How the right ride gets picked
Non-emergency medical rides come in levels. Each level matches how much help a rider needs, from a regular car to an ambulance.
Medicaid has to use the least costly ride that still fits the rider’s physical and emotional condition. States must also consider a rider’s support needs. For example, if you use a wheelchair, the state must make sure you ride in a wheelchair-accessible vehicle.
Each state uses its own names and rules for these levels. The examples on this page come from Virginia, Minnesota, North Dakota and Louisiana Medicaid. Your state may define them differently, so ask your plan or ride broker (the company that books Medicaid rides) what levels it offers.
Car, van or taxi: for riders who can get in on their own
This is often called an ambulatory ride. Virginia Medicaid uses this level for members who can get in and out of the vehicle on their own. It says minivans and sedans are common vehicles for these rides.
Rides also differ in how much hands-on help the driver gives. In Virginia, a curb-to-curb driver opens the vehicle door and helps you in and out of the vehicle at the curb. A door-to-door driver helps you to the main door of the pickup place and to the door of where you’re going. Virginia requires medical necessity for door-to-door help.
Some programs offer even more help. Louisiana Medicaid has an elevated level of care, often called door-through-door, for people with mobility limits who need help when using a wheelchair. Minnesota calls a ride with driver help assisted transport.
Drivers have limits. In Virginia, drivers may not go past the main entrance lobby or main door, and they don’t help members who use a wheelchair up or down stairs.
Wheelchair van: you ride in your own wheelchair
A wheelchair van carries you while you stay seated in your wheelchair. Virginia uses this level for members who can’t safely move from their wheelchair into a vehicle seat. North Dakota defines a wheelchair van as any van that has a wheelchair lift. Minnesota calls this lift-equipped or ramp transport.
Federal disability rules for accessible buses and vans require a lift or ramp and a securement system. A securement system is the set of straps or clamps that holds the wheelchair to the floor. When used correctly, it must keep an occupied wheelchair from moving more than 2 inches in any direction during normal driving.
The vehicle must also have a seat belt and shoulder harness for the rider. These belts can’t replace the straps that hold the wheelchair itself. Virginia requires drivers to secure each wheelchair facing forward with 4 securement straps, plus a shoulder and lap belt. Louisiana says lap belts and chest straps alone are not enough to restrain a wheelchair rider.
If you or your wheelchair is larger or heavier than average, say so when you book. Under the same federal rules, a vehicle lift must be built to carry at least 600 pounds, and the wheelchair space must have a clear floor area of 30 inches by 48 inches. Ask the provider about its own weight and size limits.
Stretcher van: lying flat without medical care
Some people can’t sit up for a ride but don’t need medical care on the way. Some states use a stretcher van for these trips.
North Dakota defines a stretcher van as a vehicle with a stretcher for a person who doesn’t need medical monitoring, aid, care or treatment during the trip. Virginia uses a van-stretcher for members who need a stretcher but don’t need medical care or monitoring. Minnesota’s stretcher transport is for a rider lying face down or on their back.
Not every state offers this level. Louisiana’s Medicaid manual says stretcher vans are not an allowed vehicle type for its non-ambulance rides.
Non-emergency ambulance: when you need care on the way
An ambulance is for people who need medical care or monitoring during the trip. Virginia sends members who need a stretcher plus medical care and monitoring by ambulance.
Medicare covers ambulance rides only when other ways of traveling could endanger your health. For a non-emergency ambulance, Medicare may cover the ride if your doctor writes an order saying you need it because of your medical condition.
Being bed-confined is one factor Medicare looks at. Under Medicare rules, that means you can’t get up from bed without help, can’t walk and can’t sit in a chair or wheelchair. It isn’t the only factor. Your medical condition can also make an ambulance necessary.
Ambulances come in levels too. A basic life support (BLS) ambulance has at least two crew members, and at least one must be certified as an emergency medical technician (EMT-Basic) or higher. An advanced life support (ALS) ambulance has crew trained to the level of EMT-Intermediate or paramedic, who can give more advanced care. Medicare covers a ride only when your condition needs both the ambulance and the level of care given.
Public transit and ADA paratransit
If you can ride the bus or train, that may be an option. Virginia Medicaid can give bus tickets or tokens to members who live near a bus line, and it provides tickets for an escort at no cost. Minnesota counts taxis and public transit as unassisted rides.
ADA paratransit is a ride service run by public transit agencies. Under the Americans with Disabilities Act (ADA), agencies that run fixed-route buses or trains must also offer paratransit to people whose disability keeps them from using the regular buses or trains. Only people who meet the ADA eligibility rules qualify, and some qualify only for certain trips. Paratransit is generally origin-to-destination service, which means it takes you from where you start to where you’re going.
Paratransit runs during the same hours and days as the regular buses. The agency must be able to schedule your ride if you ask the day before. It can ask you to adjust your pickup time, but not by more than one hour from the time you want. The fare can’t be more than twice the regular full fare for a similar trip.
Paratransit can’t limit rides based on why you’re going. One companion may ride with you. A personal care attendant rides free. Medicaid programs may also use paratransit for medical trips.
Mileage payments when family or friends drive
Some Medicaid programs pay mileage when you, a relative or a friend drive you to covered care. Federal Medicaid rules count the cost of travel by ambulance, taxicab, common carrier or other appropriate means. They can also include meals and lodging on the way to and during medical care, and the cost of an attendant if one is needed.
Minnesota covers mileage for clients who have their own transportation, or for family or an acquaintance who drives them. Virginia lets family, friends, caregivers and members get mileage payments if they call before the appointment and have the treating office sign a form.
Rules differ by state. Ask your plan or ride broker how to sign up before the trip, and keep any trip log or form it gives you.