Non-emergency medical transportation, usually shortened to NEMT, is a ride to or from a covered medical service for someone who has no other way to get there. It is not an ambulance call. It is the wheelchair van that takes a member to dialysis three mornings a week, the sedan that picks someone up for a behavioral health appointment, or the stretcher transport home after a procedure.
For Medicaid members, NEMT is not a courtesy. It is a federal requirement on every state Medicaid program, and it is one of the main reasons people who do not drive can keep the appointments that let them stay healthy and living at home. This guide explains how it works in plain terms, for members, families, and the transportation companies that provide the rides.
The short answer
Every state Medicaid program must make sure that members who need a ride to covered care can get one. Federal regulation at 42 CFR 431.53 requires each state plan to "specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers" and to describe how it will do that. In December 2020 Congress wrote that long-standing rule into the Social Security Act itself, through Section 209 of the Consolidated Appropriations Act, 2021. CMS summarized the change in a July 2021 informational bulletin.
CMS's Medicaid Transportation Coverage Guide (State Medicaid Director letter 23-006, September 2023) puts the purpose simply: the assurance of transportation is "not a requirement for states to pay for a ride," but a requirement to make certain that every Medicaid beneficiary "who has no other means of transportation" can get to covered care.
Who is eligible for NEMT?
In general, a Medicaid member is eligible for NEMT when two things are true. The trip is to or from a service Medicaid covers, and the member has no other way to get there. A doctor's visit, dialysis, therapy, or a behavioral health appointment can all qualify. A trip to the grocery store does not.
The details are set state by state. States decide how to verify that a member has no other means of transportation, which modes are available, how far in advance a ride must be requested, and whether some eligibility groups or managed care plans handle transportation differently. MACPAC, the commission that advises Congress on Medicaid, describes NEMT as a required benefit "for enrollees who have no other means of transportation" and notes that delivery varies widely across states. The member handbook from a state Medicaid agency or health plan is the authoritative source for any one person.
How rides are arranged
States use three broad models, often in combination:
- Broker model. The state contracts with a transportation broker that takes ride requests, confirms eligibility, chooses the mode, and assigns trips to a network of local transportation providers.
- Managed care. A Medicaid health plan covers transportation for its own members, directly or through its own broker.
- Fee-for-service. The state, or a local agency on its behalf, approves trips and pays providers per trip.
From the member's side, the steps look similar everywhere. The member, a family member, or a facility calls the number on the member's card or plan materials, ideally well ahead of the appointment. The request includes the appointment address and time and any mobility needs. The broker or plan confirms the trip is eligible, picks a level of service such as ambulatory, wheelchair, or stretcher, and assigns the ride to a transportation provider. Standing orders cover recurring trips like dialysis.
From the provider's side, the day starts with a list of assigned trips, which then has to become a workable schedule of vehicles, drivers, and routes. That is the part of the job that software like ZeitRide, built by Prasar Health, is designed to carry: importing trips, dispatching drivers, and capturing what actually happened on the road.
Federal rules for NEMT providers and drivers
The same 2021 law added minimum requirements for NEMT providers and individual drivers, now in section 1902(a)(87) of the Social Security Act. According to the CMS bulletin, each state plan must have a mechanism, which may include attestation, to ensure that:
- Each provider and individual driver is not excluded from any federal health care program and is not on the HHS Office of Inspector General exclusion list.
- Each individual driver has a valid driver's license.
- Each provider has a process to address any violation of a state drug law.
- Each provider has a process to disclose to the state Medicaid program the driving history, including traffic violations, of each of its drivers.
CMS notes these requirements apply to transportation network companies as well as individual drivers, and exclude public transit authorities. They apply to services furnished on or after December 27, 2021. States, brokers, and plans usually add their own standards on top, such as vehicle inspections, insurance minimums, and training.
What NEMT providers should document
Federal rules require Medicaid providers to keep the records needed to show the extent of the services they furnish. 42 CFR 431.107(b) makes that a condition of every provider agreement, along with handing those records over to the state, CMS, or the state fraud control unit on request. For a transportation company, that means each paid trip should be backed by a record that answers who rode, when, from where to where, with which driver and vehicle, and who confirmed it.
In practice that usually includes the trip or authorization number, scheduled and actual pickup and drop-off times, addresses, mileage, the level of service, driver and vehicle identifiers, and whatever proof of delivery the contract requires, often a member signature. Driver files need the license, exclusion checks, and driving history behind the attestations above. We cover this in detail in documentation that survives a Medicaid audit, and explain why the record matters so much in the record is the product.
Why NEMT matters for care at home
A missed ride is often a missed treatment. For people who are older, disabled, or managing chronic conditions, reliable transportation is what makes it possible to receive care in the community rather than move somewhere care comes to them. That is why Prasar Health treats transportation as care infrastructure, part of a larger picture of home and community-based services that help people keep living at home.
Frequently asked questions
Is NEMT a required Medicaid benefit?
Yes. States must ensure necessary transportation to and from covered services under 42 CFR 431.53, and the Consolidated Appropriations Act, 2021 wrote that assurance into section 1902(a)(4) of the Social Security Act. How it is delivered, and some coverage details, vary by state.
Who qualifies for Medicaid NEMT?
Generally, a Medicaid member who needs to get to or from a Medicaid-covered service and has no other means of transportation. Each state sets its own process for confirming that, so the member handbook or health plan is the best source for a specific person.
How do I schedule a Medicaid ride?
Call the transportation number for your state Medicaid program or health plan, usually listed on the member card or in plan materials, as far ahead of the appointment as the rules allow. Have the appointment address, time, and any wheelchair or mobility needs ready.
What are the federal requirements for NEMT drivers?
Under section 1902(a)(87) of the Social Security Act, drivers and providers must not be excluded from federal health care programs, drivers need a valid license, and providers need processes to address state drug law violations and to disclose each driver's driving history to the state. States and brokers often add more.
What records should an NEMT provider keep?
Enough to prove each trip happened as billed: member, date, actual pickup and drop-off times and locations, driver and vehicle, level of service, mileage, and the proof of delivery your contract requires, such as a signature. Keep driver qualification records too.
Prasar Health builds software for Medicaid-funded community care: ZeitRide for non-emergency medical transportation and Adult Day Genie for adult day centers. More insights.