When a rider wants to change the trip: new destinations, extra passengers, and stops along the way

The trip carries only what the broker approved

A Medicaid trip is an authorization for one rider, one route, and any companions the broker agreed to. When the rider asks for something else, the honest answer from the driver is “Let me check with the office,” not yes and not no. The decision belongs to the broker on a broker trip, and to you and the rider on a private-pay trip.

Broker rules leave drivers no room here. MTM Health’s Virginia member handbook (approved July 2026) tells members that drivers transport only to the pickup and drop-off locations on the trip reservation, return to the place they dropped the rider off unless directed otherwise, and cannot make extra stops such as fast food or shopping. In Wisconsin, MTM’s word to providers is that a rider wanting to go somewhere new must get MTM’s go-ahead first.

Requests fall into four groups, and each has its own answer:

• A different destination, before or after the appointment.
• Extra people, adults or children, who were not on the booking.
• A stop on the way, such as the pharmacy or a store.
• A private-pay rider who wants any of the above.

A different destination

The most common version comes at the end of the day: “Take me to my daughter’s instead of home.” Others come at pickup (“my appointment moved to the other office”) or mid-trip (“the doctor wants me at the lab across town”).

None of these is the driver’s call on a broker trip. Who asks the broker varies. MTM Wisconsin asks providers to have the member call MTM for changes to their trip. Under MTM’s handbook for Rhode Island (updated July 1, 2026), the provider calls MTM to verify and approve the new address, and the trip goes on only after MTM changes the manifest. Missouri’s broker cannot approve more than three legs, meaning two stops, in a day without prior authorization from the state’s MO HealthNet Division, so a third destination needs a second level of approval.

A few variations come up often:

• A new office for the same doctor. If the destination really changed, the trip record is wrong and the broker fixes it. The guide on trips booked with the wrong address or level covers that from the office side.
• A referral to a lab or imaging center. That is a new leg to a new destination. The rider or clinic asks the broker, and the driver waits for the approved trip.
• Going home early, before the appointment. The rider can decline the visit, but dispatch tells the broker so the return leg is cancelled and the trip is recorded as it actually ran. Billing a trip that stopped short is covered in billing an incomplete trip.
• “Just drop me here.” Leaving a rider somewhere that is not on the trip is not a shortcut. Drop-off locations are part of the authorization, and on hand-to-hand trips a person has to be there to take over.

A rider who suddenly feels very sick is not asking for a new destination. That is an emergency. MTM’s Virginia member handbook tells members to call 911 for conditions such as chest pain, trouble breathing, or bleeding that will not stop, and CareOregon’s manual has providers call 911 if the situation calls for an ambulance, alert the brokerage at once, and file a written incident report within 24 hours. The steps for a medical emergency during a ride have their own guide.

People who were not booked

A Medicaid trip usually covers the rider plus one companion, booked in advance. Anyone else rides only if the broker agrees and there is a seat.

The limits vary by program:

• Virginia (MTM Health). One companion at most, and the rider names that person at booking so MTM can hold a seat.
• Wisconsin (MTM Health). Medically necessary riders, such as an escort backed by a health care provider’s form or a parent of a minor, ride with the member. Non-medical riders, such as legal dependents or a support person, are limited by the open seats. MTM’s own example: four open seats means three additional riders.
• MTM’s standard provider agreement. A single escort or attendant rides with the member on request. A second one has to be cleared with MTM beforehand.

Seats are a hard limit whatever the broker says. TennCare’s vehicle rules cap the people on board, driver included, at the seating capacity the manufacturer approved, and every passenger seat needs a working seat belt. When a rider arrives with two extra people and the van has one open seat, the answer is no, however the program’s rules read.

The difference between an escort who stays with the rider and an attendant your company supplies is explained under escort and attendant. Billing for an extra passenger, where a program pays for one, is covered under the TK modifier.

Children who were not on the booking

An unbooked child raises two questions at once: who is responsible for the child, and is there a proper seat. Both have to be answered before the van moves.

