Medicaid, unlike Medicare which is the federal program of health coverage for seniors, is also a federal health program intended to help low income and the poor with access to basic medical services. Millions across the country depend on Medicaid for everything from childbirth support to basic surgery and medical pharmaceuticals as well as emergency medical care. Upward in the range of 70 million plus in terms of caseload, Medicaid is distributed in all 50 states, usually in a combination with state help for the poor as well. One particular aspect of Medicaid includes medical transportation.
Medicaid vs Medicare
Medicaid and Medicare coverage are often confused because both programs receive federal support as well as state finances. However, Medicaid is often far more limited, both in the range of services it will cover as well as the amount of cost in those services as well. Interestingly, Medicaid has a much larger support for medical transportation than the same for Medicare. That includes trips for:
- Emergency medical transport for acute conditions and eligible patients
- Transporting patients who are unable to walk
- Help for patients who require a wheelchair to be mobile
- Stretcher and ambulance services for critical mobility
Generally, the approach of Medicaid services are the same from state to state. That said, there are geographical differences in the rates of transportation coverage, usually due to what Medicaid agencies are able to negotiate with different transport providers. As old contracts phase out and new ones are executed, pricing and rates of reimbursement can affect coverage cost, availability, and even the quality of services provided. On average, 61 percent of the cost of an ambulance trip is addressed by Medicaid versus what that same service can get from Medicare, so the supply availability to the program tends to be less as well.
The full fee schedule for Medicaid transport can range from $25 to as much as $250, but Medicaid coverage takes the brunt of the expense. For the patient, the out-of-pocket cost varies. In some states, there can be a minor co-pay per trip, such as $1 to $2 each way. In other states, the number of allowed trips is capped at a set number per month for non-emergency medical transport or NEMT. Again, each state is allowed to apply their specific rules for enrolled patients and contractors providing services.
Making the Most of Your Plan
To stay efficient and make the Medicaid system work to the best value, many transport providers will book and schedule trips to maximize the pickups and drop-offs as much as possible. This increases the amount of actual income the company earns versus its cost outlay transporting patients.
Transport for non-critical support but where a patient doesn’t have means for travel can sometimes be covered, but it’s not a guarantee. Approval tends to be case by case in situations where a patient has a medical appointment but cannot drive, doesn’t have a driver’s license, public transit is extremely limited or non-existent, or the patient is suffering from a disability. Usually, patients have cleared such travel support ahead of time on a regular basis and frequency with their Medicaid agency contact.
The key factor in medical transport being provided is that the medical trip is a necessity. Because this term is left to the definition of each state, it can vary from one to another depending where one lives. Those enrolling in Medicaid will get directions and already-determined details on how and what transport situations will be addressed as well as frequency. Eligible patients must be able to confirm they have no other transportation and would be unable to reach medical care without help. Patients also already need to be enrolled in Medicaid. Startups and applicants pending would not be immediately eligible for help.
Contact us today for more information about your Medicaid or Medicare plans and our NEMT services!
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