Medicaid NEMT Coverage: What's Covered & How to Get Rides
Medicaid provides non-emergency medical transportation (NEMT) as a federally mandated benefit for eligible beneficiaries. This guide explains how the Medicaid NEMT benefit works, what is covered, how to request rides in Illinois and Indiana, and when private pay may be a better option for your needs.
What Is Medicaid NEMT?
Medicaid NEMT stands for Non-Emergency Medical Transportation provided through the Medicaid program. It is a benefit that covers transportation to and from medical appointments for Medicaid beneficiaries who have no other means of getting to their healthcare providers.
The purpose of Medicaid NEMT is to eliminate transportation as a barrier to healthcare access. Studies consistently show that millions of Americans miss medical appointments each year because they lack reliable transportation. For patients with chronic conditions who require regular treatment — dialysis, chemotherapy, physical therapy, or specialist visits — missing appointments can lead to preventable hospitalizations and worsening health outcomes.
NEMT is distinct from emergency medical transportation (ambulance services). While ambulances respond to medical emergencies, NEMT provides scheduled transportation for routine, non-emergency medical needs. This includes trips to:
- ✓Doctor appointments and specialist visits
- ✓Dialysis centers and infusion clinics
- ✓Physical therapy and rehabilitation facilities
- ✓Hospital discharges (non-emergency)
- ✓Mental health and behavioral health appointments
- ✓Dental and vision appointments (when covered by the plan)
Key Fact: NEMT Is Not Optional for States
Unlike many supplemental Medicaid benefits, NEMT is a mandatory service that every state Medicaid program must provide. The federal government requires states to ensure that eligible Medicaid beneficiaries have access to transportation for covered medical services. This requirement has been in place since the Medicaid program was established in 1966.
Federal NEMT Requirements Under Medicaid
The federal mandate for Medicaid NEMT comes from 42 CFR 431.53, which requires state Medicaid agencies to ensure necessary transportation for beneficiaries to and from medical providers. This regulation reflects the understanding that healthcare access depends on the ability to physically reach healthcare facilities.
Under the federal framework, states have flexibility in how they deliver the NEMT benefit. The most common models include:
Managed Care Organization (MCO) Model
The state contracts with MCOs to provide Medicaid services, and the MCO is responsible for arranging NEMT for its members. The MCO typically contracts with transportation providers or uses a transportation broker. Illinois and Indiana both use this model for most Medicaid beneficiaries.
Transportation Broker Model
The state or MCO contracts with a transportation management company (broker) that coordinates ride requests, assigns providers, and manages the logistics. The broker serves as the intermediary between the patient and the transportation provider.
Fee-for-Service (Direct) Model
Some states manage NEMT directly through their Medicaid agency, reimbursing transportation providers on a fee-for-service basis. This model is less common but still used in certain states and for certain populations.
Regardless of the delivery model, federal law requires that transportation be provided in the most appropriate and least costly manner. This means a patient who can ride in a sedan will not be assigned a wheelchair van, and a patient who needs a stretcher will not be placed in an ambulatory vehicle.
Federal Requirements at a Glance
- ✓States must assure necessary transportation for Medicaid beneficiaries
- ✓Transportation must be to and from Medicaid-covered services
- ✓The mode of transport must match the patient's medical needs
- ✓Prior authorization may be required but cannot create unreasonable barriers
- ✓States may use MCOs, brokers, or direct management to deliver the benefit
State-by-State Medicaid NEMT: Illinois & Indiana
Dream Care Rides operates primarily in Illinois and Indiana, two states with distinct Medicaid NEMT structures. Here is how each state administers the transportation benefit and which managed care organizations coordinate rides.
Illinois Medicaid NEMT
Illinois Medicaid is administered by the Illinois Department of Healthcare and Family Services (HFS). The majority of Illinois Medicaid beneficiaries are enrolled in managed care through the HealthChoice Illinois program. Each MCO is responsible for arranging NEMT for its members.
