What federal rules say
Federal Medicaid rules say each state’s Medicaid agency must ensure necessary transportation for members to and from their providers. The state must also describe how it will do this.
In 2021, Congress added this promise to the Social Security Act itself. Before that, it was in federal regulations.
CMS, the federal agency that oversees Medicaid, explains that this is not a promise to pay for every ride. It is a promise that every member who has no other way to get there can get to covered care.
Who may get a ride
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 if you cannot travel or wait for a ride alone.
The ride must be to a service Medicaid covers. CMS says members may use these rides for any medical service Medicaid covers, including trips to and from a pharmacy.
States first look at whether you have another way to get there. That can include a free ride from family or friends, or your own car if you are able to use it. CMS notes that things like repair and fuel costs may keep someone from using their own car.
States have different rules about when a ride is necessary. You may need your state Medicaid agency’s approval before you can get a ride.
Kinds of rides Medicaid may cover
Federal rules list wheelchair vans, taxis, stretcher cars, bus passes and tickets, and other forms of transportation a state covers. CMS also lists car, van, public bus and subway rides. You might share your ride with others.
Some states pay members back for costs like bus fare or driving a personal vehicle to a medical visit. A small but growing number of states also use ride-share companies such as Uber or Lyft.
When more than one kind of ride would work, states must use the least costly one that fits your physical and emotional condition. If you use a wheelchair, the state must make sure you ride in a wheelchair-accessible vehicle.
Federal rules also count some related travel costs. These can include meals and lodging on long trips, and the cost of an attendant who needs to travel with you.
Who arranges the ride
Each state sets up its ride program in its own way. Common models use Medicaid managed care plans, statewide or regional ride brokers, or local government agencies. A broker is a company or agency that takes ride requests and assigns them to transportation providers.
When you enroll in Medicaid, you will usually get instructions about how and when to schedule a ride. You may have to call a Medicaid caseworker, a ride service or another agency. If you are in a Medicaid managed care plan, the plan’s customer service staff can usually tell you about ride benefits.
Even when a plan or broker handles rides, the state Medicaid agency is still responsible for making sure the rules are met.
For your state’s program and phone numbers, see the TripBridge covered-rides page for your state.
Booking and riding
You have to call to set up your ride ahead of time. The person you call may check that you have Medicaid, that you have an appointment with a Medicaid provider and that you have no other reasonable way to get there. Then they decide what type of ride fits your needs.
Be ready on time for pickup. Drivers may be approved only for certain pickup times. Call the ride service to cancel if you no longer need the ride.
The ride is for your medical visit and the trip back home, so don’t plan other stops. If your appointment changes, call the ride service as soon as you can to set a new pickup time.
If your ride does not show up, call the number you used to book it and explain the problem. Then call your medical provider.
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Special situations
If you have both Medicare and full Medicaid, the state must still make sure you have a ride to a service Medicaid can cover, even when Medicare pays first.
For children under 21, a state may pay for a parent or caregiver to travel when their presence is needed for the child’s care, such as for a hospital stay.
In most states, all members with no other way to get there can get rides. A few states have had federal waivers that removed this ride benefit for certain low-income adult groups. Ask your state Medicaid agency whether your coverage group includes rides.
If a ride is denied
You have the right to ask for a fair hearing if Medicaid denies a service or changes your benefits. A fair hearing is a review of the decision by your state. The state must tell you in writing about this right and how to ask for a hearing.
You may speak for yourself or have a lawyer, relative, friend or other person speak for you.
The state must give you a reasonable time to ask for a hearing. That time cannot be more than 90 days from the date the notice is mailed. Check the deadline on your notice.
If you are in a Medicaid managed care plan, you usually need to appeal to the plan first. You can ask for a state fair hearing after the plan says it is keeping its decision.