Medicaid bus passes: who qualifies for a monthly transit pass and how to request one

Medicaid must pick the least expensive ride the member can safely use, so a member who can ride the bus is often given bus fare or a pass instead of a van. A member with a pass travels on the bus schedule instead of waiting inside a pickup window. A pass is not right for everyone, and the rules for getting one change from program to program, from Utah’s mailed transit card to Nevada’s day-pass money loaded before each appointment.

Why Medicaid offers transit first

A bus or train fare usually costs Medicaid less than a car or van trip, and federal rules name transit outright. The federal definition of transportation in 42 CFR 440.170(a) includes travel by “common carrier,” and the statute behind state broker programs lists “bus passes and tickets” alongside wheelchair vans, taxis, and stretcher cars. Our page on least costly mode explains how programs apply the rule.

CMS’s 2023 transportation coverage guide, SMD 23-006, sets two limits on what Medicaid pays for transit:

• Fixed-route bus or rail. Medicaid should not pay more than the fare the general public is charged.
• ADA paratransit and dial-a-ride. Because paratransit costs more to run, Medicaid may pay more than the fare a rider with a disability is charged, but no more than other state human services agencies pay for comparable trips.

A pass is also only for members who need help getting to care. The same guide says that when other, non-Medicaid help is available, the program does not have to pay for the ride.

The monthly pass math

CMS allows a monthly pass when its price does not exceed the cost of buying the member’s medical trips one at a time. The guide gives a worked example: a pass costs $40 a month for unlimited rides, a round trip costs $10, and the member has four verified appointments that month. Four round trips cost $40, so the pass costs no more and is a fair buy for that month.

Three points follow from the CMS approach:

1. The appointment count drives the decision. For example, a member with one visit a month would usually get single fares or tickets, while a member with weekly therapy may qualify for a pass.
2. Appointments get verified. Expect the scheduler to confirm upcoming visits before issuing a pass.
3. Extra rides are not the test. CMS says that if the medical trips alone would have cost at least as much as the pass, it does not matter that the member also rides to the grocery store. Individual programs can still set tighter rules, as Utah does below.

The same reasoning applies to rail, ferry, and any other public transit pass.

How four programs issue passes

Each program turns the CMS test into its own steps. These four show the common patterns: a standing card, a pass earned by appointment count, a pass for frequent urgent trips, and fare money loaded per trip.

Some details behind those rows:

• Utah issues the card only to members who have no regular access to a working household vehicle, do not live in a long-term care facility, and live in the UTA service area, which covers Box Elder, Salt Lake, Weber, Davis, Tooele, and Utah counties. A “journey” counts every bus or train boarded within two hours of the first tap.
• Nevada’s card can only buy transit day passes. Monthly passes are picked up in person at three locations, and the ride to the future appointment has to be booked with MTM Health before the member comes in.
• Missouri lists bus tokens and bus passes among the modes its broker may assign. Ask the broker how often a pass is issued and what it needs to see first.

When the bus is the wrong ride

A pass only works if the member can safely get to the stop, board, and ride. Programs spell out exceptions, and a scheduler should hear about them before assigning transit.

• Distance and health. Missouri’s manual rules out transit when a pregnancy is high-risk or beyond eight months, and for high-risk heart problems or severe breathing trouble. It also rules it out when the walk to the stop runs past four blocks, or past half a mile if that comes first. Our coverage guide compares other states’ limits.
• Disability. Utah covers UTA paratransit for members who cannot use fixed-route buses on their own, once UTA’s own evaluation finds them eligible. After approval, the member calls Utah’s Medicaid Operations Office for monthly stickers. Members who need help beyond the curb can get it as a reasonable modification. Our page on paratransit explains how the service works.
• Infrequent trips. A member who has a working car and rarely goes to appointments may cost less on mileage. Utah pays mileage instead of issuing a card in that case, and counts trips as infrequent when the household averages one to three trips a month in the bus area, or about $10 to $12 or less in monthly mileage. It also pays mileage when transit does not serve the member’s home or destination. See mileage reimbursement.

When transit does not fit, the next step is usually a taxi, sedan, or van booked through the same line. Ask for the change when the trip is booked, not at the bus stop.

Riding with a child or an attendant

Caregivers have their own rules on transit:

• Parents of minors. Utah issues a card to the parent or guardian of an eligible member under 18, and up to two cards when the parents live at separate addresses listed in the child’s records. Children five and under ride without a card, but the adult still needs one.
• Personal care attendants. UTA lets one attendant ride free with a member whose card is printed “Attendant: Yes.” A second helper needs a pass or pays the fare.
• On ADA paratransit. Federal rules at 49 CFR 37.131 bar charging a personal care attendant any fare. A companion pays the same fare as the rider, and the rider’s fare cannot exceed twice the full fixed-route fare for a similar trip.

Reduced fares for everyday trips

A Medicaid pass covers rides to care. For trips outside Medicaid’s coverage, many members qualify for reduced transit fares from the transit agency itself.

Transit agencies that receive federal urbanized area formula grants must certify that, during off-peak hours, they charge three groups no more than half the peak fare. Under 49 U.S.C. 5307(c)(1)(D), they are seniors, people who cannot use transit effectively without special facilities or design because of illness, injury, age, or disability, and anyone who shows a Medicare card issued to them. Ask the local transit agency what proof it accepts and which hours count as off-peak.

A reduced fare card and a Medicaid pass work together. Use the Medicaid pass or tickets for appointments, and the reduced fare for everything else. For transportation companies, the billing side of passes and tickets is on our A0110 code page.

When the rider needs a van instead

Members who cannot manage the bus move to a car, van, or wheelchair trip. A transportation company that runs on HealthRide keeps each rider’s seat or wheelchair needs on the trip record, so wheelchair, stretcher, and oxygen needs are matched before the trip goes out. Each trip is assigned in one motion; see the dispatch board.