Medicaid Transport: Your Guide to Accessing Medical Transportation Benefits

Navigating healthcare can be complex, especially when transportation to medical appointments becomes a barrier. Medicaid offers crucial support through various transportation services, ensuring beneficiaries can access necessary medical care. This guide clarifies the different types of Medicaid Transport available, how to determine your eligibility, and step-by-step instructions on arranging your rides. Understanding your Medicaid transport benefits is key to maintaining your health and well-being.

Understanding Non-Emergency Medical Transportation (NEMT)

Non-Emergency Medical Transportation (NEMT) is a vital service under Medicaid, designed for beneficiaries who need assistance getting to routine medical appointments but do not require emergency services. This encompasses doctor visits, therapy sessions, dental appointments, and other essential healthcare services. NEMT ensures that lack of transportation doesn’t prevent you from receiving the medical attention you need.

How to Access NEMT Services

Accessing Medicaid transport for non-emergency situations is typically managed through your health plan or a Fee-For-Service (FFS) transportation broker. The process generally involves contacting a designated call center to schedule your ride.

For Medicaid beneficiaries enrolled in a health plan:

• Contact your health plan’s NEMT call center. Phone numbers are usually provided by your health plan and are often listed on your membership card or health plan website.
• Schedule your transportation at least 48 hours in advance of your appointment. This advance notice allows for proper arrangements and ensures availability.

For Medicaid beneficiaries NOT enrolled in a health plan (FFS):

• Reach out to Verida, the designated Fee-For-Service (FFS) transportation broker, at (855) 325-7626.
• Similar to health plan arrangements, schedule your transport request at least 48 hours before your medical appointment.

Contact Information for Specific Health Plans:

For your convenience, here are the specific brokers and contact numbers for some major health plans. Please note that these details might change, so always verify with your health plan directly for the most up-to-date information.

• Aetna Better Health of Louisiana: Uses MediTrans. Contact them at 1(877) 917-4150 or TTY 1(866) 288-3133.
• AmeriHealth Caritas Louisiana: Uses Verida. Contact them at 1(888) 913-0364 or TTY 1(866)428-7588.
• Healthy Blue: Uses MediTrans. Contact them at 1(866) 430-1101 or TTY 1(800) 846-5277.
• Humana Healthy Horizons: Uses MediTrans. Contact them at 1 (844) 613-1638 or TTY 1(800) 618-4781.
• Louisiana Healthcare Connections: Uses MTM. Contact them at 1(855) 369-3723 or TTY 711.
• United Healthcare Community Plan: Uses ModivCare. Contact them at 1(866) 726-1472 or TTY 1(844) 488-9724.

Alt text: A non-emergency medical transportation van, representing Medicaid transport services for healthcare access.

NEMT Eligibility Criteria

To be eligible for Medicaid transport under NEMT, certain conditions must be met:

• Medicaid Enrollment with Transportation Benefits: You must be enrolled in a Medicaid program that explicitly includes transportation services as a covered benefit. Check your specific plan details to confirm this.
• Lack of Alternative Transportation: You must declare that you do not have any other means of transportation available to you. This is a crucial factor in determining eligibility for NEMT benefits.

Covered NEMT Services

NEMT services typically cover transportation via:

• Local Transit Authority (Local Buses): In some cases, public transportation options are utilized when appropriate and accessible.
• NEMT Providers: These are transportation companies contracted with your health plan’s transportation broker to provide specialized transportation services.

NEMT ensures transportation to and from Medicaid-covered medical services when no other transportation options exist. Depending on your specific health plan, transportation to additional services might also be approved. Notably, beneficiaries eligible for physical health services through Legacy Medicaid are automatically enrolled in a health plan that includes Medicaid transport services.

Attendant Policy for NEMT

For beneficiaries under the age of 17, an attendant is required during NEMT. The attendant must be:

• A parent, legal guardian, or a responsible adult designated by the parent/legal guardian.
• Capable of authorizing medical treatment and care for the beneficiary.

Attendants cannot be:

• Under 17 years of age.
• A Medicaid provider or employee of a Medicaid provider offering services to the beneficiary, with exceptions for mental health facility employees in specific situations.
• A transportation provider or employee of a transportation provider.

When transporting children, it is the responsibility of the parent or guardian to provide and properly use an appropriate child passenger restraint system, in compliance with local regulations.

Exception: Females of any age seeking prenatal or postpartum care are not required to have an attendant.

Meals and Lodging Coverage with NEMT

In situations involving long-distance travel for medical care (defined as trips exceeding 12 hours including appointment duration and travel time), Medicaid transport benefits can extend to:

• Transportation for both the beneficiary and one attendant.
• Coverage for meals, lodging, and other related travel expenses for both the beneficiary and one attendant.

This coverage applies when these expenses are necessary to ensure access to medically necessary services and are not covered by other sources like inpatient per diem, primary insurance, or other payers.

Important Comments Regarding NEMT

• Transportation Issues: If your scheduled Medicaid transport doesn’t arrive or is canceled, immediately contact your MCO/transportation broker. This allows them to promptly reassign your transport.
• Prior Approval: Generally, prior approval is not needed for standard NEMT services (ambulatory or wheelchair level) unless the destination is out-of-state.
• Scheduling in Advance: Except for urgent situations and hospital discharges, schedule your NEMT at least 48 hours in advance, excluding non-business days.
• Out-of-State Transportation: Out-of-state medical care transportation may be approved if the beneficiary has pre-authorization for out-of-state treatment and it is the nearest available option. These arrangements may require more than 48 hours for coordination.

