Medi-Cal rides, from request to payment.

Medi-Cal pays for rides to covered care in two ways. NEMT is “transportation by ambulance, wheelchair van, or litter van for those who cannot use public or private transportation,” and needs a prescription from a licensed provider. NMT is “transportation by private or public vehicle for people who do not have another way to get to their appointment”: a sedan, taxi, rideshare, bus pass or mileage reimbursement.

The line between them is the member’s condition, not the vehicle. DHCS tells plans to provide NEMT for members who cannot reasonably walk or stand without help, including people with a walker or crutches, to make sure door-to-door assistance is provided for every NEMT member, and never to downgrade a member from NEMT to NMT, including ambulatory door-to-door service.

Most Medi-Cal members are in a managed care plan, and the plan must cover both benefits. A plan may arrange rides itself or subcontract a broker to run the call center, schedule and assign rides, but it keeps the review of PCS forms, the oversight of providers and grievances. Members in fee-for-service Medi-Cal go through DHCS, and those trips are billed to Medi-Cal with a TAR.

So the same van can carry, on one day, trips from two brokers, a plan that coordinates its own rides, fee-for-service Medi-Cal, a dialysis center and a private-pay rider. Each is a separate payer with its own rates, notice periods, paperwork and deadlines. The plans below show how different they are.

• The member, or their doctor’s office, asks the plan for a ride, through member services or the plan’s transportation line. Plans must have a direct line to a transportation liaison for providers and members to request rides and get status updates.
• For NEMT, the doctor sends the plan a PCS form naming the mode and the dates, up to 12 months. The plan approves it; the broker can’t change the mode.
• The plan or broker schedules the ride with a transportation provider in its network, usually as a trip file or a portal download in that broker’s columns.
• If the provider is late or doesn’t arrive, the plan must arrange urgent NEMT so the member doesn’t miss the appointment. Hospital discharges to a skilled nursing or psychiatric facility must be picked up within 3 hours of the request.

Notice periods are set by each plan and range from same day for discharges to five business days or more for routine trips. Dialysis and other recurring treatments are often exempt from the notice period, which is why they make up so much of a wheelchair van company’s standing orders.

Every NEMT and NMT provider in a plan’s network must meet DHCS’s Medi-Cal enrollment requirements. A plan may let a provider carry its members for up to 120 days while enrollment is pending, and must end the contract if DHCS denies it.

Since March 27, 2025, an application to enroll litter or wheelchair vans must include a Vehicle Safety Systems Inspection (VSSI) certificate from the Bureau of Automotive Repair for the vehicle; DHCS no longer accepts the old brake and light certificate. Brokers and plans add their own requirements for drivers, vehicles and insurance; commonly asked for are DOJ and FBI LiveScan background checks, PASS training, CPR and first aid, driving records, drug tests and certificates of insurance naming the broker.

The steps from company to first trip are in Starting an NEMT business in California.

Plans must require their brokers to be able to name the provider and the driver for any ride by date, time, pickup and drop-off place and member, and members can name a driver in a grievance. A provider’s own records have to answer the same question, leg by leg.

The trip record a payer checks before paying usually holds the driver and vehicle, the member and their ID, actual pickup and drop-off times, full addresses, loaded miles, the authorization number, the required signatures and GPS evidence. Most denials come back to one of those being missing or not matching.

• Broker trips are billed through the broker, by its portal or invoice process and its own filing deadline. Anthem’s manual, for example, makes ModivCare responsible for paying non-emergency ground transportation claims.
• Fee-for-service Medi-Cal trips go on a CMS-1500 or an 837P, with a TAR, under the HCPCS codes in the Medi-Cal provider manual: A0130 for a wheelchair van, T2005 for a stretcher van and A0380 for their miles, with modifiers for night trips, shared rides and dry runs. Medi-Cal’s billing limit is six months from the month of service.
• Plans that take claims directly set their own rules; Health Plan of San Joaquin, for example, gives a 365-day filing limit and box-by-box instructions.

Payment answers come back as remittances, electronically as an 835, with each line paid, reduced or denied. The codes and modifiers are walked through in Medi-Cal NEMT billing codes, and posting in 835 remittance posting.