EPSDT and rides: the transportation help Medicaid owes children under 21
EPSDT transportation is the ride help Medicaid owes children and young adults under 21 in the Early and Periodic Screening, Diagnostic, and Treatment benefit. 42 CFR 441.62 requires the state to offer help with transportation and with booking appointments, and to give it when the family asks. CMS reads this to cover the trip of a parent or other adult who must go with the child.
On this page
What the rule requires
EPSDT is Medicaid’s benefit for children and young adults under 21. Transportation is written into it. 42 CFR 441.62 requires the state agency to offer the family or the young person, and provide if they ask, two things: necessary assistance with transportation under the general assurance of transportation, and necessary assistance with scheduling appointments.
The state also has to tell families this help exists. Under 42 CFR 441.56, it must explain in clear, nontechnical language that transportation and scheduling assistance are available on request. That notice generally goes out within 60 days of a child’s first Medicaid eligibility decision, and every year after that to families who have not used EPSDT services.
CMS repeated these duties in its 2023 transportation guide and again in a September 2024 letter to state health officials on EPSDT, SHO 24-005. Both tell states to consider the needs and best interests of the child when deciding what rides are necessary.
Parents and escorts
The biggest practical difference from adult NEMT is the adult who comes along. CMS’s position:
- Accompanying adult. If the child needs someone with them to get to care, the state must cover that person’s transportation, both ways, for admissions and discharges, and for trips out of state.
- Parent without the child. When a child is in inpatient, NICU, or psychiatric residential care and a parent must take part in treatment, the state may pay for the parent’s trip on its own. The state can also fold that cost into the facility’s payment.
- Visits. Rides for relatives who are only visiting are not covered.
States turn this into billing rules. Indiana requires an adult for members under 16. It bills the adult as an add-on under the child’s ID: T2001 alongside a T2003 base trip, or the base code with a TK modifier for wheelchair and taxi trips. The driver’s ticket must carry the adult’s name, signature, and relationship to the member. Our escort and attendant page compares age rules in other states.
Other help for families
Some states add travel support for young riders. Texas’s Medical Transportation Program offers meals, lodging, and advance funds for travel costs to clients from birth through age 20, with meals and lodging also covering their guardian or responsible adult. Illinois lets a parent ride as a non-employee attendant with prior authorization, and it allows extra passengers when the provider knows about them and has enough room, seatbelts, and car seats.
EPSDT also holds up when other rides are cut. Iowa’s and Georgia’s section 1115 waivers both removed rides for some adults but kept them for EPSDT.
For car seats and consent rules on the road, see transporting children in NEMT.
Seats for the whole family
A child’s trip often carries a parent and sometimes a sibling. When HealthRide’s Ryder Go plans the day, escorts and extra riders count toward each vehicle’s seats, so every route can actually board. See the route optimizer.
Frequently asked questions
- Is the adult traveling with a child covered too?
- Yes, when the child cannot go alone. In CMS's reading, the state must pay for the companion's travel as well, to and from the service. That includes the round trips for an admission or a discharge, even when the trip crosses state lines. How that shows up on a claim depends on the state. Indiana pays it through accompanying adult codes billed under the child's Medicaid ID.
- At what age can a child ride without an adult?
- Each state sets its own line. Indiana requires members younger than 16 to have an adult, such as a parent, go with them to a medical service. Ages differ from state to state, so check your state manual and broker contract before carrying a minor alone.
- Will Medicaid pay for a parent to travel to a child in the NICU?
- It can. When a parent's presence is needed so they can take part in the child's treatment, such as bringing breast milk, joining family therapy, or consenting to surgery, CMS lets the state pay for the parent's trip without the child in the vehicle. Ordinary visits to a hospitalized child are not covered.
- Do 19 and 20 year olds get EPSDT rides?
- Yes, in the eligibility groups EPSDT covers, which include everyone under 21 in a categorically needy group. That matters in waiver programs. Georgia's Pathways program, which otherwise leaves out rides, keeps them for members eligible for EPSDT, and it names members aged 19 and 20 as receiving EPSDT services.
