Application for Non-Emergency Medical Transportation Program (NEMT)
Form Template
As part of the Medicaid program, enrollees can obtain non-emergency medical transportation services that are deemed a medical necessity by their physician.
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The Application for Non-Emergency Medical Transportation Program (NEMT) app allows users to apply for Medicaid non-emergency medical transportation within sixty days of the earliest trip. Patients must provide: name, purpose of visit, name and address of medical provider, date of the appointment, time of the appointment, and Medicaid enrollment information. The Application for Non-Emergency Medical Transportation Program (NEMT) app is easy to fill out and great for recordkeeping for both patients and providers.
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