SRTR-Published Risk: Long-Wait + Medicaid States

Medically reviewed by James F. Trotter, MD and Joseph S. Redman, MD, PhD, National Friends Medical Advisory Board · Last reviewed October 1, 2026

Public SRTR reports can reveal states where nearby liver programs have long waits and narrow Medicaid paths. Here is how to spot that risk and act on it.

The SRTR (Scientific Registry of Transplant Recipients) is the federally funded registry that measures every U.S. transplant program. It publishes a program-specific report (PSR) for each liver program, with waitlist outcomes, time-to-transplant measures, and details about the candidates, recipients, and donors at that program. When you line those reports up state by state, certain geographic patterns emerge.

The long-wait + Medicaid risk pattern

Some states have only one or two adult liver transplant programs. In some of those states, the programs have structurally long waits, and the path to listing for patients with Medicaid is narrower than the path for patients with commercial insurance. Patients in those states who depend on Medicaid can face a harder road to transplant, and leaving the state to list somewhere else is often the hardest step for them to take.

This is National Friends' reading of public data, not a ranking SRTR publishes. But research supports the concern. A national study of more than 100,000 liver waitlist registrations from 2004 to 2016 found that only 2.8% of patients listed at a distant center (outside their home region and more than 500 miles from home). Those who did had a 22% lower risk of dying within a year. Patients with Medicaid were less likely to list far from home, along with patients with less education or lower incomes (Kwong et al., 2019).

Why this matters

The pattern is not a moral failure. It reflects donor supply geography, payer mix, and how many patients a program can evaluate and list.
It is, however, an actionable risk. Patients can ask about dual listing at a second center that is far enough away to draw from different donor hospitals, or that has a broader path for Medicaid patients.
Dual listing takes work. It requires a second evaluation, insurance approval, and travel planning. None of it is easy. All of it is doable. Our step-by-step dual-listing guide walks through it.

How liver allocation works today (and why distance matters)

Since February 2020, donor livers in the U.S. have been offered using acuity circles: circles of 150, 250, and 500 nautical miles drawn around the donor hospital. Priority depends on medical urgency and on how close a patient's center is to that hospital (Wood et al., 2021). Older region- and donor-service-area-based rules no longer decide where a liver goes.

Since July 2023, adult candidates have been ranked by MELD 3.0, which adds sex and albumin to the earlier lab-based formula (Kim et al., 2021; OPTN implementation date, Hepatology 2026). You can check a score with our MELD calculator.

What this means: a second listing helps most when it puts you inside a different set of donor circles, at a program that may accept a liver for you sooner. SRTR's own patient guidance says candidates who list in different areas may benefit more than candidates who list at multiple centers in the same area (SRTR FAQ for patients).

How to read the SRTR report for your program

SRTR's center search and PSRs are at srtr.hrsa.gov (the old srtr.org address now forwards there). Reports are released every January and July, and the data are usually about six months old when they come out (SRTR, Program-Specific Reports).

Look for these measures:

Getting a Transplant Faster — how quickly patients at this program receive a transplant compared with similar patients nationally.
Survival on the Waitlist — how patients at this program fare while waiting, compared with what would be expected.
1-Year Survival — how patients do in the first year after transplant.
Transplants in a Year — how many liver transplants the program performs.

SRTR rates several of these on a 5-tier scale, shown as a colored dial. Tiers 1 and 2 mean outcomes worse than expected, tier 3 means about the national rate, and tiers 4 and 5 mean better than expected (SRTR, dial icons). A tier is not a grade out of five, and a lower tier does not mean a program is unsafe — it means its results differ from what the model expected for its patients.

To see how wait times compare across the country, start with our liver waiting list guide and the transplant center directory.

What Medicaid rules say about going out of state

Federal rules require each state Medicaid program to pay for care in another state in certain situations, including when the state decides, based on medical advice, that the needed services are "more readily available in the other State" (42 CFR 431.52). In practice, out-of-state transplant care for Medicaid patients usually needs prior approval from your state's Medicaid program, and the receiving center has to be willing to bill it. Rules and processes differ by state, so get answers in writing.

What to ask your local center

"What is the median time-to-transplant for Medicaid patients at this program over the past 24 months?"
"How many of your transplants in the past year were in Medicaid recipients?"
"Do you support patients who choose to dual-list at another center? Will you share my records and test results?"
"If my MELD score does not reflect how sick I am, will you request an exception for me?"

What to ask a candidate dual-list center

"Do you accept out-of-state Medicaid? Through what mechanism?"
"What is your program's evaluation timeline for an out-of-state patient?"
"Can you use tests I already had done at my home center, or do I need to repeat them?"
"What does the first 90 days post-transplant look like for an out-of-state Medicaid patient? Where would I stay, and who covers lodging?"
"How far from your center do I need to live while I wait?"

What to ask your state Medicaid office

"What is the prior-authorization process for an out-of-state transplant evaluation?"
"Do you cover travel and lodging for out-of-state transplant care?"
"Who signs off on the medical necessity letter, and how long does a decision usually take?"

Common misconceptions

"Medicaid means I can't list anywhere else." Not necessarily. Federal rules allow out-of-state coverage in defined situations. It takes paperwork and a willing center.
"Dual listing doubles my chances." It does not work that simply. A second listing helps most when the second center is in a different donor area or accepts offers differently. SRTR notes the benefit depends on many factors.
"A long average wait means I will wait that long." Averages hide a lot. Your blood type, MELD score, and any exception points change your own odds.
"My center will be offended if I ask." National policy allows listing at more than one center. A good team will discuss it with you openly, even if some centers choose not to list patients who are already listed elsewhere.

Ask your hepatologist, transplant coordinator, or a patient advocate to walk through your program's PSR with you. Our caregiver hub has more tools for those conversations.

Sources

Educational only. Not medical advice. Your transplant team has the final word.

← Back to the comparison map