Transportation Services for Medi-Cal Recipients


Transportation Services for Medi-Cal Recipients

This fact sheet explains how to obtain transportation to your medical appointments from your Medi-Cal Managed Care Plan (MCP). The end of this publication discusses how to obtain transportation services if you have Fee-For-Service (FFS) Medi-Cal.

Disclaimer: This publication is legal information only and is not legal advice about your individual situation. It is current as of the date posted. We try to update our materials regularly. However, laws are regularly changing. If you want to make sure the law has not changed, contact DRC or another legal office.

This fact sheet explains how to obtain transportation to your medical appointments from your Medi-Cal Managed Care Plan (MCP). The end of this publication discusses how to obtain transportation services if you have Fee-For-Service (FFS) Medi-Cal.


There are two types of Medi-Cal funded transportation for appointments. Nonemergency medical transportation (NEMT) is transportation by ambulance, wheelchair van, or litter van for those who cannot use public or private transportation. Effective July 1, 2017, all MCPs are required to also provide Nonmedical Transportation (NMT) to obtain medically necessary services.  Nonmedical transportation (NMT) is transportation by private or public vehicle for people who do not have another way to get to their appointments.

A service is “medically necessary” when it is reasonable and necessary to protect life, prevent significant illness or significant disability, or alleviate severe pain.1

Examples of NMT services include transportation to and from a doctor’s visit, the pharmacy or medical supplier to pick up prescriptions, medical equipment or devices, attend to a sick baby in the Neonatal Intensive Care Unit (NICU), or to receive any other Medi-Cal covered service, including mental health and dental services. 

As of October 1, 2017, MCPs must also provide NMT for Medi-Cal services that are not covered under the MCP contract including, but not limited to, specialty mental health, substance use disorder, dental, and any other services delivered through the Medi-Cal FFS delivery system.2

I. Non-Emergency Medical Transportation (NEMT)

NEMT is a covered Medi-Cal benefit when a member needs to obtain medically necessary services, and the services are prescribed in writing by a physician, dentist, podiatrist, mental health or substance use disorder provider, or a physician extender.3

a. How do I know if I qualify for NEMT?

MCPs are required to provide NEMT services if your medical or physical condition prevents you from using ordinary methods of public or private transportation, and transportation is required for obtaining medically necessary services.4  MCPs must provide NEMT for members who cannot reasonably ambulate or are unable to stand or walk without assistance, such as those using a walker or crutches, and ensure door-to-door assistance. At a minimum, MCPs must authorize the lowest cost type of NEMT that meets your medical needs, as determined by a medical professional.5 NEMT services are subject to prior authorization, except for those transferred immediately from an inpatient stay at the acute level of care to an acute care hospital, skilled nursing facility (SNF), licensed intermediate care facility or imbedded psychiatric unit, or any appropriate inpatient acute psychiatric facility.6

b. What if I need services that are NOT covered by my MCP’s contract?

For Medi-Cal services outside of the MCP contract, the MCP must make its best effort to refer for and coordinate NEMT services. MCPs must provide you with medically appropriate NEMT services for all pharmacy prescriptions prescribed by your Medi-Cal provider(s) and those authorized under Medi-Cal Rx. MCPs must ensure that there are no limits to receiving NEMT as long as your services are medically necessary and you obtained prior authorization for the NEMT.

c. What if the MCP member is a minor?

If the member is a minor, MCPs must also provide transportation for a parent or guardian. MCPs may arrange NEMT for an unaccompanied minor with the written consent of the minor’s parent or guardian, unless the minor is seeking Minor Consent Medi-Cal services like reproductive care. Before arranging transportation for unaccompanied minors, the MCP must make sure it has received all necessary written consent forms. Parental consent is NOT required for Minor Consent Medi-Cal services.

d. What types of NEMT services are available to me?

