Posted on December 10, 2022

Medicaid covers the cost of emergency medical transportation for eligible individuals. An emergency is when your medical needs are immediate. Examples include having a heart attack or being seriously injured in a car accident. In cases like these, you may be taken to the emergency room by ground (ambulance) or air (medical flight). You do not need pre-approval for emergency transportation. If you need a ride to a medical appointment, Medicaid does not consider this an emergency, but you may still be able to get a ride. Medicaid covers rides for eligible individuals to and from the doctor’s office, the hospital, or another medical office for Medicaid-approved care. This coverage is called “non-emergency medical transportation,” because it does not involve a medical emergency. Medicaid may give you a ride if you do not have a car that works or do not have a driver’s license. You may also be able to get a ride if you have a physical or mental disability or are unable to travel or wait for a ride alone. Coverage for these rides may be different depending on your individual situation and needs. You may need to get your State Medicaid agency’s approval to qualify for a ride.

Who Can Get a Ride? Federal regulations say that Medicaid beneficiaries can get rides to and from providers when necessary.

States have different rules about when rides are necessary, so make sure you check with your State. Generally, when you enroll in Medicaid, you will receive instructions about when a ride is necessary and how and when you can schedule a ride. Medicaid covers the cost of emergency medical transportation for eligible individuals. An emergency is when your medical needs are immediate. Examples include having a heart attack or being seriously injured in a car accident. In cases like these, you may be taken to the emergency room by ground (ambulance) or air (medical flight). You do not need pre-approval for emergency transportation. If you need a ride to a medical appointment, Medicaid does not consider this an emergency, but you may still be able to get a ride. Medicaid covers rides for eligible individuals to and from the doctor’s office, the hospital, or another medical office for Medicaid-approved care. This coverage is called “non-emergency medical transportation,” because it does not involve a medical emergency. Medicaid may give you a ride if you do not have a car that works or do not have a driver’s license. You may also be able to get a ride if you have a physical or mental disability or are unable to travel or wait for a ride alone. Coverage for these rides may be different depending on your individual situation and needs. You may need to get your State Medicaid agency’s approval to qualify for a ride.

Who Can Get a Ride? Federal regulations say that Medicaid beneficiaries can get rides to and from providers when necessary. States have different rules about when rides are necessary, so make sure you check with your State. Generally, when you enroll in Medicaid, you will receive instructions about when a ride is necessary and how and when you can schedule a ride. You may have to call a Medicaid caseworker, a ride service, or another agency. That contact should 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; Let Medicaid Give You a Ride. Make sure that you have no other reasonable way to make it to your appointment and 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.

Generally, if you are enrolled in a Medicaid managed care plan, the customer service staff can give you facts about ride benefits.

How Do I Get a Ride? Depending on your needs and your state’s rules, rides might be by taxi, car, van, public bus, or a subway. You might share your ride with others. You must call to set up your ride in advance, and you should call if you need to cancel. Remember, the driver can give you or an eligible family member a ride only to a medical office and back home. If the driver gives you a ride anywhere else, you and the driver could be charged with stealing from Medicaid. Make sure to follow the rules so Medicaid will approve and pay for your ride. Drivers may be authorized only for specific times to pick up the rider. 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. In some places, Medicaid might not pay ride services for the time a driver waits for you to arrive or if you do not show up for planned pickups. In other States, there may be limits on how long the driver can wait for you if you are not on time. 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. 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 If My Ride Does Not Show Up?

What should you do if your ride does not show up? Call the number you used to set up your ride. Stay calm and explain the problem. The ride service should help you. Then call your medical provider and explain it to them.

What If My Appointment Is Changed?

If your appointment is changed, call your ride service as soon as you can. Explain why you are changing your ride time and set up a new pickup time.

What Happens If the Rules Are Not Followed?

If providers and beneficiaries do not follow the rules for Medicaid, the added cost to the Medicaid program can be significant. Fraud and abuse can affect the amount of money available for Medicaid benefits. Help prevent fraud by reporting an incident when your driver takes someone to a nonmedical location other than their home. Your driver takes a route that adds extra time or mileage. You get a ride in an ambulance when a wheelchair or regular van would have worked, or you see someone sharing his or her Medicaid card or number with others to get medical services. These are just some examples of fraud. If you know of someone who is breaking the rules, including a driver, report it.

Fraud and Abuse: How Do I Report Them?

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.

Disclaimer This fact sheet was current at the time it was published or uploaded onto the web. Medicaid and Medicare policies change frequently so links to the source documents have been provided within the document for your reference. This fact sheet was prepared as a service to the public and is not intended to grant rights or impose obligations. This fact sheet may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. Use of this material is voluntary. Inclusion of a link does not constitute CMS endorsement of the material. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. April 2016.

Original Article: https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/nemt-factsheet.pdf

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