Medicaid is a state and federal program that helps people with limited income and resources cover medical costs (like CDPAP).
Though Medicaid readily covers the cost of emergency medical transport for those who are eligible, non-emergency medical transport to medical appointments is a different story.
Non-emergency transportation to and from Medicaid-approved services may be covered, but only with prior approval from a Medicaid caseworker, a ride service, or some other agency.
In this article we will break down how you can get approved for Medicaid transportation in NY and contact information for companies that provide this service.
In New York State medical transportation for Medicaid enrollees who are traveling to receive Medicaid-covered services are managed by two different agencies: Medical Answering Services or MAS and LogistiCare.
MAS and LogistiCare are Medicaid transportation management companies that work closely with medical practitioners as well as transportation providers to make sure Medicaid recipients in New York state receive high-quality, professional transportation services. There are different modes of transportation that a Medicaid recipient might use to go to a medical appointment or to receive some other Medicaid-covered service. These modes of transportation include the following:
● Walking
● Private car
● Ambulance
● Ambulette
● Commercial bus
● Public bus
● Taxi
● Train
● Metro
● Commercial air
The mode of transportation that the state will approve for an enrollee to use to get to Medicaid-covered service appointments depends on the type of transportation they use on a day-to-day basis.
The medical service provider determines which mode of transport is best for the beneficiary based on:
- The typical mode of transportation that the beneficiary uses on a day-to-day basis
- The beneficiary’s needs and mobility
- The location of the medical service being provided relative to the beneficiary’s home
Certain medical conditions may make it necessary for a particular beneficiary to use a specialized type of transportation such as an ambulette. When this happens, Medicaid will pay for the most medically-appropriate type of transport that’s also cost-effective. Medicaid recipients do not need to pay for transportation in these situations which must be pre-authorized in advance.
In evaluating which mode of transportation is necessary for any given Medicaid enrollee the state of New York first considers what type of transportation would be medically appropriate for the enrollee and then they consider which type of transportation would be most cost-effective.
The suitability of a particular mode of transportation is determined by the enrollee’s medical practitioner. This person must provide mobility-related reasons why a specific mode of transportation is necessary for the enrollee.
An enrollee who is wheelchair-bound or who recently underwent back surgery, for example, will have specific transportation needs. A person with difficulty walking and an unstable gait or blindness may have other transportation needs that must be met by the state.
A medical professional must provide medical justification for the use of certain modes of transportation for non-emergency medical services. The justification form for non-urgent transportation must be signed and then sent to the transportation manager who will review, approve, and then file it.
In the state of New York, all non-emergency transportation must be authorized by MAS or LogistiCare before payment is made for services. In other words, in order for the beneficiary to receive compensation, the beneficiary must obtain approval for non-emergency transportation from MAS or LogistiCare before they incur the expense.
How do Medicaid enrollees get transportation?
The Medicaid recipient’s medical provider or the recipient must contact a transportation manager at LogistiCare or MAS to make a request for non-emergency transportation services.
The New York State Department of Health requires 3 days’ notice for non-emergency transportation. Though transportation agencies such as LogistiCare and MAS make every effort to arrange transportation services with less than 3 days’ notice, transportation options decrease substantially as transportation service providers fill up their daily rosters.
If there is an urgent need for transportation, or if a Medicaid patient is being discharged from the hospital, this request for transportation is considered to be an urgent priority and is not subject to the 3-day advance-notice requirement.
When a Medicaid enrollee calls the transportation manager to request transportation, the manager will ensure that the enrollee has Medicaid coverage and that they are requesting transportation to a location within their service area.
Then, the manager will consider the mode of transportation requested to determine if it is medically necessary and cost effective. The enrollee’s address and pick-up time as well as the destination address, appointment time, and location within the facility will also be recorded by the manager. Non-urgent transportation to doctors, approved therapists, and dentists are all covered by Medicaid with pre-approval.
Medicaid enrollees who go through the necessary steps to gain pre-approval for non-emergency transportation to Medicaid-approved services do not need to pay for transportation services.
The state reimburses the transportation service agencies which offer fee-for-service transportation through various providers that take enrollees to appointments with approved Medicaid-service providers.
Below are modes of transportation that Medicaid enrollees regularly use to access Medicaid-approved services in New York:
Walking
Walking is an approved mode of transportation for certain Medicaid beneficiaries in New York. According to LogistiCare, if the Medicaid beneficiary lives within 10 blocks of the Medicaid-approved service, then the beneficiary should walk to the appointment. This mode of transportation is free to the Medicaid recipient as well as to the state.
