Citizenship and Residency Rules

Along with the financial and medical tests, every Long-Term Care Medicaid applicant must meet two basic, non-financial requirements: they must be a U.S. citizen or an eligible non-citizen, and they must be a resident of the state where they apply. These rules are usually simple for lifelong residents, but they can become complicated when a parent moves to be near family, lives part of the year in another state, or was born abroad. This guide explains both rules, what proof is needed and what changed in federal law in 2026.

Figures change periodically. Double-check current amounts before relying on them.

Citizenship

U.S. citizens and nationals

U.S. citizens and nationals who meet all other rules can get Medicaid. Applicants declare their citizenship on the application, and the state verifies it, usually electronically through Social Security records.

Under federal rules, some groups do not have to provide documents to prove citizenship, because it has already been verified through another federal program. They include people who:

receive SSI;
are entitled to or enrolled in any part of Medicare;
receive Social Security disability benefits.

Because most Long-Term Care Medicaid applicants are on Medicare, extra citizenship paperwork is usually not needed. When it is, a U.S. passport, a birth certificate, a naturalization certificate or a certificate of citizenship are common documents. Identity documents, such as a driver’s license or state ID, may also be required.

Non-citizens

Federal Medicaid rules for non-citizens are more complicated and changed in 2026. Under a 2025 federal law (Public Law 119-21), starting October 1, 2026, federal Medicaid funding is generally available only for non-citizens in these groups:

lawful permanent residents (green card holders);
Cuban and Haitian entrants;
people living in the United States under the Compacts of Free Association (citizens of the Federated States of Micronesia, the Marshall Islands and Palau).

Many lawful permanent residents must also wait five years after obtaining qualified status before they can get full Medicaid, under a 1996 federal law. Some groups are exempt from the five-year wait, such as Cuban and Haitian entrants and Compact of Free Association migrants, and in some cases veterans and active-duty service members and their families. Some states use their own money to cover people who do not qualify for federally funded Medicaid.

Emergency Medicaid, which covers treatment of emergency medical conditions, remains available to people who meet all other rules but not the immigration rules. It does not cover ongoing long-term care.

Because immigration rules are technical and depend on each person’s history, families of non-citizen applicants should get advice from an immigration attorney or a qualified planner before applying.

Will applying affect immigration status?

Families sometimes worry that applying for Medicaid will hurt a relative’s immigration case. Federal “public charge” rules are complex and have changed over time. Long-term institutional care paid by Medicaid has been treated differently from other Medicaid services in some versions of those rules. This is a question for an immigration attorney.

State residency

The basic rule

An applicant must live in the state and intend to stay. There is no minimum length of time. A person who moved to the state last week with the intent to stay can apply there.

Proof of residency usually includes things like:

a lease, deed or mortgage statement;
utility bills;
a driver’s license or state ID;
voter registration;
mail from government agencies at a state address.

For a nursing home resident, the nursing home’s address and admission records usually show residency.

Moving a parent to another state

A common situation is moving a parent into a nursing home or assisted living near an adult child in another state. In general:

once the parent lives in the new state and intends to stay, they become a resident there and should apply there;
they should close out Medicaid in the old state, if they have it, to avoid having coverage in two states;
the new state’s rules apply, including its asset limit, income rules and penalty divisor.

Rules can differ a lot from state to state. A move should be planned with both states’ rules in mind. See the state guides.

When the person cannot state their intent

People with advanced dementia may not be able to say where they intend to live. Federal rules give states special tests for these cases. For an adult who became incapable of stating intent after age 21 and lives in an institution, the state of residence is generally the state where the person is physically present with the intent to remain, as shown by other evidence, or, in some cases, the state that placed them. A guardian’s or family’s decision about where the person will live is often important evidence. A state agency that arranges a placement in another state usually remains responsible.

Snowbirds and second homes

A person who lives part of the year in two states is a resident of the state they consider home. That is usually where they vote, file taxes, register their car and spend most of the year. Applying in one state while keeping strong ties to another can cause problems, so be consistent.

Temporary absences

A person does not lose residency by being temporarily out of state, for example for a hospital stay or to visit family, as long as they intend to return.

Applicants generally must provide a Social Security number or proof of applying for one. Most older adults already have one.

A worked example

Doris, 87, lives in Ohio. Her daughter lives in North Carolina. After a hospital stay, Doris moves into a North Carolina nursing home near her daughter, intending to stay permanently.

Residency: Doris becomes a North Carolina resident when she moves there with the intent to stay. She applies for Medicaid in North Carolina.
Proof: The nursing home admission record, mail at the nursing home address and a statement of intent support her residency.
Old state: Her daughter notifies Ohio of the move, closes Doris’s Ohio coverage effective the date of the move, and asks North Carolina whether coverage can start from the move date.
Rules: The family checks North Carolina’s asset limit and penalty divisor, which differ from Ohio’s.

Common questions

My mother is a green card holder who has lived here 20 years. Can she get Medicaid? Lawful permanent residents generally remain eligible for federally funded Medicaid after October 1, 2026, if they meet all other rules and any waiting period has passed.

My father has a pending immigration case. Can he get Long-Term Care Medicaid? It depends on his status. Many statuses are no longer eligible for federally funded Medicaid after October 1, 2026, though some states cover certain people with state funds. Emergency Medicaid may be available for emergencies.

Can someone keep Medicaid if they move? Medicaid does not transfer between states. The person must apply in the new state, and coverage in the old state should end.

Does a person need a home address to be a resident? No. A nursing home or other facility can be their residence.

What about U.S. citizens living abroad who return? They can apply once they return and live in a state with the intent to stay.

Steps to take

Gather proof of citizenship or immigration status and identity, though Medicare recipients usually will not need citizenship documents.
Gather proof of residency at the current address.
Before an out-of-state move, compare the two states’ rules in the state guides.
For non-citizens, get advice on the 2026 federal changes before applying.
A Certified Medicaid Planner (CMP) can help plan a move and the timing of the application.

When documents are missing

Older adults sometimes lack a birth certificate or have records with different spellings or dates. Some practical steps:

request a list of accepted alternative documents, such as hospital birth records, early school or church records, or census records;
order a certified birth certificate from the vital records office of the state of birth;
for naturalized citizens, request a replacement naturalization certificate if the original is lost, which can take months, so start early;
keep copies of everything submitted.

Because most applicants on Medicare are exempt from citizenship documentation, this usually affects identity or immigration proof rather than citizenship itself.

Residency and the look-back

Moving to a new state does not reset the look-back. The new state reviews transfers made during the full 60 months before the application, including those made while living in the old state.

Renewals

Citizenship is verified once. Residency is checked again at renewals and whenever an address changes. Report any move, including a move between facilities, promptly, and keep proof of the date you reported it.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.