If your medical or physical condition prevents you from using ordinary means of public or private transport and the transportation is required for you to obtain needed medical car­­­e, 7 MCPs must provide the following four modes of NEMT transportation:8

i. NEMT Ambulance Services for:

  • Transfers between facilities for members who require continuous intravenous (IV) medication, medical monitoring, or observation;9
  • Transfers from an acute care facility to another acute care facility;10
  • Transport for members who have recently been placed on oxygen (does not apply to members with chronic emphysema who carry their own oxygen for continuous use);11
  • Transport for members with chronic conditions who require oxygen if monitoring is required.12

ii. Litter Van Services

A litter van is a modified vehicle that is used for the purpose of providing NEMT for passengers with stable medical conditions who require the use of a litter or gurney, and which is not routinely equipped with the medical equipment or personnel required for the specialized care provided in an ambulance. MCPs must provide litter van services if your medical and physical condition does NOT meet the need for NEMT ambulance services, but meets both of the following:

  • Requires that you be transported in a prone or supine position because you are unable to sit for the duration of the transport;13 AND
  • Requires specialized safety equipment above and beyond what is normally available in passenger cars, taxicabs, or other forms of public transportation.14

iii. Wheelchair Van Services

MCPs must provide wheelchair van services when your medical and physical condition does NOT meet the need for litter van services, but meets any of the following:

  • You cannot sit in a private vehicle, taxi, or other form of public transportation for the period of time needed to transport;15 OR
  • You must be transported in a wheelchair or assisted to and from a residence, vehicle, and place of treatment due to a disabling physical or mental limitation;16 OR
  • Requires specialized safety equipment above what is typically available in passenger cars, taxis, or other forms of transportation.17

    You can qualify for wheelchair van transport if you have any of the following conditions AND your doctor submits a signed Physician Certification Statement form (discussed further below):18
    • Severe mental confusion
    • Paraplegia
    • Dialysis recipients
    • You have a chronic condition that requires oxygen but do not require monitoring

iv. NEMT by Air

MCPs must provide NEMT by air when it is necessary because of your medical condition or because ground transportation is not practical.19 Your doctor, dentist, podiatrist, mental health, or substance use disorder provider must submit a written order explaining why air transportation is necessary.20

e. NEMT Physician Certification Statement (PCS) Forms

You must have an approved Physician Certification Statement (PCS) form authorizing NEMT by your provider. Each MCP has its own PCS form. You can request a form from your doctor by telephone, electronically, in person, or another method established by your MCP. If an MCP makes any changes to the PCS form since the last approval received from DHCS, the MCP must resubmit for approval. The PCS form is used to determine the appropriate level of service for members. Once your doctor prescribes the form of transportation, the MCP cannot modify the authorization. At a minimum, your doctor must include the following information:

  • Functional Limitations Justification: Your doctor must document your limitations and provide specific physical and medical limitations that prevent you from reasonably ambulating without assistance or transporting by public or private vehicles.
  • Dates of Service Needed: Provide start and end dates for NEMT services up to a maximum of 12 months.
  • Mode of Transportation Needed: List the mode of transportation that is needed when receiving services: ambulance, litter van, wheelchair van, or air transport.
  • Certification Statement: Your physician must certify that medical necessity was used to determine the type of transportation you need.

Your provider must submit the PCS Form to the MCP for the approval of NEMT services and the MCP must use the PCS form to provide the appropriate mode of NEMT for you.

i. PCS Form Exceptions

MCPs can provide telephone authorization for NEMT requests when you require an MCP-covered medically necessary service of urgent nature and a PCS form could not have reasonably been submitted beforehand.21 However, telephone authorization is still only valid if confirmed by a written request for authorization. PCS forms are also not required for Major Organ transplant (MOT) donors requesting NEMT services to ensure the donor has the ability to get to the hospital for the MOT transplant.

II. Non-Medical Transportation (NMT)

MCPs must provide NMT for all Medi-Cal services, including those NOT covered by the MCP contract. Services not covered under the MCP contract include, but are not limited to, specialty mental health, substance use disorder, dental, and any other benefits delivered through FFS, including pharmacy services provided to you through Medi-Cal Rx.

a. How do I know if I need NMT or NEMT?

