Medicaid Policy
Medicaid Policy
There are different modes of transportation to meet the needs of Traditional Medicaid recipients. Non-emergency medical transportation includes: UTA Transit Cards, personal transportation reimbursement, special bus services (Flex Trans), and ModivCareTransport for door-to-door services.
A. UTA Transit Card (Wasatch Front)
1. Traditional Medicaid recipients living within the UTA service area who need transportation to and from medical treatment and covered mental health services may request a UTA Transit Card. If a Traditional Medicaid recipient does not have a UTA Transit Card, direct them to MyBenefits (https://mybenefits.utah.gov) to request one. If a Medicaid recipient does not have access to the internet or needs help, they may call a Health Plan Representative (HPR) at 1-844-238-3091.
· Medicaid recipients will use the same card for as long as they remain eligible.
· Individuals in wheelchairs who can get to bus stops may be able to use regular bus services. They should call UTA to see if the bus they need accommodates wheelchairs.
2. UTA Transit Cards can only be used by Traditional Medicaid recipients, parents/guardians and an attendant if needed. Coverage for an attendant to accompany Traditional Medicaid recipients is allowed for recipients that require assistance during transportation for medical reasons (physical or mental).
· For more information on who qualifies for an attendant, please visit medicaid.utah.gov › Documents › pdfs › Medicaid_Member_Guide.
· For more information on parents/guardians who need to accompany children under age 18, please visit medicaid.utah.gov › Documents › pdfs › Medicaid_Member_Guide.
3. Recipients eligible for the UPP program and those ONLY eligible for QMB, SLMB, QI, QDWI or Emergency Medicaid are not eligible for non-emergency medical transportation.
4. When members need curb-to-curb or door-to-door service because of a disability or medical condition, tell them about UTA Flex Trans Service, ModivCare Medical Transport services, or mileage reimbursement if they could be transported in a personal vehicle. (See items #2, #3 & #4 below.)
5. Parents with small children who are eligible for Medicaid may request personal mileage reimbursement instead of a UTA Transit Card to go to their children's appointments. This is because traveling with small children and strollers, etc., may be too difficult for public transportation. It may also be more cost effective if they must take all the children with them at the same time.
6. Traditional Medicaid recipients who make infrequent trips for medical services may request mileage reimbursement instead of a UTA Transit Card if it will be more cost effective. Infrequent trips would be an average of 1-3 trips a month or less (or about $10-$12 or less in mileage reimbursement in a month.) Refer to Sec. 651-3 for more information about when to use mileage reimbursement. If a recipient begins making more frequent trips and can use regular bus services, they will need to start using UTA instead of receiving a mileage reimbursement.
7. Do not reimburse mileage for members who receive a UTA Transit Card in the same month unless they verify why they could not use their UTA Transit Card to get to an appointment. For example: when a member has to travel out of the public transit service area to get needed medical care. Workers may require verification of appointments before approving a mileage reimbursement.
B. Special Bus Services - Curb-to-Curb: UTA Flex Trans
Special paratransit bus services are available for Traditional Medicaid recipients who have a functional inability to use the regular UTA bus service, need curb-to-curb service, and live in Box Elder, Salt Lake, Weber, Davis, Tooele, or Utah counties. The recipient must obtain a physician's certificate indicating the need for transportation.
1. If the physician's certificate indicates the person can ride the bus, the recipient cannot receive special bus services.
If the physician's certificate indicates the person can use curb-to-curb service, the recipient is required to apply for paratransit services from UTA Flex Trans along the Wasatch Front.
o To schedule an appointment at the UTA Mobility Center to determine functional inability to use buses and Trax, members should call 801-287-7433 in Salt Lake and Davis Counties; Box Elder, Weber, Utah, Davis and Tooele counties, call 877-882-7272. If you use a TDD, call a relay operator at 711 and then give the above number.
o Dial-A-Ride: Call CATS, 1-435-865-4510
2. UTA Transit Cards are not valid for special bus services. To use special bus services, recipients must have a "Special Medical Transportation Card." Once you have qualified for paratransit services from UTA Flex Trans, call the Medicaid office at (801) 538-6155 or 1-800-662-9651 to request the monthly stickers.
The recipient will then arrange needed trips with UTA Flex Trans.
