How to get transportation to dialysis: ride options, standing rides, and what to do after a missed ride

Start with the dialysis social worker

The social worker at the dialysis center is the first person to ask about rides. Federal rules for dialysis facilities put a social worker on every patient’s care team and require an evaluation of each patient’s psychosocial needs (42 CFR 494.80). The plan of care must then include social work help, such as counseling and referrals to other services (42 CFR 494.90). Medicare’s dialysis booklet points the same way: for rides other than an ambulance, ask your facility’s social worker what the options are.

The need is common. A national study of 115,982 adults on in-center hemodialysis, published in the Clinical Journal of the American Society of Nephrology in 2025, found that 27 percent had no private ride, meaning they neither drove themselves nor had a friend or relative drive them. Those patients used Medicaid rides, paratransit, private-pay transportation, or public transit. Every one of those groups was more likely to miss a treatment for transportation reasons than patients with a private ride.

Bring three things to that first conversation:

• Your schedule. Treatment days, chair time, and how long a session usually runs.
• Your coverage. Medicaid, Medicare, a Medicare Advantage plan, or more than one of them.
• What you need on the ride. A wheelchair or walker, help to the door after treatment, or an adult who rides along.

If the chair time is what makes every ride option fail, ask the clinic about a different shift. A facility that refuses a shift change you need for work is one of Medicare’s own examples of a complaint the ESRD Network handles, covered further down.

Which program pays for which ride

Medicaid is the main payer for car, van, and wheelchair van rides to dialysis. Original Medicare pays only for an ambulance, and only when other transport would endanger your health. Here is where each option fits and who to call.

Medicaid

Every state Medicaid program must make sure members with no other way to reach covered care can get there (42 CFR 431.53). Dialysis is covered care, so a member without a car or a driver qualifies for rides to each treatment. Many states run those rides through a transportation broker or the member’s Medicaid health plan. In Virginia, for example, people in fee-for-service Medicaid book through the state’s broker, MTM Health, while members of a Medicaid health plan use the plan’s own transportation benefit. Our guide to what Medicaid transportation covers explains the “no other way to get there” test.

People with both Medicare and Medicaid usually get rides from Medicaid. Medicare pays first for dialysis, but CMS’s transportation coverage guide says that when a person with full Medicaid benefits gets a service Medicaid can cover and Medicare pays first, the state must still ensure the ride. The guide defines full benefits as QMB Plus, SLMB Plus, or full benefit dual eligible status. Someone whose Medicaid only pays Medicare premiums and cost sharing may not qualify: Missouri leaves members whose only coverage is QMB out of its ride program. Our dual eligible entry explains the categories.

Original Medicare

Original Medicare’s only ride benefit is an ambulance. Part B covers one from home to the nearest dialysis facility when any other vehicle could endanger your health, and you pay 20 percent of the approved amount after the deductible. For scheduled, repeating trips, the ambulance company needs your doctor’s written order saying the ambulance is medically necessary, and the order’s date can be at most 60 days before the ride.

Repeat trips add one more step. A dialysis schedule soon counts as repetitive under Medicare’s ambulance prior authorization program, so the company, or you, can ask Medicare to approve the rides ahead of the fourth round trip within 30 days. If Medicare does not approve them and the rides go on, the company can bill you. Our guide to Medicare and NEMT explains the program and the rest of the benefit.

Paratransit

ADA paratransit is the shared van service a transit agency must run alongside its bus and rail lines for riders whose disability keeps them from using those lines. It can work for dialysis, with two limits to plan around:

• The pickup window. You book by the day before, and the agency may negotiate a pickup up to one hour before or after the time you ask for (49 CFR 37.131). With a fixed chair time, an hour late can mean a shorter treatment.
• The service area. Paratransit must serve trips within three quarters of a mile of a bus route, so a home or clinic farther out may fall outside it.

The fare can be up to twice the regular bus fare, and a personal care attendant rides free. The federal guidance on reasonable requests uses dialysis as its example of a rider who waits at the curb on the way in but needs help to the door on the way home, and says the operator should generally give that help (49 CFR Part 37, Appendix E). Ask for it when you register or book.

Help with costs

The American Kidney Fund’s Safety Net grant helps dialysis and transplant patients with costs insurance does not pay, and transportation to dialysis is one of the typical uses. In most states the grant is $200 a year. Apply through the clinic social worker or by calling AKF.

Set up a standing ride

A standing ride, usually called a standing order, is a ride booked once that repeats on your treatment days. In-center hemodialysis usually means three treatments a week of about four hours each, the National Kidney Foundation says, so one booking covers six one-way trips every week.

Who books it and how long it lasts depend on the state:

• Virginia (fee-for-service Medicaid). Your health care provider must schedule the standing ride, for up to six months at a time. Dialysis is first on the handbook’s list of services that qualify.
• Missouri. You or a clinician at the treating facility (a facility support worker, case manager, or nurse) can ask the broker to enter one. Dialysis standing orders have no expiration date. A hospital stay switches the standing order off, and a new one has to be arranged after discharge.

Missouri also pays mileage to patients who drive themselves or have someone drive them. The trip log needs a facility clinician’s signature and must reach the broker within 60 days of the appointment.

