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Dear Advocate,

My father is in a nursing home. He needs to go to a specialized clinic each week for treatment of a skin condition. However, he requires much medical attention, so I can’t drive him to the clinic myself. I also can’t afford to pay an ambulance or van to take him. Can Medicare or Medi-Cal cover the cost of medical transportation?

Stumped in Stockton

Dear Stumped,

If your father has Medicare Part B, it might pay for the cost. In general, Part B will pay for emergency ambulance services. Part B will also pay for nonemergency ambulance services if a physician orders them as medically necessary.

Three criteria must be met in order for transportation to be medically necessary. The beneficiary must be: (1) unable to get up from bed without assistance; (2) unable to ambulate; and (3) unable to sit in a chair or wheelchair.

Note that Medicare only pays for ambulance services; it does not pay for other forms of medical transportation, such as wheelchair vans or litter vans.

If your father has Medi-Cal, it might pay for the cost. Medi-Cal covers ambulance, litter van, and wheelchair van medical transportation if transportation by ordinary means is medically contraindicated, and if transportation is required in order to obtain needed medical care. In other words, a physician needs to prescribe or order the transportation as necessary.

Under Medi-Cal, emergency medical transportation does not require prior authorization from Medi-Cal. However, nonemergency medical transportation requires prior authorization; the transportation provider must submit a treatment authorization request (“TAR”) to Medi-Cal for approval. Remember that for Medi-Cal coverage, the transportation provider must be certified to accept Medi-Cal.

For assistance with the relevant regulations, contact CANHR at 1-800-474-1116.