Private Vehicle
The use of a private vehicle is an approved mode of transportation for certain Medicaid beneficiaries in New York. Medicaid enrollees who regularly use a private vehicle to go about their normal day-to-day activities, should use this same mode of transportation to access Medicaid-approved services.
Medicaid enrollees who use a private vehicle on a regular basis may be eligible to receive mileage reimbursement. Enrollees should be sure to get prior approval from their caseworker to ensure that they’re eligible to receive the mileage reimbursement.
Commercial Bus
Commercial buses are an approved form of transportation for certain Medicaid beneficiaries in New York. If a commercial bus is medically appropriate and the most cost-effective way of transporting the beneficiary to and from non-emergency services, the caseworker may approve this mode of transport for the Medicaid beneficiary.
Public Bus
Public buses are an approved mode of transportation for certain Medicaid beneficiaries in New York. If the Medicaid beneficiary regularly uses a public bus for their normal, daily activities, the same means of transportation can be used to access non-emergency services.
Some medical practitioners in New York state participate in the Public Transit Automated Reimbursement (PTAR) system. In New York City, these medical providers pre-purchase Metrocards and distribute them to Medicaid beneficiaries when they show up for their appointment.
PTAR reimburses the medical provider $5.50 per claim and then the provider reimburses the Medicaid recipient’s Metrocard in real-time. Beneficiaries who are able to use mass transit and who go to a medical practitioner who participates in the PTAR system will not receive reimbursement for their transportation costs from LogistiCare because they can use the Metrocard provided directly by the medical provider.
If you go to a Medicaid service provider who does not participate in the PTAR system, contact your caseworker to get a Metrocard directly from LogistiCare or MAS for Medicaid-approved services.
To use this service, the enrollee must live within 10 blocks of the bus or subway stop and the medical facility must be located within 10 blocks of the bus or subway destination stop. The enrollee may walk up to 10 blocks. In order for the enrollee to use this form of transportation, they must be able to understand common signs and directions.
Metro
The Metro is an approved mode of transportation for certain Medicaid beneficiaries in New York. Medicaid enrollees who are able to use the metro may be able to find a medical practitioner who participates in the Public Transit Automated Reimbursement (PTAR) system.
In this case, the enrollee should get a Metrocard directly from the medical practitioner rather than requesting transportation reimbursement from LogistiCare. The medical practitioner pre-purchases the Metrocards for distribution to Medicaid recipients.
Enrollees who live more than 10 blocks away from the Medicaid-approved public transportation service, but who use the Metro on a daily basis, can contact LogistiCare if their practitioner has not provided a Metropass to them already. LogistiCare can, in some cases, provide a Metrocard that would make it possible for the Medicaid recipient to take the bus or the subway.
Enrollees who utilize the Metro system can walk up to 10 blocks to the Medicaid-approved service as long as they understand common signs and directions.
PTAR reimburses medical providers $5.50 for each claim and the medical provider then reimburses the beneficiary in real-time. Medicaid recipients who receive reimbursement from their medical provider cannot also receive reimbursement from LogistiCare.
Taxi for Medicaid Recipients
Taxis are an approved mode of transportation for certain Medicaid beneficiaries in New York, but all orders for taxi or livery services need to be made in advance by the enrollee or the enrollee’s medical provider.
To receive reimbursement, taxi services must have prior authorization, but in certain situations, the Medicaid beneficiary may need curb-to-curb service. Indeed, in some cases, ambulatory services may be required to assist the enrollee all the way to the door of the Medicaid-approved service provider.
Typically, the enrollee should be able to walk unassisted from the door to the curb to board the vehicle.
Companies that provide this service can be found below.
Star6 Transportation –
● Serves Tonawanda, NY
● Offers private car, taxi
716-335-6333
1745 Colvin Blvd.
Tonawanda, NY 14223
Buffalo Medicaid Taxi –
● Serves Buffalo, NY
● Offers private car, taxi
https://buffalomedicaltaxi.com/contact-us
30 Horton Place
Buffalo, NY 14209
Ambulette for Medicaid Recipients
Ambulettes are an approved mode of transportation for certain Medicaid beneficiaries in New York. The use of an ambulette can only be requested under certain conditions including the following:
● The enrollee must be transported in a supine or recumbent position.
● The enrollee is wheelchair bound and cannot use a private vehicle, taxi, livery, or other public modes of transportation.
● The enrollee uses a walker or crutches due to a disabling physical condition and are not able to use a private vehicle, taxi, livery, or other public modes of transportation.