When you set up the ride, give the ride line:

1. Your treatment days, your chair time, and the time you are usually ready to leave.
2. Any mobility equipment, such as a wheelchair or walker.
3. Whether you need help from the door, or an adult riding with you.
4. The clinic’s phone number, so the dispatcher can reach staff.

If your state puts an end date on standing rides, write it on the calendar so the ride is renewed before it lapses. When the clinic moves your day or chair time, for a holiday or a shift change, call the ride line the same day so the standing ride moves with it. Clinic staff who book these rides will find more detail in our guide to standing orders.

Know the on-time rules before you need them

Every ride program has written timing rules, and they tell you when to call. Two examples:

• Virginia (MTM Health member handbook). Be ready 15 minutes before pickup, and call MTM Health once the driver is 15 minutes past the scheduled time. A ride home booked in advance should come within 15 minutes of the appointment ending. A ride home you call for when treatment ends should come within 45 minutes. When the ride home runs later than that, call the Where’s My Ride line at 1-866-246-9979.
• Missouri (MTM Health, the fee-for-service broker). Drivers get a 15-minute grace period past a standing order’s appointment or pickup time. After that, the patient or clinic staff call the Where’s My Ride line at (866) 269-5944. It is also the number to call when you are ready to go home and no pickup time was set.

Timing matters more for dialysis than for most visits. Your prescriber sets how long and how often you dialyze, and the National Kidney Foundation warns that missed treatments can push potassium to dangerous levels and leave fluid in the lungs. Staff at four California dialysis clinics told UC Davis Health researchers in 2026 that some sessions ended early when a driver refused to wait, and patients described waiting outside for hours after treatment while dizzy. In the national study above, Medicaid ride users missed 5.5 treatments per 100 scheduled, against 4.03 for patients with a private ride.

If the ride does not come

Make these calls in order:

1. Call the ride line right away. Ask where the driver is and, if the ride is not coming, for a replacement. CMS expects states to tell members how to report a driver who never came and get a replacement, and to let replacement companies step in on short notice.
2. Call the dialysis center. Tell them you are delayed or stranded, and ask whether a later chair is open that day.
3. Get medical help if you feel unwell. Shortness of breath after a missed treatment can mean fluid in the lungs, which the National Kidney Foundation says may need emergency dialysis at a hospital.
4. File a complaint once you are safe. In Virginia, call MTM Health at 1-866-386-8331, 24 hours a day. In Missouri, say “I would like to file a complaint” on the Where’s My Ride line. The broker must acknowledge a grievance in writing within 10 business days.
5. Appeal a denial. If the broker refuses a ride, ask for the decision in writing. Virginia members have 30 days from a written denial to appeal to DMAS, and Missouri members have 90 days to ask for a state fair hearing. Our guide to appealing a denied ride walks through it.

Past lateness does not cost you the benefit. CMS says states may not deny transportation because of member no-shows or lateness, even when they happen often, and members cannot be charged for a missed pickup. The state can require extra steps, like confirming the ride the evening before, but CMS expects it to send a letter first, documenting its efforts to help and the behavior behind the change. For complaint routes beyond the broker, see our guide to Medicaid transportation complaints.

The clinic grievance and the ESRD Network

When missed rides turn into a problem with the clinic itself, two more doors open. Every dialysis facility must run a grievance process that lets patients complain orally or in writing without reprisal or loss of services, with set timeframes for review (42 CFR 494.180). The facility must also tell you how to reach the ESRD Network and the state survey agency, and post their phone numbers where patients can see them (42 CFR 494.70).

ESRD Networks are regional organizations that monitor and improve care for people with kidney failure, and they take complaints about dialysis facilities and transplant centers. You can file with the Network without using the clinic’s process first, and the Network can still represent you if you want to stay anonymous. IPRO, which runs several of the Networks, including those for New England, the South Atlantic and the Ohio River Valley, says most grievances wrap up in a few days, while complicated cases can take up to 60. Call 1-800-MEDICARE (1-800-633-4227) for your Network’s number.

The Network also matters if a facility mentions discharge. A facility may discharge a patient against their will only if the patient or payer stops paying, the facility closes, it can no longer meet the patient’s documented medical needs, or the patient’s behavior is so disruptive and abusive that care is seriously impaired. Missed treatments are not on that list. For the behavior reason, the facility must give the patient and the Network 30 days’ notice, get a written order signed by the medical director and the attending physician, try to place the patient at another facility, and notify the state survey agency.

When a storm or emergency closes the route

The ESRD Network helps with rides in a disaster too. Medicare says that for people with Original Medicare, the Network can help keep treatments going and tell you whom to call about rides to dialysis. People in a Medicare Advantage plan call the plan instead. Ask your clinic now where it would send you if it closed, and save the Network’s number in your phone.

For the transportation company on these routes

On dialysis routes, the two jobs are arriving inside the pickup window and getting riders home when treatment ends. HealthRide’s recurring trips build a dialysis schedule once and keep it going, and a series can be paused during a hospital stay and resumed after. Riders and families can follow their driver live from a text link. The details are on the recurring trips page.