Medicaid Policy                                                                 

651-1 Exceptions to Eligibility for Non-Emergency Medical Transportation

Effective Date: January 1, 2024

Previous Policy

 

1.  Recipients who are eligible for the UPP program, or who are ONLY eligible for QMB, SLMB, QI, the QDWI program or Emergency Medicaid are not eligible for non-emergency medical transportation.

2.  Transportation is not available to obtain services from non-Medicaid providers.

3.  Transportation is not available to obtain non-Medicaid covered services.  Refer to the Dept. of Health's Benefits Chart for a guide to Medicaid-covered services.

4.  Transportation is not available to pick up prescriptions at a pharmacy UNLESS the Traditional Medicaid recipient is on the way to or from a medical appointment with a Medicaid provider.  Recipients can talk to their pharmacy about having refills mailed or delivered to them.  If the pharmacy will not or cannot mail or deliver the prescriptions (certain prescription orders cannot be phoned in by providers, and certain drugs must be picked up in person), the individual can ask for transportation to pick up the prescriptions.

a.  If the individual needs door-to-door service, he or she must follow procedures for LogistiCare services.  (The telephone number to call is 1-855-563-4403.)  Prior authorization from Logisticare may be required.

b.  If the individual can use a personal vehicle and wants mileage reimbursement, he or she can receive reimbursement if:

i.    The pharmacy cannot mail or deliver the prescriptions,

ii.   Neither the recipient nor any covered family member have any medical appointments on the day they need to pick up the prescription, and

iii.  The recipient has no other way to get the prescriptions. 

iv.  If the above three factors are met, the eligibility worker can reimburse mileage for a Traditional Medicaid Recipient to pick up prescriptions.  Prior authorization is not required for mileage reimbursement, but will only reimburse the mileage if the above three criteria are met.  Review the situation with your supervisor if needed.

5.  Transportation is not available to go to work, school, shopping, etc.  Transportation is only to be used by Traditional Medicaid recipients to obtain Medicaid-covered services from a Medicaid provider.

6.  See section 651 for special rules regarding residents of nursing homes and recipients of mental health services.