3. Specialized Transportation - ModivCare
a. When a Traditional Medicaid recipient is denied paratransit services from UTA Flex Trans, or is outside the UTA service areas, the recipient may be eligible for ModivCare Services. If the household has a licensed vehicle, the recipient is not eligible for ModivCare services unless there is no one available to drive or the physician’s statement says that the person cannot be transported in a private vehicle. (Exceptions may be made for members with chronic conditions that require constant medical attention.) Recipients may receive ModivCare services for up to four weeks while they are obtaining the physician's statement.
b. ModivCare is available from 8:30 a.m. to 5:30 p.m. Monday through Friday. Some limited services are available on Saturdays and holidays to accommodate dialysis patients. Transportation for urgent care needs is available to free-standing urgent care facilities, doctor's offices or an after-hour clinic from 7:00 a.m. to 11:00 p.m. Requests for transportation for urgent care needs may be verified with the provider to assure that it is not a prescheduled appointment.
c. Requests for ModivCare services must be made 3 business days before the transportation is needed. Requests for appointments on Mondays must be made by the previous Wednesday. Recipients should not schedule the transportation several days in advance if they are not sure they will be going to the appointment. Cancellations and rescheduling are costly for the provider and can cause inconvenience to other riders.
d. ModivCare provides various methods of transport to accommodate the needs of the recipient. They will provide the most appropriate method of transport based on the needs of the recipient.
e. To schedule transportation for Traditional Medicaid recipients with ModivCare Medical Transport, recipients need to call 855-563-4403 weekdays between 8:30 a.m. and 5:30 p.m.
f. Recipients who will use ModivCare services need to receive a copy of the Medicaid Transportation Riders Guide. This guide will tell them what information they need to provide to ModivCare along with the rules and requirements for using this service.
g. Recipients must tell ModivCare if they travel with a service animal, or if they have a medically necessary attendant who must travel with them. If the recipient is a child, a parent or guardian may accompany the child. Other family members are not to be transported.
C. Other Transportation Services
1. Cache Valley Transit District
Provides free bus service to the Cache Valley area, for routes and schedules visit cvtdbus.org.
2. Cedar Area Transportation Services (CATS)
Traditional Medicaid recipients who need transportation, and are able to use the bus, may use CATS for transportation to and from medical appointments. Medicaid recipients living in an area serviced by CATS will not be issued a bus pass or a UTA Transit Card. Members using CATS will need to show their Medicaid card along with a photo ID.
3. Park City Transit
Provides free bus service in Park City and the surrounding area including Summit Park, Kimball Junction, Canyons, Deer Valley and Kamas. For routes and schedules visit parkcity.org.
4. SunTran
Provides bus service for St. George, Ivins, Santa Clara and Washington. For information about fares, routes and schedules, visit sgcity.org.
D. Personal Transportation
Some Traditional Medicaid recipients may receive mileage reimbursement for using personal vehicles (car, truck, etc.) to travel to and from their medical appointments. Traditional Medicaid recipients may also be reimbursed for overnight costs (lodging & food costs) under certain circumstances. The local office will reimburse Traditional Medicaid recipients for mileage and overnight expenses.
1. When Personal Transportation Costs May be Reimbursed
For specific information on when Traditional Medicaid recipients may receive mileage reimbursement for using personal transportation, and when overnight costs may be reimbursed, refer to the following sections:
a. Mileage reimbursement for travel within the local area, see section 651-3.
b. Mileage and overnight costs (lodging & food) reimbursement for travel outside of the local area, see section 651-4.
c. Mileage reimbursement for multiple trips on the same day, see section 651-5.
d. Rates and method of reimbursement for mileage and overnight costs for lodging & food, see section 651-6. Limits apply.
2. Specific Limitations on Reimbursing Personal Transportation Costs
a. Do not reimburse mileage for portions of a trip an individual travels to pick up the Traditional Medicaid recipient or to return home after leaving the recipient at a medical facility. Reimburse mileage only for the portions of the trip when the recipient is being transported to or from medical treatment.
b. Do not reimburse individuals who travel to visit a Traditional Medicaid recipient who is receiving medical treatment. The purpose of the trip is to visit and not to obtain a Medicaid covered service from a Medicaid provider, so transportation costs cannot be reimbursed. Reimbursement is only available when the Traditional Medicaid recipient is being transported.
c. When multiple trips are made on the same day to receive medical treatment, some mileage reimbursement limitations exist. See section 651-5 for more information.
3. Who May be Reimbursed for Personal Transportation
a. Either a Traditional Medicaid recipient or an individual who takes a Traditional Medicaid recipient to and from medical appointments may receive mileage reimbursement. Only reimburse mileage for personal transportation used to obtain a Medicaid covered service from a Medicaid provider. Only reimburse actual mileage for trips made to and from medical appointments; i.e., the Traditional Medicaid recipient must be on board going to or from their appointment.
b. When two or more Traditional Medicaid recipients travel together to their medical appointments, the reimbursement amount can only be equal to the mileage rate times the actual miles traveled. Payment for mileage is usually made to only one recipient. If one of the Traditional Medicaid recipients is the owner of the vehicle, the owner should be reimbursed for mileage. If another individual transports two or more Traditional Medicaid recipients at the same time, only the actual miles traveled can be reimbursed and usually just to one recipient. Do not reimburse both recipients for the total miles traveled.
[When reimbursements are done through the EBT system, the reimbursements can only be made to a recipient. When two recipients travel together, though, only reimburse one of them.]