Medicaid Transportation Questions: All About Medicaid Transportation.
Medicaid Transportation Questions: The Medicaid Transportation program covers the medical transportation costs for eligible persons. Medicaid beneficiaries can get rides to and from providers as required, according to Federal regulations.
States have different rules on when rides are needed In this post, we will answer the most frequently asked questions about the Medicaid Transportation program and what you need to know about the program for your state.
About Medicaid Transportation Services
Travel support incentives are funds that cover travel expenses for Medicaid patients. These funds help members make medical appointments to and from. Once the participant meets those criteria, mileage, meals, and accommodation can be helpful to him/her.
Before you travel the Medicaid Transportation Center must approve all trips to get paid. Transportation is covered from and to the appointment of the Member. The method of transportation is based upon the medical needs of the member. The member may use the following types of transportation:
Personal transportation (privately owned vehicle)
Specialized non-emergency transportation (wheelchair or stretcher van)
Commercial transportation (taxi, bus, etc.)
Medicaid transportation is a federally–required State–Plan–approved service managed and administered by the Department of Health to ensure that enrollees have access to approved medical services.
The Department of Health contracts with professional transportation management companies to manage non–emergency fee–for–service transportation.
Most transportation services are provided by Medicaid–enrolled service providers who are reimbursed by the State.
Emergency vs. Non–Emergency Transportation
Emergency transportation is for the provision of initial, urgent, medical care including the treatment of trauma, burns, and respiratory, circulatory and obstetrical emergencies. Emergency transportation typically emanates from a 911 call.
Non–emergency transportation– necessary in order for an enrollee to access medical care.
The Medicaid Non–Emergency Medical Transportation benefit (NEMT) is authorized under the Social Security Act §1902(a)(70) and 42 C.F.R. §440.170 and requires that states:
Ensure necessary transportation to and from providers;
Use the most appropriate form of transportation; and
Here are the most frequently asked questions we get about the Medicaid Transportation program.
Who can request Medicaid Transportation?
The Medicaid Transportation program provides Non-Emergency Medical Transportation (NEMT) to Medicaid members who need rides to and from their medical appointments and other Medicaid-covered services.
How much does a single trip cost?
The cost of a Medicaid transportation trip varies based on a number of factors including:
Time/distance from a patient’s home to the appointment and back
The mode of transportation required
The availability of transportation options in a given area
States that employ NEMT brokers usually pay a set per-beneficiary fee to the brokers who provide necessary transport to Medicaid beneficiaries using the most clinically appropriate and cost-effective transportation option.
What Types of Appointments Qualify for Medicaid Transportation?
Medicaid Transportation covers a wide array of medical visit types as long as the services being provided are Medicaid covered.
Some of the most common medical needs that require medical transportation are:
Visits with primary care physicians or specialists
Dialysis services for patients with End-Stage Renal Disease (ESRD)
Substance abuse counseling sessions
Behavioral health or mental health appointments
Chemotherapy or other recurring infusion treatments
How Do I Get Approval for Medicaid Transportation?
States have different rules, but you can search for eligibility conditions with your state’s Medicaid Agency. When you enroll in Medicaid, you will generally receive instructions as to who to call to schedule a ride. See our state-by – state guide here if you don’t have that information.
If you contact your State department or caseworker, the following details will be checked for you:
Help you decide if you have an immediate need for care
Make sure you are eligible for Medicaid
Verify that you have an appointment with a Medicaid provider
Make sure that you have no other reasonable way to make it to your appointment
Decide what type of ride Medicaid can give you for your situation.
Based on this information, your contact will either set up the ride you need or will tell you how to set up the ride yourself. A person or ride service approved by the State Medicaid program will take you to and from your appointment.
Should my Appointment Time Change?
Should your appointment time change, call your ride service as soon as you can. Explain why you are changing your ride time and set up a new pickup time.
How much notice is needed to request transportation?
This varies by state. However, in most states, requests for routine/non-urgent Medicaid Transportation services must be pre-arranged at least two 48 hours (two (2) business days) in advance: Generally, urgent care transport can be requested 24 hours a day, 7 days a week.
Can I be Picked Up from the Emergency Room?
Yes. The transportation service can pick you up from the ER once a discharge order has been issued for you. Call your state’s provider and tell them you need same-day picked up from the ER. Because of the short notice, there may be a long wait until the driver can pick you up.
How Do I Schedule a Medicaid Transportation Ride?