Illinois Medicaid MCOs with NEMT Responsibility
One of the largest MCOs in Illinois, serving members across Cook County and statewide. Meridian coordinates NEMT through contracted transportation providers.
Serves Illinois Medicaid members with a network of transportation providers. Members call Molina's transportation line to schedule NEMT.
Operated by Cook County Health, CountyCare serves Cook County Medicaid members with locally focused transportation coordination.
Provides Medicaid managed care in Illinois with NEMT arranged through their transportation coordination department.
The Medicaid managed care plan from Blue Cross Blue Shield of Illinois. Coordinates NEMT through a centralized transportation benefit management system.
How Illinois Medicaid NEMT Works
- 1Contact your MCO's transportation department (the phone number is on the back of your Medicaid card)
- 2Provide your appointment details: date, time, location, and the type of medical service
- 3The MCO verifies your eligibility and the medical appointment
- 4A transportation provider is assigned based on your location, mobility needs, and vehicle availability
- 5You receive confirmation with your pickup time and provider information
Indiana Medicaid NEMT
Indiana Medicaid is administered by the Family and Social Services Administration (FSSA). Indiana operates several Medicaid programs, each with its own NEMT coordination structure.
Key Indiana Medicaid Programs
Indiana's Medicaid expansion program for adults ages 19 through 64. HIP members access NEMT through their assigned managed care entity. The program serves low-income adults who do not qualify for traditional Medicaid categories.
Indiana's Medicaid managed care program for children, pregnant women, and certain low-income families. Hoosier Healthwise members receive NEMT through their managed care plan.
Serves aged, blind, and disabled Medicaid beneficiaries in Indiana. Members in this program often have the highest NEMT utilization due to chronic conditions and mobility limitations.
How Indiana Medicaid NEMT Works
Indiana Medicaid NEMT follows a similar process to Illinois. Members contact their managed care entity's transportation department to schedule rides. Indiana typically requires 48 to 72 hours advance notice for routine appointments. For recurring medical needs such as dialysis, standing transportation orders can be established.
For detailed information about coverage areas, visit our Illinois coverage page or our Indiana coverage page.
Medicaid NEMT Eligibility Requirements
To qualify for Medicaid NEMT, you generally must meet all of the following criteria. These requirements apply across all states, though specific documentation and verification processes vary.
Active Medicaid Enrollment
You must be currently enrolled in a Medicaid plan in your state. This includes traditional fee-for-service Medicaid, managed care plans, and Medicaid expansion programs (such as the Healthy Indiana Plan). Your enrollment must be active at the time of the transportation request.
Medicaid-Covered Medical Appointment
The trip must be to a medical appointment or service that is covered under your Medicaid plan. This includes visits to doctors, specialists, hospitals, dialysis centers, rehabilitation facilities, and other approved healthcare providers.
No Other Available Transportation
You must demonstrate that you do not have access to other means of transportation. This does not necessarily mean you must have zero access to a vehicle — it means that transportation represents a genuine barrier to receiving your medical care. Factors considered include disability, lack of a vehicle, lack of a licensed driver in the household, and distance to the provider.
Prior Authorization (When Required)
Most Medicaid NEMT requires prior authorization from your MCO or the state Medicaid agency. This typically involves calling the transportation department 48 to 72 hours before your appointment. The authorization verifies your eligibility, confirms the medical appointment, and assigns the appropriate vehicle type.
Types of Trips Covered by Medicaid NEMT
Medicaid NEMT covers a wide range of medically necessary trips. The following are the most common trip types covered under the benefit:
Routine Medical Visits
Primary care appointments, annual checkups, follow-up visits, and preventive care screenings. These are the most common trips covered under Medicaid NEMT.
Specialist Appointments
Visits to cardiologists, oncologists, pulmonologists, neurologists, and other medical specialists when referred by your primary care physician.
Dialysis Treatment
Recurring transportation to and from dialysis centers, typically three times per week. Dialysis is one of the highest-volume NEMT trip types due to its recurring nature. Learn more about NEMT for dialysis patients.
