How do I manage insurance and Medicaid while moving Mom from state to state?

Emmarie asked...

I live in California, and my parents live in Florida by the Mayo Clinic. Father, 88, has cancer and end-stage heart failure; mother, 83, has increasing undiagnosed dementia and sits silently in her chair all day, no housework, no bathing or any hygiene. Dad's doctor recommends hospice care, which he's refused. Neither cooks, Dad gives Mom meds as she's mostly listless. I've a sister in NY and another in GA - both are willing to research extensively but can't help parents physically too much now. Both sisters report that Mom seemed OK when they visited in August, but was slipping by Thanksgiving and was shockingly worse by Christmas. My wife (who homeschools our kids) is willing to do in-home care of Mom after Dad dies until Mom no longer can walk.
My Questions: 1. What insurance difficulties might we find in moving Mom from FL (with Mayo Clinic Medigap-type insurance) to CA for in-home care, and then possibly moving her to a nursing home in GA (another out-of-state move)?
2. Is it too hard to change from FL Medicaid to CA Medi-Cal and then to GA Medicaid?
3. Are there long waiting periods without Medigap insurance after moving to another state?

Expert Answer

Mary Koffend is the president of Accountable Aging Care Management (AACM), an eldercare consulting and care management firm that works with elder clients and their families to find the best care providers and services to meet their needs.

Moving seniors from one state to another can be very complex because of health insurance issues. Original Medicare, Part A and B, are the only portable part of the insurance. Medicare Advantage and Medicare Supplement programs are generally for a specific area as contracts are with service providers in that area and/or licensed in a specific service area. Medicaid offers very different services and options in each state. There are open seasons for Medicare Advantage and Supplements with a move if the policies in the prior location are not options in the new location. Because of the complexities involved, a strong and knowledgeable advocate like a geriatric care manager could assist. This website has a list of care managers in each area. Not all are experts in health insurance, but many are and could assist when a move is necessary. A care manager could also be your family's onsite representative and advocate in Florida. Care managers are aware of the variety of resources in an area. If your father is really in need of hospice services, the recommendations and education by a professional third party with no vested interest can be very impactful in his willingness to accept this service. A care manager could advise you and your siblings about the best plan of action for the present for your mom and your dad as well as assist with a plan in the future.