NEMT (non-emergency medical transportation)

Medicaid programs pay for NEMT so members can reach dialysis, doctor visits, therapy, the pharmacy and hospital discharges. In California, the Department of Health Care Services (DHCS) describes it as transport “for those who cannot use public or private transportation.” People who can travel in an ordinary car but have no way to get there use the other benefit, NMT.

Besides Medi-Cal, transportation providers carry NEMT riders for Medicare Advantage plans, PACE programs, facilities, workers’ compensation administrators and private pay, often in the same van on the same day.

Most Medi-Cal members are in a managed care plan. The member or their doctor asks the plan for the ride; the plan, or a broker working for it, schedules it with a transportation provider. Fee-for-service members go through DHCS. Either way the ride needs a signed Physician Certification Statement that names the mode, and the plan or broker can’t change that mode.

Under the DHCS rules for plans, NEMT is covered for members who cannot reasonably walk or stand without help, including people who use a walker or crutches, and plans must make sure door-to-door assistance is provided.

An NEMT company runs on the details each payer checks before paying: the right space type, a pickup inside the window, signatures, loaded miles and an authorization on file. Missing any of them is the usual reason a leg isn’t paid.