How Much Does Medicaid Pay For Transportation?

The cost of calling an ambulance can shock you. Even in emergency situations, your ride to the hospital or to receive medical care is often not free. Without insurance coverage, your bill could go up into the thousands! 

Thankfully, Medicaid always fully covers the cost of emergency medical transportation for eligible Medicaid beneficiaries. An emergency medical situation means that your medical needs are immediate and urgent that may put your life at risk, if not given immediate medical attention, such as having a heart attack or you got involved in a serious car accident. In these kinds of situations, you no longer need pre-approval to get medical transportation.

On the other hand, even if it is not an emergency, Medicaid may still fully cover your transportation in some situations. This coverage is called “non-emergency medical transportation (NEMT)”. We’ll talk about when you can qualify for NEMT later in the article. 

When Will Medicaid Cover Non-Emergency Medical Transportation?

Individuals who are eligible for Medicaid benefits can get medical transportation both in emergency and non-emergency medical situations. Make sure to call your local Medicaid office since different states have different rules in covering medical transportation services. 

Here are some non-emergency medical situations where you can get medical transportation on Medicaid:

  • You do not own a car
  • You do not have a driver’s license
  • You have physical or mental disability
  • You are unable to travel alone
  • You had a surgery that left you unable to drive

Usually, if you have enrolled in the Medicaid program, you will receive instructions about how and when to get a ride. For instance, you may call your local Medicaid office to ask for assistance on how to set the ride you need or give you instructions on how to set up the ride yourself. You can see below the mode of transportations covered by Medicaid.

The NEMT coverage varies, but it generally includes the following modes of transportation:

  • Public transportation
  • Private vehicle
  • Taxi/Livery
  • Wheelchair van
  • Ambulance
  • Stretcher
  • Commercial airline

Therefore, you already know what are the modes of transportations covered by Medicaid. On the other hand, there are instances, wherein you might share a ride with others, or you are allowed to bring one family member to accompany you. Hence, here are some things you must know when getting a ride.

What You Need to do for Medicaid to Cover your Ride

If you are a Medicaid beneficiary, make sure you follow your state’s Medicaid guidelines on how to get a ride so that Medicaid will approve and cover your ride. Therefore, it is important to know these  things beforehand since the drivers are only authorized for specific times

1. Be Prepared at the Time of the Pick-up

This is because Medicaid may not pay the transportation service if your driver waits for you to arrive on the pickup location. Some states impose limits on how long your driver should wait for you, if you are not on time. 

2. Cancel a Scheduled Ride Beforehand

If you do not need a ride on your scheduled date, make sure you call your transportation service to cancel your ride. This is because if you practice the habit of not showing up during your scheduled pick-up dates, Medicaid may place a restriction on your ride benefits. For example, you are only allowed to use one service for your rides.

Moreover, there are some situations that may affect your ride service. During these times, here are some tips you should do:

Situation 1: The Ride does not Show up

If your ride does not show up, call the number you used in getting a ride, and then ask the reason why the driver did not show up. Once you have known the reason why the ride does not show up, call your local Medicaid office and explain the reason to them.

Situation 2: Your Appointment was Changed

If your scheduled appointment was changed, call the ride service right away, and then tell them the reason why you are changing your pick-up date. Also, tell them your new scheduled pick-up time so that they can make an appointment on that day for you since the drivers are authorized only for specific time and day.

What Will Happen if these Guidelines are not Followed?

If you and the ride service did not follow the rules, for example, the driver gave you a ride anywhere, aside from the service benefit you are only allowed to, you and the driver may be charged with stealing or abuse from Medicaid. 

To protect yourself from fraud and abuse, you may report these following incidents on your state’s Medicaid office:

  • Your driver took a route that adds extra time and mileage
  • You received a ride in an ambulance, even though a regular van or a wheelchair will do
  • Your driver took someone to a non-medical location, instead of to their home
  • You knew someone sharing his/her Medicaid card details with others to get also free coverage

Those are just some examples of scenarios, wherein you must report if you know someone and even the driver breaking the rules.

Finally, you have learned the basics about the medical transportation benefits of Medicaid; therefore, it’s now time to learn how much does Medicaid cover for these transportation services; though the rules vary from state-to-state. 

Some require co-payment and prior-authorization, while other states put limits on the number of trips that Medicaid will cover for a year. Let’s find this out below.

Non-Emergency Medical Transportation Fee Schedule

Most NEMT providers will charge a base rate depending on the mode of transportation needed, such as a wheelchair, stretcher, private vehicle, or public transportation. Moreover, it will also affect the cost based on the date you will need the transportation service since they are cheapest during weekdays. 