Each state has different rules about Medicaid Transportation. Depending on your state, your Medicaid ride may come in the form of a taxi, car, van, public bus, or a subway.
Here’s what you need to know:
You might share your ride with others.
Also, you have to call to set up your ride in advance, and you should call if you need to cancel.
In addition, the driver can give you or an eligible family member a ride only to a medical office and back home.
However, If the driver gives you a ride anywhere else, you and the driver could be charged with stealing from Medicaid.
Medicaid has strict rules about how it pays for rides. Make sure to follow the rules so Medicaid will approve and pay for your ride. The driver sent to pick you up may be authorized to pick you up within a certain timeframe.
Therefore, it is important to:
Be ready on time for the pickup; and
Call the ride service to cancel a scheduled ride if you do not need the ride anymore.
NOTE: If you make a habit of not showing up for scheduled rides, you may have to make extra calls to the ride service to verify that you intend to keep your appointment. Furthermore, Medicaid may also place additional restrictions on your ability to get a ride, like requiring you to use only one service to get your rides.
What Type of Transportation Should I Expect?
Depending on your needs and circumstances the level of service required varies. bHere are factors that may be important to the type of ride you might get for a specific appointment:
Available transport modes:
A. Public Bus – if the person:
Lives within ½ mile of a bus stop and
The medical facility is within ½ mile of a bus stop and
The member can walk to and from bus stop and
The member understands common signs and direction
B. Car/Minivan – if the person:
Cannot take the bus or walk
C. Wheelchair Van – if the person:
Is confined to a wheelchair or ADA-compliant scooter
Requires a lift-equipped or roll-up wheelchair van
Requires assistance of a trained professional
D. Stretcher – if the person:
Is confined to a bed
Cannot sit in a wheelchair
Does not require medical attention during transport
E. Non-Emergency Basic Life Support (BLS) or Non-Emergency Advanced Life Support (ALS) if the person:
Is confined to a bed
Cannot sit in a wheelchair
Requires medical attention and/or monitoring during transportation
Can I receive Medicaid mileage reimbursement?
Medicaid recipients may qualify for mileage reimbursement under certain circumstances. The program may reimburse you for mileage, lodging, and meals at the current rate of payment (if you qualify). Call your state’s Medicaid Agency for details.
What If My Ride Does Not Show Up?
If your scheduled ride does not show up, call the number you used to set up your ride and explain the problem. The ride service should be able to help you resolve the issue. In addition, you should call your medical provider, and explain to them why you are going to miss your appointment.
How Long Will the Driver Wait for Me?
The driver will contact you when he or she arrives at your pick-up location. The driver will wait ten (10) minutes for you. If you don’t respond in ten (10) minutes, the driver may leave and mark the trip as a “no show.” Remember. Drivers may not enter homes or facilities.
Under what circumstances would my Medicaid Transport Request be denied?
If your request for medical transportation under Medicaid is denied, it may be due to one of the following reasons:
You are not eligible for Medicaid Transportation services on the date of service.
The medical service for which you requested Medicaid Transportation is not medically necessary and/or is not a Medicaid-covered service.
You have access to transportation of your own or through family, friends or neighbors.
The provider you are trying to use is not enrolled in as a Medicaid Transportation provider in your state or is not a VA provider.
How Much Does the Government Spend on Medicaid Transportation?
The Medicaid transportation program is a small component of the Medicaid program. In 2014, the government spent about $3 billion on the NEMT, which accounted for less than one percent of total Medicaid spending that year.
How do I report Medicaid Transportation Fraud and Abuse?
Abusing the Medicaid transportation benefit or committing fraud can land you in jail.
The following are examples of fraud and abuse of Medicaid Transportation Program:
A driver takes someone to a nonmedical location other than their home
Your driver takes a route that adds extra time or mileage
Someone shares his or her Medicaid card or number with others to get medical services.
You get a ride in an ambulance when a wheelchair or regular van would have worked
If you know of someone who is breaking the rules, including a driver, there are two ways to report it.
Option 1 – Report fraud to your State Medicaid Fraud Control Unit
Option 2 – Report fraud to the U.S. DHHS Office of Inspector General
Office of Inspector General
U.S. Department of Health and Human Services
P.O. Box 23489
Washington, DC 20026
Phone: 1-800-HHS-TIPS (1-800-447-8477)
Email: [email protected]
Note: You can report fraud anonymously, but it is helpful to give your phone number or email address so an investigator can contact you for more information. If you do give your contact information, the investigators will protect your identity to the maximum extent provided by the law.
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