Physical Therapy & Rehabilitation
Transportation to physical therapy, occupational therapy, speech therapy, and rehabilitation sessions. These trips are often recurring, ranging from twice to five times per week.
Hospital Discharges
Transportation home after a hospital stay or to a skilled nursing facility, rehabilitation center, or other post-acute care setting. See our hospital discharge transportation guide.
Mental & Behavioral Health
Appointments with psychiatrists, psychologists, counselors, and behavioral health providers are covered under Medicaid NEMT when the service is a Medicaid-covered benefit.
What Is Typically NOT Covered
Medicaid NEMT generally does not cover transportation for:
- ✗Non-medical trips (grocery shopping, social visits, errands)
- ✗Services not covered under your Medicaid plan
- ✗Appointments that could be handled via telehealth when telehealth is available
- ✗Transportation when the member has other available means
Need a Ride to a Medical Appointment?
Whether you use Medicaid NEMT or private pay, Dream Care Rides provides safe, reliable medical transportation with trained attendants and specialized vehicles.
How to Request a Medicaid NEMT Ride
The process for requesting a Medicaid NEMT ride depends on your state and managed care plan. Here is the general step-by-step process that applies to most Medicaid programs in Illinois and Indiana.
Locate Your MCO's Transportation Number
Find your MCO's member services or transportation department phone number. This is typically printed on the back of your Medicaid insurance card. You can also find it on your MCO's website or by calling the general member services line.
Call at Least 48-72 Hours in Advance
Most MCOs require a minimum of 2-3 business days advance notice. When you call, have the following information ready: your Medicaid ID number, appointment date and time, provider name and address, type of medical service, and any special transportation needs (wheelchair, stretcher, oxygen).
Receive Ride Confirmation
After your request is processed, you will receive confirmation of your ride with a pickup time window and the assigned transportation provider. Some MCOs provide confirmation via phone, text, or through a member portal.
Be Ready at Your Pickup Time
On the day of your appointment, be ready at your designated pickup location within the pickup time window (typically a 15-30 minute window before your scheduled pickup time). Have your Medicaid card and photo ID available.
For Return Trips, Notify After Appointment
Many Medicaid NEMT services handle return trips as “will call” — meaning you or the medical facility contacts the transportation provider when your appointment concludes. Some providers schedule the return trip for a pre-set time. Confirm the return process when you book.
Tip: Set Up Standing Orders for Recurring Appointments
If you have regular medical appointments (such as 3x weekly dialysis), ask your MCO about setting up a standing transportation order. This eliminates the need to call before every appointment and ensures a vehicle is automatically scheduled for each recurring trip.
Managed Care Organizations (MCOs) and NEMT
In most states, including Illinois and Indiana, Medicaid managed care organizations are the primary entities responsible for arranging and funding NEMT. Understanding the MCO's role helps you navigate the system more effectively.
What MCOs Do for NEMT
- 1Contract with Transportation Providers
MCOs build networks of NEMT providers — including companies like Dream Care Rides — that meet their quality, safety, and credentialing standards. These contracted providers handle the actual transportation.
- 2Authorize and Schedule Rides
When a member requests transportation, the MCO (or its broker) verifies eligibility, authorizes the trip, and assigns a provider. This process ensures the appropriate vehicle type and service level match the patient's needs.
- 3Pay the Transportation Provider
The MCO reimburses the transportation provider directly. The Medicaid beneficiary does not pay out of pocket for authorized NEMT trips.
- 4Monitor Quality and Compliance
MCOs track on-time performance, complaint rates, and safety records of their transportation providers. This oversight helps maintain service quality across the network.
Dream Care Rides as an MCO-Contracted Provider
Dream Care Rides works with multiple Medicaid MCOs in Illinois and Indiana as a contracted transportation provider. This means that when your MCO assigns Dream Care Rides to your trip, you receive the same professional, compassionate service we provide to all patients — trained transportation attendants, ADA-compliant vehicles, and reliable scheduling.