Hence, here is a table that shows a typical NEMT rate:

TYPE OF TRANSPORTATION SERVICE AND/ OTHER CHARGES

BASE RATE DURING

WEEKDAYS

BUSINESS HOURS

BASE RATE DURING

WEEKENDS 

OFF HOURS

BASE RATE DURING

HOLIDAYS

Ambulatory

$25 - $30

$30 - $40

$35 - $45

Wheelchair

$45 - $50

$75 - $90

$85 - $100

Stretcher

$100 - $200

$125 - $225

$150 - $250

Mileage fees

$3 - $5 per mile

$5 - $7 per mile

$5 - $10 per mile

Wait-time fees

(every 30 mins has passed)

$15 - $30

$15 - $30

$15 - 30

Attendant fees

$5 - $10

$5 - $10

$5 - $10

Aside from the type of transportation service and the date when you will need the service, the mileage rate and additional cost for an attendant may also affect the rate for a non emergency medical transportation service. To see an example of a non-emergency transportation schedule, you may check this site

Meanwhile, here is a table that shows the state-to-state of Medicaid benefits for Non-Emergency Medical Transportation Services:

STATES​​​​

IS NEMTS COVERED?

IS COPAYMENT REQUIRED?

LIMITATIONS ON SERVICES

Alabama

YES

NO

None

Alaska

YES

NO

Requires prior authorization

Arizona

YES

NO

Medically necessary and no other means of transportation

Arkansas

YES

NO

Not specified

California

YES

NO

• For specialized transportation, it requires prescription from the provider

• For non specialized transportation, it requires the beneficiary to prove that other resources are reasonably exhausted or not available

Colorado

YES

NO

None

Connecticut

YES

NO

For family member, transportation will be provided, if they need to be present during family services

Delaware

YES

NO

During medical appointments only

District of Columbia

YES

NO

You must present a physician certification for certain services

Florida

YES

Charges a $1 copayment per one-way NEMT trip

None

Georgia

YES

Charges a $1 copayment per one-way NEMT trip

None

Hawaii

YES

NO

None

Idaho

YES

NO

None

Illinois

NO RECORD

NO RECORD

NO RECORD

Indiana

YES

Charges a $0.50 to $2 copayment per NEMT trip, or depending on the payment

• Requires prior authorization

• Non emergency transports beyond 20 one-way trips per year

• Non emergency transports greater than 50 miles

Iowa

NO RECORD

NO RECORD

NO RECORD

Kansas

YES

NO

None

Kentucky

YES

NO

No coverage, if there is a working vehicle in your household

Louisiana

YES

NO

NO RECORD

Maine

YES

NO

None

Maryland

YES

NO

None

Massachusetts

YES

NO

None

Michigan

YES

NO


Minnesota

YES

NO

None

Mississippi

YES

NO

NO RECORD

Missouri

YES

Charges a $2 copayment for each NEMT trip except for children, pregnant women, individuals who live in a nursing facilities, and others

For NEMT, Medicaid beneficiaries are covered by Missouri HealthNet services

Montana

YES

NO

Needs to be reviewed first for medical necessity

Nebraska

YES

NO

None

Nevada

YES

NO

None

New Hampshire

NO RECORD

NO RECORD

NO RECORD

New Jersey

YES

NO

Requires prior authorization

New Mexico

YES

NO

None

New York

NO RECORD

NO RECORD

NO RECORD

North Carolina

YES

NO

Arranged by their local DSS and limited only to one procedure per day with the same or different service provider

North Dakota

YES

NO

Requires prior authorization for all types of transportation services

Ohio

YES

NO

None

Oklahoma

YES

NO

NO RECORD

Oregon

YES

NO

Needs to be verified first if the beneficiary does not have access to other means of transport

Pennsylvania

YES

NO

Transportation services is limited to their local Medical Assistance Program

Rhode Island

YES

NO

None

South Carolina

NO RECORD

NO RECORD

NO RECORD

South Dakota

YES

NO

NO RECORD

Tennessee

YES

NO

None

Texas

YES

NO

Requires prior authorization

Utah

YES

NO

None

Vermont

YES

NO

Needs to be verified first if the beneficiary does not have access to other means of transport; the medical service must be covered by Medicaid, and must be medically necessary

Virginia

YES

NO

NO RECORD

Washington

YES

NO

Requires prior authorization

West Virginia

YES

NO

For NEMT, it must be provided by a single contracted transportation broker and a qualified provider that must be within the 30 miles border of West Virginia

Wisconsin

YES

Charges a $1 copayment per trip in a specialized medical vehicle; while $2 per trip in a non emergency transportation; no copayment for common carrier

Must be approved and coordinated first with a transportation manager

Wyoming

YES

NO

None

Robert Taylor Smith
 

Robert's motto is to start "with the end in mind." He married the love of his life in December 2016. Together with his wife Tanya, they're putting the building blocks in place for their eventual retirement. He's taken over the mantle at retirementsavvy.net and hopes to share his experiences with our readers.

Click Here to Leave a Comment Below 0 comments

Leave a Reply: