Medicaid is nation-wide program that is provided to low-income individuals who need access to quality healthcare and healthcare related services but who are unable to afford the costs. The Medicaid program is known as MO HealthNet in Missouri. Eligibility for the program depends on financial resources, assets, disabilities, and other relevant factors. Currently, Medicaid in Missouri is available to the elderly, pregnant women and infants, the blind, deaf, and disabled, and low-income families in need of medical care and it covers the following healthcare visits and situations:
● In-patient and out-patient care
● Nursing facility services
● Emergency dental care and visits
● Coverage of medical durable equipment
● Services provided by an in-network primary care physician
● Emergency room visits
● X-rays
● Testing and treatment of certain specified diseases
● Doctors visits
● Home health services
● Laboratory testing
● Nurse/midwife services
● Family planning services
● Pediatric care (for children)
● Smoking cessation therapy for pregnant women
● Transportation to and from medical establishments (including doctors offices, hospitals, and other designated, specialized facilities)
There are also certain optional or case-specific services that are covered by Medicaid for individuals in need. Some of these services include:
● Dental visits
● Psychiatric care and visits
● Rehabilitation services
● Mental health care
● And more…
In addition to other federally required health services, MO HealthNet covers transportation to and from medical establishments (including doctors offices, hospitals, and other designated facilities) in both emergency and non-emergency situations. Emergency transportation, such as ambulance services, as well as non-emergency medical transportation (taxis, private buses, etc.) are covered by Medicaid in Missouri, but the coverage details of each are somewhat different and case-specific.
For Missouri Medicaid recipients, emergency transportation to a medical facility is always covered. However, non-emergency transportation isn’t always covered by Medicaid; the non-emergency trips that are covered by Medicaid must meet a certain set of criteria and be scheduled correctly. Nonetheless, according to federal law any visit to or from a healthcare facility can be covered by Medicaid. In Missouri, that means that the transportation costs incurred from any visit to the doctor, the hospital, dentist, or any other healthcare practitioner or office are able to be covered by Medicaid.
The forms of transportation covered by Medicaid in Missouri include:
● Walking
● Driving
● Wheelchair van
● Public transportation (including buses and the metro/subway)
● Taxi
● Private car
● Ambulance
● Ambulette
● Airplane (medical evacuation and/or commercial flight)
Medicaid recipients who need transportation will be eligible for different types of transportation based on their individual situation and the location of the medical appointment. Although all emergency transportation is covered by Medicaid, non-emergency medical transportation is not always granted to Medicaid recipients in every situation. If a particular individual is not able to walk or drive themselves to a medical appointment, they are then able to apply for and schedule a ride with an appropriate vehicle and provider. However, if the person is able to walk or drive (and they hold a valid driver’s license), they may not be granted transportation. Proof of the need for transportation to an appointment must be given before any ride is accepted.
For non-emergency medical appointments, transportation to the following appointments is frequently granted and covered for individuals on the Missouri Medicaid Managed Care Plan:
● Primary care provider (PCP) visits
● Obstetrician appointments (for prenatal and postnatal care)
● Pediatrician appointments
● Dental appointments
● Eye exams
● Behavioral health appointments
● Physical therapy
● Counseling/therapy appointments
● Hospital discharges
● Lamaze and other birthing classes
Transportation to other types of appointments may also be covered. If you have doubts about which type of transportation or in which situation you would qualify to receive as non-emergency medical transportation coverage, call your Medicaid insurance provider directly for clarification. Although most MO HealthNet and MO HealthNet Managed Care recipients are eligible for the Non-Emergency Medical Transportation program in Missouri, there are some cases when a person may not be granted coverage for these non-emergency services. Nonetheless, emergency transportation will still be covered by law.
Non-Emergency Medical Transportation in Missouri
The Non-Emergency Medical Transportation (NEMT) program in Missouri is designed to ensure that Medicaid recipients receive coverage for the transportation fees for any healthcare-related trip to Medicaid-network practitioners. Medicaid enrollees who qualify to participate in the NEMT program will receive coverage for transportation to and from an appointment with a healthcare practitioner or establishment that accepts MO HealthNet or MO HealthNet Managed Care. Generally, the NEMT program only covers the costs of trips to locations close to home, but in some special cases Medicaid recipients must travel further for specialized medical care. If this is the case, an appeal must be made with verifiable reasons for why the individual must travel farther from home for medical care.
The NEMT program has certain exceptions, and not all non-emergency medical transportation services are covered. Some of the types of appointments for which transportation to/from the appointment might not be covered include:
● Developmental Disability (DD) Waiver Services
● Adult day care services
● Some Comprehensive Substance Abuse and Rehabilitation (CSTAR) services
● Some Community Psychiatric Rehabilitation (CPR) services
● Certain Durable Medical Equipment services (such as repairs)
● Pharmacy visits
For children who go to school and need transportation services, the school district is responsible for supplying a ride plan for each child’s Individual Education Plan (IEP) and IEP-related medical services.
NEMT does not cover or take responsibility for covering the costs of transportation for the above services. Medicaid transportation covered by NEMT requires that the participant pay $2 per trip (regardless of whether the trip is one-way or round-trip), although a ride cannot be denied if the Medicaid recipient is unable to pay the $2. Recipients on a Managed Care Health Plan do not have to pay anything, and neither do pregnant women, children under age 19, blind individuals, or people who live in a nursing home. NEMT also does not require the $2 payment if you are using public transportation or are receiving Medicaid coverage to pay for gas.
How do Medicaid enrollees get transportation?
Medicaid enrollees are encouraged to request transportation approximately 3 days in advance in the case of a non-emergency medical visit. Same-day transportation can only be scheduled in the case of a visit to an Urgent Care center or to a primary care physician or an obstetrician and requires that enrollees provide no less than three hours of notice before the scheduled ride. In Missouri, Medicaid recipients can either contact a qualified, in-network transportation provider directly to schedule a ride, or they can go through LogistiCare or MO Rides.
When scheduling medical transportation, it’s very important to let the service provider know in advance if you will be bringing any other passengers or luggage with you. For children under the age of 17, Medicaid requires that the child travel with a parent or guardian and covers the transportation costs for one extra passenger (any extra passengers will not be covered in this case). Individuals under the age of 21 must travel with another adult, and the cost of this person’s transport will also be covered. For individuals traveling with babies or small children, ask the service provider in advance if a car seat can be provided. Luggage is (within moderation) almost always allowed in Medicaid-approved transport vehicles.
When a Medicaid recipient contacts a transportation provider or uses the MO HealthNet number to schedule a ride, they must have the following information/documentation available during the call:
● Basic person information (full name, birth date, and home address)
● MO HealthNet ID number
● Name, address, and phone number of the destination
● Date and time of the appointment
● Medical reason for transportation
● Type of MO HealthNet service to be covered (doctor’s visit, psychotherapy appointment, dental visit, etc.)
● Any special needs or requests (individuals who are in wheelchairs, for example, will need to voice this disability)
● Express the age of the patient scheduling the the ride (if the patient is under age 21 or age 17 they will need a companion to ride with them)
When scheduling Medicaid-approved transportation, the operator may ask other questions or request extra information in addition to what is listed above. Be prepared to answer and provide the necessary details during the call so that your ride will be accepted. Medicaid recipients are all eligible in Missouri to receive medical transportation coverage as long as they have no other way to reach their appointment and they have followed the rules to schedule their ride in advance through the appropriate channels.
To schedule non-emergency transportation directly through the NEMT Medicaid program, call (866) 269-5927. Regular, non-urgent appointments can be made between 8am and 5pm, Monday through Friday. For emergency or urgent appointments or for hospital discharges, operators are available to take calls 24 hours a day, 7 days a week. Scheduling transportation five days in advance of the appointment is ideal, but three days is acceptable for most situations.
If your NEMT ride is late by more than 15 minutes, contact (866) 269-5944 right away and explain the situation. Arrangements will be made to help you still get to your appointment on time. Individuals who are a part of a Medicaid Managed Care plan will need to call the phone number on the back of their Medicaid card instead of the one shown above. If you cancel your appointment and no longer need transportation or if you need to reschedule the transportation for a different day, contact the transportation provider or the NEMT program directly about the change of plans.
Medicaid recipients in Missouri are eligible to use the following forms of transportation to get to and from medical centers in emergency and/or non-emergency situations:
Walking
According to Logisticare, Medicaid recipients who live within 10 blocks of the location of their medical appointment and who are ambulatory (able to walk and navigate) are encouraged to walk to their appointments rather than schedule transportation. Walking is a form of transportation that is completely free both to the Medicaid recipient as well as to the state of Missouri.
Driving
Medicaid recipients who wish to drive their own car to a medical appointment may be eligible to receive coverage for the cost of gas. Mileage coverage may be covered in certain cases. However, the request to drive to and from appointments must be approved by NEMT in advance by submitting the appropriate paperwork, and coverage is only permitted in some situations. Individuals may only drive themselves and receive coverage if they are mentally, physically, and legally able to do so.
Public Bus
Individuals with Medicaid coverage in Missouri who live in a city and wish to use the public transportation systems, including public buses, can inquire with the bus company as to whether or not they can ride for free. Most public transportation in Missouri is covered by Medicaid for no extra fee when it’s used to get to or from medical appointments. Medicaid recipients may be required to present verification that they are indeed a part of the Medicaid program whenever they choose to use the public bus to go to a medical appointment.
Taxi
Taxi services are considered a form of public transportation and are covered by Medicaid, but not all taxi companies are in the Medicaid network. If you want to book a taxi for your next medical appointment, you must call a Missouri non-emergency medical transportation broker, like Logisticare, to arrange a Medicaid-approved taxi ride. Just like with other forms of non-emergency medical transportation, Medicaid recipients must schedule their taxi ride in advance 3 days before their appointment.
Private Car/Wheelchair Van
Private transportation services are available to certain eligible individuals who receive Medicaid coverage. There are many private car transportation companies in Missouri that offer comfortable, secure, Medicaid covered transport services to and from medical appointments. Disabled individuals in a wheelchair can request special transport to accommodate their needs. Generally speaking, if the Medicaid recipient uses private transportation most often in their daily lives for non-medical trips, it’s likely that they will be approved for coverage to travel in a private car for non-emergency medical visits.
Ambulance
Emergency ambulance services are covered by Medicaid in Missouri. Non-emergency ambulance rides are covered according to the same rules as other forms of non-emergency transport, including that patients must pay $2 per trip and must schedule the trip either 3 days or 3 hours in advance, depending on the circumstances.
Ambulette
An ambulette is a non-emergency vehicle that is designed to transport individuals who are not ambulatory (they are unable to walk to the vehicle by themselves) and who may need to travel with medical equipment. An ambulette is almost identical to an ambulance, except it does not have the same amount of medical equipment as an ambulance and it may be smaller. Ambulette rides are covered by Medicaid in Missouri so long as the Medicaid recipient can prove that they require extra assistance when traveling.
Ambulette rides include the participation of trained assistants who are able to help the Medicaid traveler at all stages of the journey. Gurneys, specialized medical equipment, and other tools and equipment are available to make the trip smoother and more comfortable. Depending on the specific needs of the Medicaid recipient, the patient riding in the ambulette can expect to receive assistance for all aspects of moving that are necessary for the ride.
Airplane
Emergency and non-emergency airplane transportation may be available and covered for some Medicaid enrollees. Individuals who require transportation to a medical appointment via airplane travel will need to prove the reason for using an airplane for the transport and must submit their request in advance if the transport is for a non-emergency situation. Medical air evacuations may be covered in some cases even without advance notice.
Medicaid Transportation Companies Servicing Missouri:
Medicaid recipients have a few options when it comes to booking transportation for non-emergency medical situations. The first option is to call the Medicaid insurance provider directly to arrange transport. Another option is to call a transportation “broker”, like LogistiCare, to arrange the appropriate form of transportation. The third option is to contact a transportation company directly. All three of these methods for arranging transport are supported by the rules laid down by Medicaid.
Here are some of the most popular and well known Medicaid transportation companies in Missouri:
(866) 269-5927
Visit this link for more detailed contact information
Provides and brokers all kinds of Medicaid-approved transportation services
(417) 414-9100
Call the above phone number to request a ride.
Provides most non-emergency medical transportation services
(888) 875-6287
Visit this link for more about their services and contact information
Provides private bus transportation services and other shared public transportation
(636) 561-5686
Visit this link for more information about specific services
Provides most kinds of non-emergency medical transportation, including public transportation assistance and support
Eastern Royal Medical Transport
(800) 696-1495
Provides private long-distance medical transportation throughout the USA
(303) 792-7400
Visit this link for more information about their services
Provides helicopter and airplane transportation services to eligible Medicaid recipients
(844) 836-7433
Visit this link to see more information about their contact information
Provides and brokers most kinds of Medicaid-approved transportation services