NMT does not include transporting those who must be transported by ambulance, litter van, wheelchair van, or air transport. For example, your doctor can prescribe NMT if you currently use a wheelchair, but you can ambulate without assistance from the driver. Like NEMT, the NMT must be the least costly method of transportation that meets your needs.

b. What NMT services are available to me?

MCPs are contractually required to provide you with a Member Services Guide that includes information on the procedures for obtaining NMT services. The Member Services Guide must include a description of NMT services and the conditions under which NMT is available. Contact your managed care plan if you need a copy of your Member Services Guide.

c. At a minimum, MCPs must provide the following NMT services:22

Round trip transportation by passenger car, taxicab, or any other form of public or private vehicle, including by ferry,23 or mileage reimbursement for medical purposes when transport is in a private vehicle and arranged by you and not through a transportation broker, bus passes, taxi vouchers, or train tickets.24

Round trip NMT is available for the following:

  • Medically necessary covered services
  • Picking up drug prescriptions that cannot be mailed directly to you
  • Picking up medical supplies, prosthetics, orthotics, and other medical equipment

MCPs must provide NMT in a manner that is physically and geographically accessible to you and consistent with applicable state and federal disability rights laws.

MCPs must arrive within 15 minutes of their scheduled appointment. If the NMT provider does not arrive at the scheduled pick-up time, the MCP must provide alternate NMT or allow you to schedule alternate out-of-network NMT and reimburse for the out-of-network NEMT.25

d. Do I need prior authorization for NMT services?

NMT does not require prior authorization, however MCPs may use the prior authorization process for approving NMT services and reauthorize services every 12 months when necessary.26 “Prior authorization” is a decision by your health insurer or plan that a health care service or treatment plan is medically necessary.

If the MCP decides to have a prior authorization process for NMT, it must use a Notice of Action (NOA) letter to inform members of the MCP’s decision and the member’s right to appeal.27 The MCP must also ensure that NMT is provided in a timely manner for their members to obtain all medically necessary Medi-Cal services.28 This means that there are limits on how long you have to wait to obtain services and any delays because of NEMT or NMT do not make those limits longer. For more information on timely access care standards, see publication #5610.01 Medi-Cal Managed Care Time and Distance Standards for Providers, available here:

e. What services are NOT covered by NMT?

NMT does NOT cover trips to a non-medical location or appointments that are not medically necessary.

f. What are the requirements to authorize NMT by private vehicle?

Your MCP must authorize the use of private vehicle when no other transportation method is reasonably available or provided by the MCP.29 Private vehicles can include the member’s personal vehicle, or that of a friend or family member. This does not include vehicles that are connected to businesses, such as Uber or Lyft. Before applying for private vehicle use, you must exhaust all other reasonable transportation options and confirm that no other method is available either in person, electronically, or via telephone to your MCP.30 This can include verifying that you do not have a valid driver’s license or working vehicle available; cannot travel or wait for medical or dental services alone; or you have a physical, cognitive, mental, or developmental limitation.31

III. Common Questions for NEMT and NMT

a. Will my MCP cover related travel expenses for NEMT or NMT?

MCPs must cover transportation-related travel expenses determined to be necessary for NEMT and NMT, including the cost of transportation and reasonably necessary expenses for meals and lodging for you and your accompanying attendant. If your attendant is not a family member, their salary is a covered travel expense as well.32 MCPs may utilize prior authorization and utilization management controls for related travel expenses, including protocols for determining whether an attendant is necessary. This does not preclude the MCP from requiring a PCS form for all NEMT authorizations.