For more information about our MCO partnerships, visit our MCOs & Health Plans page.
Common Challenges with Medicaid NEMT
While Medicaid NEMT is a valuable benefit, patients frequently encounter challenges that can make the experience frustrating. Understanding these common issues helps you prepare and know your options.
Late Pickups and No-Shows
One of the most common complaints about Medicaid NEMT is unreliable scheduling. Because MCOs and brokers assign providers based on availability and cost, the assigned provider may be managing a heavy load, leading to late arrivals or missed pickups entirely. This can cause patients to miss critical medical appointments.
Long Wait Times After Appointments
Return trips are often handled on a “will call” basis, meaning you must wait for a vehicle to be dispatched after your appointment ends. Wait times can range from 30 minutes to several hours, leaving patients stranded at medical facilities.
Advance Notice Requirements
The 48-72 hour advance notice requirement can be challenging when medical needs arise unexpectedly. Urgent appointments, same-day follow-ups, or last-minute schedule changes may not be accommodated through the Medicaid NEMT system.
Limited Provider Choice
Under Medicaid, you typically cannot choose your transportation provider. The MCO or broker assigns whichever provider is available, which means you may have a different driver and vehicle each time. For patients who value consistency — particularly elderly patients or those with cognitive impairments — this lack of continuity can be distressing.
Authorization Denials and Delays
Some trip requests are denied due to eligibility issues, missing documentation, or the MCO determining that the trip is not medically necessary. Authorization delays can also prevent timely scheduling, particularly for time-sensitive appointments.
Key Insight: These challenges are systemic to how Medicaid NEMT is administered, not unique to any single provider. They arise from the intermediary layers (MCOs and brokers) between the patient and the transportation provider. Private pay eliminates these intermediaries entirely.
Private Pay: A Reliable Alternative for Medicaid Patients
Even if you have Medicaid coverage for NEMT, there are situations where paying privately for medical transportation makes sense. Private pay gives you direct control over your ride — no broker, no authorization, no uncertainty.
When Private Pay Makes Sense for Medicaid Members
When you cannot afford to be late — pre-surgical consultations, time-specific procedures, or appointments with narrow scheduling windows. Private pay guarantees your pickup time.
When an urgent medical need arises and you cannot wait 48-72 hours for Medicaid authorization. Private pay allows same-day or next-day booking.
When you want the same provider and driver every time for comfort and continuity. Private pay lets you choose Dream Care Rides directly, without MCO or broker assignment.
When you need a specific service level — such as door-through-door, hand-to-hand, bed-to-bed, or room-to-room — that may not be routinely authorized through Medicaid. Private pay gives you access to all six service levels: Curb-to-Curb, Door-to-Door, Door-through-Door, Hand-to-Hand, Bed-to-Bed, and Room-to-Room.
When no-shows, late arrivals, or poor experiences with MCO-assigned providers have caused you to miss appointments. Private pay eliminates the uncertainty.
Private Pay vs Medicaid NEMT Comparison
| Feature | Medicaid NEMT | Private Pay |
|---|---|---|
| Cost | No cost to patient | Patient pays directly |
| Scheduling | 48-72 hours advance notice | Same-day or next-day available |
| Provider Choice | Assigned by MCO/broker | You choose your provider |
| Authorization | Required for each trip | None needed |
| Service Levels | Limited by authorization | All 6 levels available |
| Reliability | Varies by assigned provider | Guaranteed scheduling |
For transparent pricing on private pay rides, visit our NEMT Cost Guide or view our Rates & Pricing page.
Book a Private Pay Ride
Skip the authorization process. Get a transparent, upfront price and guaranteed scheduling for your next medical appointment.
Dream Care Rides & Medicaid Transportation
Dream Care Rides serves Medicaid patients through two pathways: as a contracted provider within MCO networks, and as a private pay option for patients who want direct booking and guaranteed service.
MCO-Contracted Provider
Dream Care Rides works within MCO networks as a contracted transportation provider. When your MCO assigns us to your trip, you receive our full service at no cost to you.