Non-Emergency Ambulance Transportation (NEAT)

Non-Emergency Ambulance Transportation (NEAT) is another form of Medicaid transport, specifically for situations where a beneficiary’s medical condition requires ambulance services, but the situation is not an emergency. This may be necessary when other forms of transport are contraindicated due to the patient’s health status.

Accessing NEAT Services

Similar to NEMT, accessing NEAT involves contacting your health plan or the FFS transportation broker.

For Medicaid beneficiaries enrolled in a health plan:

• Contact your health plan’s call center to arrange NEAT services, ideally 48 hours before the required transport.

For Medicaid beneficiaries NOT enrolled in a health plan (FFS):

• Contact Verida at (225) 726-2800 to schedule non-emergency ambulance transport, also with a 48-hour advance notice.

Specific Health Plan NEAT Contact Information:

• Aetna Better Health of Louisiana: (877) 917-4150, [email protected], or fax (337) 366-6760.
• AmeriHealth Caritas Louisiana: (225) 726-2800, [email protected], or fax (225) 448-2017.
• Healthy Blue: (844) 349-4324, [email protected], or fax (337) 366-6760.
• Humana Healthy Horizons: (844) 613-1638, [email protected], or fax (337) 366-6760.
• Louisiana Healthcare Connections: (866) 595-8133, [email protected], or fax (480) 757-6082.
• United Healthcare Community Plan: (866) 886-4081, [email protected], or fax (877) 457-3349.

NEAT Eligibility

Eligibility for Medicaid transport via NEAT mirrors NEMT:

• Enrollment in a Medicaid program that covers transportation services.
• Demonstrated lack of other transportation options.

Ground Ambulance Covered Services Under NEAT

NEAT covers ground or air ambulance transport to and from Medicaid-covered services when a beneficiary’s condition prevents the use of other transport methods or would risk injury. A key requirement for NEAT is the Certification of Ambulance Transportation (CAT) form.

Certification of Ambulance Transportation (CAT):

• Requirement: A completed and valid CAT form is mandatory for ALL NEAT trips.
• Certification Provider: The CAT form must be certified by the beneficiary’s treating physician, registered nurse, nurse practitioner, physician assistant, or clinical nurse specialist.
• Content: The certification must confirm the medical necessity of ambulance transport and detail the medical condition necessitating this level of service.
• Timing: The CAT form must be completed before scheduling the transport.

Alt text: A non-emergency ambulance, illustrating NEAT services within Medicaid transport options.

Attendant Policy for NEAT

The attendant policy for NEAT is identical to NEMT. An attendant is required for beneficiaries under 17, with the same requirements and restrictions as outlined for NEMT. The exception for females seeking prenatal/postpartum care also applies. Child passenger restraint system guidelines are also the same as NEMT but apply to ambulances.

Comments on NEAT Services

• Prior Approval: Prior approval is required for all NEAT services, including out-of-state transport.
• Advance Scheduling: Similar to NEMT, schedule NEAT at least 48 hours in advance, excluding non-business days, except for urgent cases or hospital discharges.
• Out-of-State Medical Care: Approval for out-of-state NEAT is contingent on prior authorization for out-of-state medical treatment and its status as the nearest available option. Coordination may take longer than 48 hours.
• Transportation Issues: If issues arise with scheduled NEAT, contact the MCO/transportation broker immediately for reassignment.

Gas Reimbursement Program

Louisiana Medicaid also offers a Gas Reimbursement Program, allowing family members or friends to transport beneficiaries and receive reimbursement for gas expenses.

Gas Reimbursement Program Details

• Provider Eligibility: Family members or friends (gas reimbursement providers) must be 18 years or older and cannot reside at the same address as the beneficiary.
• Beneficiary Restriction: Beneficiaries cannot act as their own gas reimbursement providers, nor for their children.
• Reimbursement: Reimbursement is based on the total mileage of each trip, as determined by the health plan.
• Covered Services: Covers transport to Medicaid-covered services and additional services approved by the health plan.

For detailed information on participating in the Gas Reimbursement Program, contact your assigned health plan or their transportation broker. Contact numbers for brokers are listed in the NEMT section above.

Emergency Medical Services – Ambulance Transportation (EMS)

For emergency medical situations requiring immediate ambulance services, Medicaid transport also covers Emergency Medical Services (EMS).

Accessing EMS

• In Emergencies: Dial 911. For all situations requiring emergency medical services, immediately dial 911.

EMS Eligibility

• Emergency Transportation Coverage: Medicaid covers emergency transportation services for enrolled beneficiaries when medically necessary.

General Transportation Inquiries

For any questions or inquiries regarding Medicaid transport services (NEMT, NEAT, and EMS), you can reach out via email: [email protected].

Key Contacts:

• Janessa Baudoin – (225) 342-9566 or [email protected]
• Melanie Doucet – (225) 333-7473 or [email protected]

By understanding the different types of Medicaid transport and how to access them, beneficiaries can ensure they receive the medical care they need, regardless of transportation challenges. This guide aims to empower you to utilize your benefits effectively and maintain consistent access to healthcare services.