Transportation-related travel expenses are subject to retroactive reimbursement. To qualify for retroactive reimbursement, the underlying NEMT or NMT service and the related expenses must be appropriately documented in accordance with the MCP’s policies and procedures. If you fail to comply with a MCP’s prior authorization process, the MCP is not required to cover your related travel expenses.

i. Payment

MCPs are required to have procedures in place to provide the following methods of payment for related travel expenses:

  • Member Reimbursement: MCPs can reimburse members for approved travel expenses. Reimbursement must cover your and your attendant’s actual expenses as long as those expenses are reasonable and supported by receipts. If you or your family paid for travel expenses up front, MCPs must approve and reimburse you no later than 60 calendar days after confirming that all required receipts and documentation have been received by the MCP.
  • Pre-payment to Vendor: If you and your accompanying attendant are unable to pay in advance, MCPs must prepay vendors for related travel expenses, including expenses for meals and lodging. You must attest to the MCP in person, electronically, or over the phone that you are unable to pay in advance for related travel expenses.

ii. Lodging and Meals

If an MCP does not prepay for you and your accompanying attendant’s lodging and/or meals, the MCP is required to provide reimbursement for approved lodging and meal expenses. Reimbursement must cover actual expenses, if those expenses are reasonable and supported by receipts. MCPs may reference the IRS per diem rates for meals and lodging as a guide.33 As part of the prior authorization process, MCPs may arrange your lodging, if it is located within a reasonable distance from the location where you will obtain medically necessary services. Hospital meal voucher(s) may be deducted from the meal expenses submitted by you and your attendant.

iii. Other Necessary Expenses 

If an MCP does not prepay for other necessary expenses (e.g., parking, tolls) incurred by the member and accompanying attendant, the MCP is required to provide reimbursement for those expenses. Like lodging and meal expenses, reimbursement must cover the actual expenses, if those expenses are reasonable and supported by receipts.

b. What can I do if my MCP denies my request for NEMT or NMT?

If your MCP denies your NEMT or NMT request based on medical necessity, level of transportation requested, or refuses to pay for transportation, you can appeal the decision with your MCP. An appeal is a review by your MCP of the denial.34 You must file your appeal within 60 days after you receive notice of the denial. For more information on filing an appeal with your MCP, as well as additional appeal rights including a state fair hearing and Independent Medical Review, see publication #5606.01 Medi-Cal Managed Care: Appeals and Grievances, available online. Click here to read more about Medi-Cal Managed Care: Appeals and Grievances. In addition, helpful answers to frequently asked questions regarding NEMT and NMT services is available online. Click here for more information on DHCS Transportation Workgroup Frequently Asked Questions (FAQs).

c. I have FFS Medi-Cal. Can I still obtain transportation services?

Beginning July 1, 2018, full-scope FFS recipients and pregnant women (during pregnancy and for 60 days postpartum) can access NMT services to and from Medi-Cal covered medical, mental health, substance use disorder, or dental services.35 Transportation is also covered for one person to go with the Medi-Cal beneficiary when necessary, such as an attendant to accompany an elderly person or for a parent to take their child to the doctor.

d. I am dual eligible for Medi-Cal and Medicare. Can I take Medi-Cal-funded transportation services to Medicare appointments?

You can access NEMT and NMT services through your Medi-Cal managed care plan.36 It should not matter whether you are receiving Medicare through an integrated plan such as Cal MediConnect, a non-integrated Medicare plan, or Original Medicare.

To access NMT, call or email the transportation contact from your county. A complete list of county contacts is available online. Click here for a list of NMT County Contacts.37  If you are still unable to access NMT services through your county contact above, send all inquiries to with a CC to  You can also call the San Diego Field Office contact info ((916) 688-6131) for FFS NEMT requests (even if you are not a San Diego County resident).

Finally, if you are still unable to obtain NMT through your county and the DHCS contact above, you have the right to ask for a state hearing. You must file your hearing request within 90 days of receiving a Notice of Action (NOA) denying your transportation. You may request a hearing by phone by calling the State Hearings Division at (800) 743-8525, or in writing by completing the “Request for State Hearing” on the back of your NOA or writing your request on a separate piece of paper. You must include your full name, address, telephone number, the name of the county that denied your transportation request, and a detailed reason why you disagree and want a state hearing. Submit your written request in one of the following ways:

  1. By mail or in person to the county welfare department at the address shown on your NOA.
  2. By mail to the California Department of Social Services – State Hearings Division, P.O. Box 944243, Mail Station 9-17-37, Sacramento, CA 94244-2430.
  3. By fax to (833) 281-0905
  4. You can submit a hearing request online [Request Here]

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