Private Pay Option
Any patient can book directly with Dream Care Rides using private pay. No authorization needed, transparent pricing, and guaranteed scheduling.
Our Service Types for Medicaid & Private Pay Patients
Regardless of how you access our service, Dream Care Rides offers a full range of NEMT vehicle and service options:
Ambulatory Transportation
Comfortable sedan or SUV transport for patients who can walk with minimal assistance. Trained drivers provide door-to-door support.
Wheelchair Transportation (Standard & XL/Bariatric)
ADA-compliant vans with hydraulic lifts and wheelchair securement systems. Standard and XL/bariatric wheelchair accommodations available for patients of all sizes.
Stretcher Transportation
Specialized medical vehicles with a two-person crew for patients who must remain reclined. Includes conventional gurney and Broda Traversa stretcher alternative with adjustable positioning.
Six Service Levels
Curb-to-Curb
Vehicle-side pickup
Door-to-Door
Entrance assistance
Door-through-Door
Inside facility help
Hand-to-Hand
Caregiver handoff
Bed-to-Bed
Complete transfer
Room-to-Room
Full facility escort
Get Started with Dream Care Rides
Whether through your Medicaid MCO or private pay, Dream Care Rides delivers safe, reliable medical transportation with trained attendants and specialized vehicles. Book online or call us today.
Frequently Asked Questions About Medicaid NEMT
Yes. Non-emergency medical transportation (NEMT) is a federally mandated benefit under Medicaid. All state Medicaid programs are required to provide transportation to and from covered medical appointments for eligible beneficiaries who have no other means of transportation. The specific implementation varies by state, but the benefit itself is guaranteed under federal law.
To qualify for Medicaid NEMT in Illinois, you must be enrolled in an Illinois Medicaid plan (either fee-for-service or through a Managed Care Organization like Meridian, Molina, CountyCare, Aetna Better Health, or Blue Cross Community). You must be traveling to a Medicaid-covered medical appointment and must not have other available means of transportation. Your MCO or the state manages the authorization process.
Most Medicaid MCOs and transportation brokers require a minimum of 48 to 72 hours advance notice for non-emergency medical transportation requests. Some plans may allow shorter notice for urgent (but non-emergency) medical needs. For recurring appointments like dialysis, you can often set up a standing ride schedule so you do not need to call before each trip.
Under most Medicaid managed care plans, the MCO or transportation broker assigns the NEMT provider. However, some plans allow members to request a specific contracted provider. If Dream Care Rides is a contracted provider within your MCO network, you may be able to request us by name. Contact your MCO's transportation department to ask about provider preferences.
Medicaid NEMT covers the vehicle type appropriate for the patient's medical condition and mobility level. This includes sedans and SUVs for ambulatory patients, wheelchair-accessible vans with hydraulic lifts for wheelchair users, and stretcher vehicles for patients who must remain in a reclined position. The transportation provider and MCO determine the appropriate vehicle based on the patient's documented needs.
Coverage for pharmacy and medical equipment trips varies by state and specific Medicaid plan. In general, Medicaid NEMT is designed for transportation to and from covered medical services. Some states and MCOs include pharmacy trips if no pharmacy delivery option is available and the prescription is medically necessary. Contact your MCO to verify coverage for specific trip types.
If your scheduled Medicaid ride does not arrive, contact your MCO's transportation hotline immediately. They are required to arrange alternative transportation. If the missed ride causes you to miss a medical appointment, document the incident and file a complaint with your MCO. Repeated no-shows may be grounds for switching providers. This is one reason many patients choose private pay for critical appointments — it eliminates the uncertainty.
Yes. Having Medicaid does not prevent you from paying privately for NEMT. Many Medicaid beneficiaries choose private pay for time-sensitive appointments, when they want to guarantee scheduling, or when they prefer a specific provider. With private pay, there is no pre-authorization, no broker intermediary, and no risk of last-minute provider changes. You book directly with Dream Care Rides and receive a transparent, upfront price.
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