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States are required under federal regulations 42 C. When travelling to medical appointments, a Medicaid beneficiary is expected to use the same mode of transportation as the beneficiary would use to carry out the activities of daily life. Generally, this mode is public transit or a personal vehicle. However, for some Medicaid beneficiaries, their medical condition necessitates another form of transportation, such as an ambulette.

Medicaid will pay for the most medically appropriate and cost-effective level of transportation to and from services covered by the Medicaid Program. All non-emergency transportation must be authorized prior to payment and only emergency ambulance transportation can be reimbursed without a prior authorization.

Non-emergency transportation was carved out of the Medicaid managed care benefit package as part of the Medicaid Redesign Team's Transportation Reform Initiative. The carve-out took place in and Enrollees in mainstream Medicaid managed care plans do not access transportation services through their plans, but directly through private contractors. LogistiCare continues to be the contractor for Nassau and Suffolk Counties. MLTC enrollees must arrange for non-emergency transportation through their plans. Prior Authorization for Non-Emergency Transportation. Prior authorization will be granted by the prior authorization official only when payment for transportation expenses is essential in order for an eligible MA recipient to obtain necessary medical care and services which may be paid for under the medical assistance program.

Prior authorization generally must be obtained by the medical assistance recipient, his representative, or an ordering practitioner before the transportation expenses are incurred, but such authorization is not required for emergency ambulance transportation or Medicare approved transportation by an ambulance service under certain circumstances. The request must be made in the manner required by the prior authorization official.

The prior authorization official may approve or deny the request, or require additional information before doing so. Prior authorization official is defined as the department, a social services district, or their designated agents. The prior authorization official must use the following criteria to determine whether to authorize the payment of transportation expenses. DOH Contact Information. Syracuse University Press. Retrieved September 23, The State of New Jersey.

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