How Medicaid pays for rides to the doctor

Rides to the doctor are a Medicaid benefit

Many people do not know that Medicaid can pay for a ride. The federal Medicaid website lists transportation to medical care among the benefits that states must provide. A federal rule says each state's Medicaid agency has to make sure members have the transportation they need to get to and from their providers.

CMS, the federal agency that runs Medicaid, defines these rides as trips that do not involve an immediate threat to your life or health. A routine check-up, a dialysis session or a cancer treatment are examples of a trip you plan ahead.

Who can use Medicaid rides

You need to be enrolled in Medicaid, but being enrolled does not always guarantee a ride. CMS says a state may ask if you truly need the ride. Examples are having no valid driver's license or no working car in the household. Another is a physical, mental or learning limit that makes travel hard. MACPAC, a federal advisory group on Medicaid, says members generally qualify when the trip is necessary and they have no other way to get there.

States can also set their own limits on rides. MACPAC reported in 2019 that some states cap the number of trips or charge a small co-payment for a ride. It also said two states had received permission to drop the benefit for the adults added by Medicaid expansion, with exceptions for certain groups. That was several years ago, so check what your state does today.

CMS also says many states require a ride to be approved before you travel. Ask the ride line whether you must get that approval first. You should also ask who handles the paperwork, the ride line or your doctor's office.

What kind of ride you will get

The state picks the most suitable kind of ride for your needs. MACPAC says the benefit usually includes taxis, wheelchair vans, private vehicles and public buses. A private vehicle can belong to you, a family member or a friend, and some states repay mileage in that case. A person who uses a wheelchair may need a van built for one.

Many states hire a company called a broker to arrange the rides, and MACPAC says this is the most common setup. In other states your Medicaid health plan books the ride. Either way, you usually book the ride by phone, on a website or in an app.

How to book a ride

1. Find the ride phone number on your Medicaid card, your member handbook or your state Medicaid website. The same page may list an online booking site or an app.
2. Keep your details handy when you call. You will need your name, address and Medicaid ID. You will also need the doctor's name and address, the date and time of the visit, and the reason for it.
3. Call as early as the rules require, and see the next section for examples.
4. Ask for a confirmation of the ride, and write down the date, the pickup time window and the name of the person you spoke to.
5. Book the ride home at the same time as the ride there, since your appointment may run late.

If you have standing visits, such as dialysis, ask whether you can set up repeat rides. Wisconsin gives one example of how this works. Its state page says repeat rides can be set up for up to three months at a time, or six months for dialysis. Your provider can help you set them up.

How far ahead you must call

Each state has its own notice period, and most want a few days. Indiana's Medicaid page says members on traditional Medicaid should call at least two business days before the trip. For members in its managed care plans, Indiana lists a 48-hour notice to the plan's broker.

Wisconsin asks for two business days for a routine ride. Urgent trips can be booked the same business day, and so can critical ones, such as dialysis or cancer treatment. Bus rides need five business days of notice. If you want gas money for your own car, Wisconsin says approval is due by 11:59 p.m. on the appointment day.

These are two examples and not national rules, so use your own state's page. When in doubt, call as soon as you book the appointment.

If your ride does not come

First, call the ride line right away and ask where the driver is. Have your confirmation details ready when you call. Then call the doctor's office, tell them you may be late and ask if they can still see you or reschedule. Write down what happened while you remember it.

After a missed ride, call your plan or your state Medicaid office to report it. Your member handbook explains how to file a complaint. A complaint can lead to a fix, and it also helps the state see where service is failing.

Please do not skip an important visit because a ride failed. If you cannot get to care, tell the doctor's office, since many can offer a video visit or a new time. You can also search for a doctor who offers visits you can do from home. A community health center is another place that may offer care closer to you.

Emergencies and other options

Medicaid rides are meant for planned care and not for emergencies. If you have chest pain, trouble breathing, heavy bleeding or signs of a stroke, call 911 or go to the nearest emergency room. If a bill follows, read our ambulance cost without insurance guide.

If you do not have Medicaid yet, read how to apply for Medicaid. Local groups, county senior services and 2-1-1 may also know of free or low-cost rides. This page is general information and not medical advice.