You will need to ask your state Medicaid agency because this could be different from state to state. However, as an example, in my state, the Medicaid agency does not provide prior approval. Instead, the Medicaid recipient or applicant effects the transfer and informs the Medicaid agency along with an explanation as to why it qualifies for the caretaker child exception, along with supporting documentation. If there’s a denial as a result, then they have to go to a fair hearing at which it may be possible to present additional documents.