• The seat. MTM’s standard provider agreement has the driver refuse the trip if there is no proper child restraint or the parent will not use one, and it bars placing a child seat in the front. MTM Wisconsin tells members that parents must bring and install the car seat or booster, drivers cannot help install it, and without one the ride cannot happen. CareOregon’s manual says supplying and installing child seats is not the driver’s job, and a child who needs a seat does not ride without one.
• The adult. Under Oregon’s rule cited in CareOregon’s manual (OAR 410-141-3935), members 12 and younger need an attendant supplied by the parent or guardian. Missouri’s manual requires a parent or guardian, or an adult they designate, for riders under 17, apart from unaccompanied youth defined in state law.

When a parent brings a sibling along, the same rules apply to the sibling: a seat, a seatbelt position, and the broker’s approval. The full set of child rules, including state seat laws and teens riding alone, is in the guide to transporting children.

A stop on the way

If a stop is not on the trip, it is not approved. TennCare’s manifests, for example, list any additional stops, such as a pharmacy, as their own item, so a driver can see at a glance whether one was authorized. MTM’s Virginia member handbook tells members not to ask drivers for additional stops on the way to or from an appointment.

Riders can usually get a pharmacy stop the right way. CareOregon’s manual makes requesting additional stops in advance, pharmacy stops included, a member responsibility, and MTM’s Virginia handbook tells members who learn at the visit that they need the pharmacy to call MTM and have the stop put on the ride home. The additional stop entry compares program rules on pharmacy trips and how a stop splits a trip into legs.

A restroom break on a long ride is different from a side trip. It is part of caring for the rider, not a new destination. Tell dispatch when it happens and note it on the trip. The guide to long-distance trip rider care covers planning those breaks.

Private-pay riders

When the rider pays, the trip is your agreement with them, so a change is a change to what they are buying. Say yes or no on the spot only if your price sheet already answers it.

1. Price it from your rate sheet. An added stop usually means extra miles plus wait time at your posted rates. If you do not have a written rate sheet, the first request like this is a good reason to make one.
2. Tell the rider the new price before the change, and get a clear yes. A text reply works.
3. Update the trip and the invoice so the charge matches what happened.
4. Charge the card on file if the rider agreed to one. A signed card authorization makes this simple.

Facility-paid rides are not private pay for this purpose. The facility is the customer, so check with the facility before adding a stop it will be billed for. Medicaid riders cannot buy their way around broker rules: MTM’s standard provider agreement makes MTM your only source of payment and bars charging the rider, apart from a copay or fee MTM or its client authorizes. The guide on charging Medicaid patients covers where that line sits, and the private-pay guide covers pricing.

What the driver says and does

Give drivers a short routine so the answer is the same every time:

1. Acknowledge, do not promise. “I need to check with my office before I can change anything.”
2. Pull over somewhere safe and call dispatch. MTM’s Virginia member handbook limits drivers to a hands-free device and only for talking to their company’s dispatcher.
3. Dispatch asks the broker, or has the rider call, depending on the broker’s rule.
4. Wait for the updated trip or a clear no. Do not start toward the new place while the call is pending.
5. If the answer is no, finish the trip as booked and tell the rider how to request it next time.
6. Write it down before the next pickup.

Recording the request

Every change request gets a line on the trip, approved or not: what the rider asked for, who decided, when, and the new trip or authorization number if there is one. Record who actually rode. TennCare’s driver logs, for example, must show the actual number of wheelchairs, escorts, and accompanying adults for riders under 18, and the actual destination and time.

Those notes answer the complaint that comes later (“the driver refused to take me to my daughter’s”) and the audit that compares billed trips with what the broker approved. The documentation guide lists what else a trip record needs. Keep them as long as your contract says. MTM’s standard agreement asks for a decade of records, or more where a law or the client requires it.

Handling requests in HealthRide

When a rider asks for a change, the driver can message the office from the HealthRide driver app by chat or voice note. Every driver has one conversation with dispatch, and the whole office shares it, so whoever is on the desk can answer. Because a HealthRide trip holds up to eight legs, a broker-approved stop or second destination is added as a leg of its own. See how drivers and dispatch talk in team chat.