● The enrollee is normally ambulatory, but they require treatment that results in a disabling post-treatment physical condition. For example, radiation therapy, chemotherapy, or dialysis treatments may make it necessary for the enrollee to have the personal assistance of an ambulette service.
● The enrollee has a disabling physical or mental condition that requires a personal assistant to provide ambulette service.
● The medical practitioner verifies and submits the necessary certifying information to the Department that communicates that the enrollee can’t be transported by private vehicle, taxi, livery, or any other type of public transportation thereby necessitating the use of an ambulette service.
Ambulettes do not have paramedic staff in the vehicle with the enrollee. Generally, there is one qualified healthcare professional on board the ambulette who is qualified to manage medical equipment and ensure the comfort and safety of the enrollee during the ride.
The ambulette team will be there for the enrollee through every stage of the journey; if the Medicaid recipient lives on an upper floor and needs help descending to street level, or if they are in need of a wheelchair or crutches, the ambulette service team can assist them. Often, the enrollee can walk, but they need help from trained personnel to walk to and get inside the vehicle.
Ambulettes typically feature adequate climate control, tinted windows for privacy, and front-facing seating for additional passengers. Passengers can expect to have a comfortable, easy ride from Point A to Point B.
For Medicaid recipients with friends or family who want to ride with them in the ambulette, it is possible for up to 7 ambulatory passengers to accompany the enrollee for the ride. It’s possible for the enrollee to bring luggage, if necessary. It’s recommended that the passenger inform the ambulette service ahead of time if they are planning to have accompanying passengers or luggage for the journey.
Below is a list of three of the biggest Ambulette providers in NY.
Metro Trans –
● Services the Rochester, NY area
● Taxi/car service and wheelchair vans are available
(585) 328-8030
200 Airpark Drive – Suite 20
Rochester, NY 14624
Arecibo Car Service –
● Luxury cars, SUVs, and vans
● Provides transportation throughout the Tri-State area and to and from airports
718-783-6465
855-428-0222
Brooklyn, NY 11217
Cathay Express Transportation –
● Services NYC only
● Ambulette Transportation & private taxi services for people who use wheelchairs or walkers, the disabled, and the elderly.
● Transportation to medical appointments, airport(s), and for leisure trips and tours
(212) 261-5555
98-51 Queens Blvt, Apt. Suite 2G
Rego Park, NY 11374
http://cathayexpresstransportation.com
Ambulance for Medicaid Recipients
Ambulance services, both ground and air, are an approved mode of non-emergency transportation for certain Medicaid beneficiaries in New York.
The use of an ambulance for non-emergency transport has to be approved through prior authorization by an official who designates whether the ambulance is medically necessary or not. This official will consider whether or not other non-specialized modes of transportation such as a taxi, livery, ambulette, private car, or other forms of public transportation would be more appropriate and perhaps cost effective.
To use an ambulance for non-emergency transportation, the Medicaid recipient’s doctor, physician’s assistant, or nurse practitioner must order the service on the recipient’s behalf. As a general rule, non-emergency transportation by ambulance is only approved if the Medicaid enrollee is in need of services en route that can only be administered by ambulance.
To procure the use of ambulance for a Medicaid recipient for non-emergency transport, the medical practitioner must reference the patient’s medical records and note the condition that warrants the use of an ambulance. Medical practitioners, programs, or facilities that don’t abide by the rules set forth by the state may be sanctioned by the New York State Department of Health.
MTM Transport Services –
● Provides private cars, ambulance, metro and public transit service help, and public bus help and services
718-298-4848
718-298-4815
882 3rd Ave., 11th Floor
Brooklyn, NY 11232
Medical Answering Services –
● Private car, public & commercial buses, ambulatory taxi, ambulette, ambulance, train, commercial air escort
● Services New York City, Western New York, the Finger Lakes/Northern NY, and Hudson Valley
Phone Numbers by Service Area: https://www.medanswering.com/locations/nys/
PO Box 12000
Syracuse, NY 13218
Train
Trains are an approved mode of non-emergency transportation for certain Medicaid beneficiaries in New York. In order for a Medicaid recipient to be authorized to use a train, this mode of transportation must be deemed medically appropriate and cost effective.
Commercial Air
Commercial air travel is an approved mode of non-emergency transportation for certain Medicaid beneficiaries in New York. Under conditions when commercial air transport is the most medically appropriate and cost effective mode of transportation, Medicaid recipients should acquire pre-approval to use this service.
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