A missed appointment because the bus did not come is a treatment failure the law tried to prevent. The benefit is real, it is in the statute, and most people on Medi-Cal have never been told it exists.
The short answer: yes. "Nonmedical transportation is covered, subject to utilization controls and permissible time and distance standards, for a beneficiary to obtain covered Medi-Cal services."¹ It "includes, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets."¹ The Department of Health Care Services says plainly that this "includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies."² If you are in a managed care plan, the ride "shall be provided by the beneficiary's managed care plan";¹ and the plan must provide it for services carved out of its contract — the Department's letter to plans names "specialty mental health services, substance use disorder services, dental services" — so a county mental health appointment counts.³ The one condition on the ordinary ride is that you "can attest in a manner to be specified by the department that other currently available resources have been reasonably exhausted."¹ The federal rule underneath it all: a state Medicaid plan "must … specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers."⁴
Two benefits, two names
- Non-medical transportation (NMT) is "transportation by private or public vehicle for people who do not have another way to get to their appointment."² It is the ride most people need: a car, a taxi, a bus pass, or money back for someone's petrol. It does not include "the transportation of a sick, injured, invalid, convalescent, infirm, or otherwise incapacitated beneficiary by ambulance, litter van, or wheelchair van …"¹
- Non-emergency medical transportation (NEMT) is "transportation by ambulance, wheelchair van, or litter van for those who cannot use public or private transportation."² It is covered "when the beneficiary's medical and physical condition is such that transport by ordinary means of public or private conveyance is medically contraindicated, and transportation is required for the purpose of obtaining needed medical care,"⁵ and it needs a prescription: "You will need a prescription from a licensed provider."² The Department's guidance to plans lists who may write it — "a physician, dentist, podiatrist, mental health provider, substance use disorder provider, or a physician extender."³
For therapy, NMT is almost always the right one. NEMT is for the person whose condition makes a car or bus medically unsafe.
Who arranges it
If your Medi-Cal comes through a plan — the Department's own examples are "Kaiser Permanente, Anthem Blue Cross, CenCal Health, or others" — "contact your plan's member service department to request NMT."² The plan is the responsible party by statute.¹ If you have fee-for-service Medi-Cal with no plan, "the department shall provide nonmedical transportation …"¹ and the Department's transportation page has an "NMT/NEMT Scheduling Form" button: you enter your name and email, and the Department emails you its Transportation Request Form.²
The carve-out is the point most plans get wrong. Your therapy may be delivered by the county mental health plan rather than your health plan, and the county does not run a ride service. The Department's letter closes that gap: plans "are further required to provide NMT for Medi-Cal services that are carved-out of the MCP Contract," including "specialty mental health services, substance use disorder services," and "must not deny NMT for an appointment to an out-of-network provider if the appointment is for a carved-out service."³ So the number to call for a ride to the county clinic is still your health plan's. Regional center or county mental health? →
The one condition, and how it is met
The ride is for people without another way. The statute puts it as an attestation: the beneficiary "can attest in a manner to be specified by the department that other currently available resources have been reasonably exhausted."¹ For rides in a private car — your own, or a friend's, with mileage — the Department tells plans that "the member must attest to the MCP in person, electronically, or over the phone that other transportation resources have been reasonably exhausted."³ Neither the statute nor the letter requires you to document the attestation.
The ride must also be usable. "Nonmedical transportation shall be provided in a form and manner that is accessible, in terms of physical and geographic accessibility, for the beneficiary and consistent with applicable state and federal disability rights laws."¹
Timing
For a ride to a carved-out service such as county mental health, the plan "must provide the NMT service within timely access standards"; for NEMT, plans "must ensure that they meet timely access standards as set forth in 28 CCR section 1300.67.2.2," and "if the NEMT provider is late or does not arrive at the scheduled pick-up time for the member, the MCP must authorize urgent NEMT to ensure the member does not miss their appointment."³ Neither the statute nor the letter sets a fixed number of days' notice for an ordinary ride; each plan must state its own notification timeframe in its member services guide,³ so ask your plan's member services what theirs is and book each session as soon as it is scheduled. The 10-day rule for a first appointment →
Mileage
If a friend or relative drives you, the statute's list includes "mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker."¹ Ask member services for the plan's mileage form before the trip; the attestation applies here too.³
What to do
- Call member services on the back of your plan card and say: "I need non-medical transportation to a mental health appointment on [date]. I do not have another way to get there." Ask whether they will send a car, post a bus pass, or reimburse mileage.¹ ²
- If the appointment is with the county mental health plan or a substance use programme, and the plan says it is not their service, quote the Department's letter: plans are required to provide NMT for carved-out services.³
- If you need a wheelchair van or cannot sit in a car for medical reasons, ask your prescriber for the NEMT prescription; the plan uses a certification form your treating provider fills in, and "once the member's treating provider prescribes the mode of NEMT, the MCP cannot modify the authorization."³ ⁵
- If the plan refuses, file a grievance with the plan and keep the reference number; the routes after that depend on your plan type. How to file a DMHC complaint →
Worked example
A woman in the Central Valley has weekly therapy at the county behavioral health clinic, twenty miles from home; her car has died and the one bus takes two hours each way. She calls her Medi-Cal plan's member services, attests over the phone that she has no other way to get there,¹ ³ and asks for non-medical transportation to a specialty mental health appointment. The plan cannot refuse on the ground that the county, not the plan, delivers the therapy.³ It books a car for each Tuesday; when a neighbour offers to drive one week instead, she asks for the mileage form.¹
Q&A
Q: I am on Medi-Cal but see a private therapist who takes it. Does the ride still apply? A: The benefit is for "covered Medi-Cal services."¹ If the therapy is a covered service, the ride to it is covered.
