Trip denial: when a broker or plan refuses a ride request
A trip denial is a Medicaid broker's or health plan's refusal to arrange a requested ride. Common reasons are that the member is not eligible, the visit is not a covered service, the request came too late, or the rider refused the assigned type of ride. The member gets a notice with the reason and appeal rights. A denied request never becomes a trip, so no provider is sent.
On this page
What counts as a trip denial
A trip denial is a decision, made when the ride is requested, that Medicaid will not arrange it. In fee-for-service programs the state’s broker makes the call. In managed care, the member’s health plan or its transportation vendor does. Federal managed care rules treat the denial of a requested service, including a decision about the type or level of service, as an adverse benefit determination, which carries formal notice and appeal rights.
A denial is different from a cancellation. A canceled trip was authorized and then called off. A denied request is never scheduled, so it never reaches a provider.
Common reasons for a denial
Missouri’s NEMT manual (posted April 2026) lists its denial reasons in Section 8, and MTM Health’s Virginia member handbook (updated June 2026), which covers fee-for-service rides on or after October 1, 2026, names its common ones. The table draws on both:
| Reason | Example from a program rule |
|---|---|
| Member not eligible | Both programs list ineligibility for the transportation benefit |
| Service not covered | Missouri does not cover pharmacy trips unless the member has a vaccination appointment; Virginia denies rides to services fee-for-service Medicaid does not cover |
| Not enough notice | Virginia expects five business days for routine visits; Missouri asks for two business days in urban counties and three in rural or basic counties, with same-day rides for hospital discharges and urgent needs |
| Missing information | The member cannot or will not give what the broker needs to schedule the ride |
| Wrong type of ride | Missouri lists a member who refuses the appropriate mode, which ties to the least costly mode rule |
| Other options exist | Missouri lists other coverage, access to a vehicle, or free transportation |
| Too far or too many legs | Missouri denies rides that exceed its travel standards, are not to the closest available enrolled provider, or go over three legs a day without approval |
Urgent requests can still be refused. Missouri lists “urgency not verified by medical provider” when a same-day ride is requested as urgent. The advance notice entry covers lead times in more programs.
The notice and the appeal
Federal rules set what a denial notice must contain. Under 42 CFR 431.210 it states the action, the specific reasons, the rule behind it, the right to a hearing, and when benefits continue during a hearing. Missouri requires the broker to tell the member verbally and in writing. Virginia’s handbook promises timely notice and points members to the DMAS Appeals Division.
Deadlines depend on the route:
- Virginia fee-for-service: appeal to DMAS within 30 days of the written denial.
- Missouri: request a state fair hearing within 90 days of the written notice.
- Managed care plans: appeal to the plan within 60 calendar days of its notice (42 CFR 438.402).
- NEMT-only plans (PAHPs): enrollees go to a state fair hearing (42 CFR 431.220).
The full process, including fast appeals for urgent trips, is in the guide to appealing a denied Medicaid ride.
What providers see
Most denials never reach a transportation provider, because a denied request is not sent out as a trip. What providers do see are the edges:
- A rider asks for a ride that is not on the manifest. Do not run it. MTM Health’s Rhode Island handbook tells providers to perform only trips that carry its unique trip ID and does not guarantee payment for any trip run without it.
- A rider asks to change the destination. The same handbook requires the provider to call MTM for approval, and MTM updates the manifest before the trip continues.
- A trip you turned back finds no taker. Missouri counts trips no provider is able or willing to accept as a denial reason, so a turnback can leave a member without a ride.
Send riders with a denied request to their broker or plan, since only they can reverse it.
Where software helps
HealthRide connects with your brokers, like MTM, Alivi and Sentry, and the rides they approve show up on your board on their own, with no retyping. The broker connections page shows how it works.
Frequently asked questions
- Is a trip denial the same as a claim denial?
- No. A trip denial happens before the ride, when the broker or plan refuses the request. A claim denial happens after a completed ride, when the payer refuses to pay the provider. The member has appeal rights on a trip denial. The provider handles a claim denial by correcting the claim or appealing it with the payer.
- Can a broker deny rides to a member who keeps missing them?
- No. CMS guidance (SMD 23-006) rules out refusing rides to a member over missed or late pickups, however frequent, and bars charging the member for a no-show. States can add steps instead, such as a confirmation call the night before or the morning of the ride.
- How long does a member have to appeal a denied ride?
- It depends on the program. Virginia fee-for-service members appeal to DMAS within 30 days of the written denial. Missouri members have 90 days from the written notice to ask for a state fair hearing. Members of a managed care plan have 60 calendar days from the plan's notice to appeal to the plan.
- Can a transportation provider cause a trip denial?
- Indirectly, yes. Missouri's NEMT manual lists, as a denial reason, trips the broker cannot assign because no transportation provider is able or willing to take them. A trip that is turned back and never picked up by another provider can end as a denial for the member.
