move generally does not require the resident to establish Medicaid eligibility in a different state, but the transfer must be carefully coordinated. Our Texarkana Medicaid Planning Attorney helps families confirm facility participation, address admission requirements, and reduce avoidable Medicaid coverage or payment problems.

Why Families Consider Switching Nursing Homes

The reasons a family might want to move a loved one from one nursing home to another are varied and entirely valid:

• A facility closer to the family's home becomes available, making regular visits more practical.
• Concerns arise about care quality, staffing levels, or a specific incident at the current facility.
• A facility that was not initially Medicaid-certified later receives certification, and the family prefers it.
• A resident's care needs change, and a new facility is better equipped to provide them.

Whatever the reason, the transfer should be coordinated in advance to confirm that the receiving facility can admit the resident and that the facilities, Medicaid program, and any applicable managed-care plan receive the information they need.

Step One: Confirm the Resident's Current Coverage Status

Before scheduling the move, confirm that Medicaid eligibility remains active and determine whether a renewal, appeal, request for information, or other eligibility issue is pending. An unresolved eligibility issue can delay payment to the receiving facility even when the transfer itself is otherwise appropriate.

Step Two: Find a Participating Facility That Will Admit the Resident

Medicaid can pay for nursing home care only when the resident receives services from a facility that participates in the Medicaid program. Even participating facilities may lack available room, be unable to meet a resident’s particular care needs, or not be accepting new Medicaid residents at that time.

A facility’s participation in Medicaid does not guarantee immediate admission. Families should ask whether the facility has space, can meet the resident’s clinical and behavioral needs, and will accept the resident under Medicaid. 

When searching for a new facility:

• Confirm that the facility is licensed, participates in Medicaid, and is authorized to provide Medicaid nursing facility services in Texas or Arkansas.
• Ask the admissions coordinator whether the facility has an available room, can meet the resident’s needs, and will accept the resident under Medicaid.
• Ask for written confirmation of the resident’s acceptance and expected admission date before finalizing the move.

Step Three: Coordinate the Discharge and New Admission

Once the receiving facility has accepted the resident and confirmed an expected admission date, notify the current nursing home of the planned transfer. Review the current facility’s admission agreement for any notice requirements and coordinate the planned discharge date with both facilities. The two facilities should coordinate the timing of the move and the transfer of the resident’s records.

The family should also contact the resident’s Medicaid eligibility worker, managed-care plan, service coordinator, or other assigned contact to confirm what must be reported. 

In Texas

In Texas, the Health and Human Services Commission administers Medicaid nursing-facility benefits. The current facility must report the discharge, and the receiving facility must report the new admission through the state’s Medicaid reporting system.

A resident enrolled in STAR+PLUS should also coordinate with the managed-care organization or service coordinator. Before the move, confirm that the receiving facility participates in Medicaid and, when applicable, works with the resident’s health plan.

In Arkansas

In Arkansas, the facilities should report the move through the procedures required by the Department of Human Services, including applicable admission, transfer, or discharge documentation. They may also need to submit or update medical-need information as part of the transfer process. 

Families should confirm that the receiving facility can admit the resident under Medicaid and ask whether any updated eligibility or medical documentation is required before the move.

Step Four: Coordinate the Care Transfer

A successful move also requires careful coordination of the resident’s medical care. The sending facility should provide the receiving facility with the clinical information needed for a safe transition, including current diagnoses, medications, physician information, advance directives, care instructions, and other relevant records. 

Common oversights that create problems after a transfer include:

• Medication lists or physician orders that are incomplete, outdated, or not reviewed promptly by the receiving facility.
• Specialty care arrangements, including physical therapy, wound care, or behavioral health services, that are not immediately available at the new location.
• Personal belongings and items of sentimental value that are left behind or lost during the move.

What Happens to the Resident’s Monthly Payment Obligation?

Many Medicaid nursing home residents must contribute part of their monthly income toward the cost of care after permitted deductions, such as a personal-needs allowance and any applicable spousal or medical allowances. Moving to another facility generally does not eliminate this obligation. 

Families should confirm the resident’s required monthly contribution, sometimes called patient liability or applied income, and ask where the payment should be directed during the month of the transfer.

What to Do if Medicaid Payment Is Delayed or Denied

If the receiving facility reports that Medicaid payment has been denied, delayed, or assigned incorrectly after the transfer, determine whether the problem involves the resident’s eligibility, the facility’s admission reporting, managed-care authorization, or a billing dispute. A payment or administrative problem does not necessarily mean the resident has lost Medicaid eligibility, but it should be investigated promptly.

If Texas or Arkansas Medicaid issues an adverse eligibility or coverage decision, the resident may have a right to receive written notice and request an appeal or fair hearing. The Medicaid Planning Attorneys at Ross & Shoalmire, P.L.L.C. can help determine whether the problem involves eligibility, managed-care authorization, facility reporting, or billing and identify the appropriate response.

Proactive Medicaid Planning can also address concerns beyond the transfer itself, including preserving assets when permitted under Medicaid rules and preparing for possible Medicaid Estate Recovery.

The Value of Professional Guidance During a Facility Transfer

A nursing home transfer may involve two facilities, medical providers, Medicaid eligibility personnel, and, in Texas, a STAR+PLUS managed-care plan or service coordinator. For families managing a transfer while also caring for a loved one who may have cognitive decline or a serious health condition, the administrative complexity can feel overwhelming.

The Medicaid Planning Attorneys at Ross & Shoalmire, P.L.L.C. work with families across Texas and Arkansas to coordinate nursing home transitions, address Medicaid eligibility concerns, communicate with the appropriate agencies or health plans, and reduce the risk of avoidable coverage and payment problems.