Q: Do I have to prove I have no car? A: The statute asks for an attestation that "other currently available resources have been reasonably exhausted";¹ for private-car rides the Department's letter says it can be made in person, electronically or by phone.³
Q: Does it cover the trip home? A: The statute says "round trip transportation."¹
Q: I am on Medicare and Medi-Cal. A: This is a Medi-Cal benefit, not a Medicare one. Request it through your Medi-Cal managed care plan, or through the Department's form if you are in fee-for-service Medi-Cal.² A Medicare Advantage plan may offer a ride benefit of its own, separately. Original Medicare vs. Advantage for therapy →
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Sources
- Cal. Welfare & Institutions Code §14132(ad) — (ad)(1) "Nonmedical transportation is covered, subject to utilization controls and permissible time and distance standards, for a beneficiary to obtain covered Medi-Cal services"; (ad)(2)(A)(i) the "at a minimum" list as quoted; (ad)(2)(A)(ii) "Nonmedical transportation does not include the transportation of a sick, injured, invalid, convalescent, infirm, or otherwise incapacitated beneficiary by ambulance, litter van, or wheelchair van licensed, operated, and equipped in accordance with state and local statutes, ordinances, or regulations"; (ad)(2)(B) "Nonmedical transportation shall be provided for a beneficiary who can attest in a manner to be specified by the department that other currently available resources have been reasonably exhausted. For a beneficiary enrolled in a managed care plan, nonmedical transportation shall be provided by the beneficiary's managed care plan. For a Medi-Cal fee-for-service beneficiary, the department shall provide nonmedical transportation …"; (ad)(3) the accessibility sentence as quoted; (ad)(4) the Legislature's intent "to affirm the requirement under Section 431.53 of Title 42 of the Code of Federal Regulations" — california.public.law.
- California Department of Health Care Services, "Transportation Services" — "Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies"; the NMT and NEMT definitions as quoted; "If you receive Medi-Cal through a managed care plan (e.g. Kaiser Permanente, Anthem Blue Cross, CenCal Health, or others), contact your plan's member service department to request NMT"; for NEMT, "You will need a prescription from a licensed provider"; the fee-for-service request form — dhcs.ca.gov.
- DHCS All Plan Letter 22-008, "Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses" (18 May 2022; the guidance in force at our reading) — "MCPs are further required to provide NMT for Medi-Cal services that are carved-out of the MCP Contract. These carved-out Medi-Cal services include, but are not limited to, specialty mental health services, substance use disorder services, dental services, and other services delivered through the Medi-Cal fee-for-service (FFS) delivery system"; "MCPs must not deny NMT for an appointment to an out-of-network provider if the appointment is for a carved-out service and must provide the NMT service within timely access standards"; NEMT "prescribed in writing by a physician, dentist, podiatrist, mental health provider, substance use disorder provider, or a physician extender"; "For private conveyance, the member must attest to the MCP in person, electronically, or over the phone that other transportation resources have been reasonably exhausted"; "MCPs must ensure that they meet timely access standards as set forth in 28 CCR section 1300.67.2.2"; the late-provider rule as quoted; "Once the member's treating provider prescribes the mode of NEMT, the MCP cannot modify the authorization"; "MCPs must also note in their Member Services Guide the notification timeframe requirements for transportation requests" — dhcs.ca.gov (PDF).
- 42 C.F.R. §431.53 — "A State plan must— (a) Specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers; and (b) Describe the methods that the agency will use to meet this requirement" — law.cornell.edu.
- 22 Cal. Code Regs. §51323 — (a) "Ambulance, litter van and wheelchair van medical transportation services are covered when the beneficiary's medical and physical condition is such that transport by ordinary means of public or private conveyance is medically contraindicated, and transportation is required for the purpose of obtaining needed medical care"; (b) "only for the lowest cost type of medical transportation that is adequate for the patient's medical needs"; (b)(2) "All nonemergency medical transportation, necessary to obtain program covered services, requires a physician's, dentist's or podiatrist's prescription and prior authorization except as provided in (C)" — law.cornell.edu.
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