Forms and Other Documents
- Escort Approval Form
(for members aged 11 and under requiring facility escorts)
- Medical Necessity Form
- Mileage Reimbursement Trip Log
(for trips occurring on or after September 1, 2023); please keep in mind these tips for completing and submitting your trip logs:
- If you are a new driver, please email a copy of your vehicle registration, vehicle insurance, and driver’s license to CTGMR@mtm-inc.net.
- If you were previously approved by Veyo, please send in a copy of your vehicle registration to CTGMR@mtm-inc.net.
- Claims can take up to 10 business days to be reviewed and processed.
- Please note, you will be issued a reloadable debit card to cover your reimbursement. It can take seven to ten business days for the card to arrive after your claim is approved.
- Completed trip logs must be emailed to PayMe@mtm-inc.net
- Minor Consent to Travel (for members between the ages of 12 and 15)
- Specialized Transportation Form
(for out-of-state trips, including ambulance)
- If you need to submit a request for mileage reimbursement for
an appointment that occurred on or before August 31, 2023,
please click here
- You can schedule a ride Monday through Friday from 7 a.m. to 6 p.m.
- You can schedule urgent trips such as dialysis, discharges, etc. 24/7
- You must call at least two business days before your routine appointment
- Have your trip information ready when you call
- Be ready at least one hour before your appointment time
Important Toll-Free Phone Numbers:
- To schedule a ride, call 1-855-478-7350
- If your ride is late, call 1-855-478-7350
- To file a complaint, call 1-866-436-0457
Frequently Asked Questions (FAQs)
NEMT is a limited transportation benefit that is provided to eligible Medicaid members in Connecticut. NEMT services are only available to HUSKY A, C, D, and limited benefit members who cannot drive themselves, and/or do not have a neighbor, friend, relative, or voluntary organization that can transport them to their appointment. The member must be attending a Medicaid-covered medical, behavioral health, or dental appointment.
There are multiple ways you can book a ride:
- You can use the web chat feature located on this website to chat with a live Representative in real time.
- You can call us at 1-855-478-7350 to speak with a Representative.
- You must call at least two business days before your appointment, unless your trip is urgent.
- If you need bus passes, please call at least five business days before your appointment.
- We schedule routine trips Monday through Friday from 7 a.m. to 6 p.m.
- We schedule urgent trips 24 hours a day, seven days a week.
When you call, please be ready to provide:
- Your name, date of birth, and Medicaid ID number.
- Your home address and phone number.
- Your health care provider’s name, phone number, and address.
- The date and time of your appointment.
- Any special needs, including if you need someone to ride with you.
If your appointment is urgent, MTM will set up your ride. An urgent request is an illness or injury that requires immediate treatment. Call us at 1-855-478-7350 24 hours a day, seven days a week, to schedule an urgent ride.
MTM does not schedule emergency transportation. Call 911 if you have an emergency.
Yes. A relative, caregiver, or health care provider may call and schedule transportation on a member’s behalf.
Yes. Just let the Representative know that you have more than one trip to schedule. You can also schedule recurring trips.
You will receive the ride that is most appropriate for you. We may consult your health care provider. Based on your needs, we will offer you:
- Gas mileage reimbursement if you, a friend, or family member can drive to the appointment.
- Fixed route bus tickets if your home and destination are within ¾ (0.75) miles of a bus stop, and you can walk there independently and safely.
- Sedan, van, or taxi services if you can walk between the door of your home/destination and the vehicle.
- Vehicle services equipped to transport standard sized and oversized wheelchairs, if you have specific mobility needs verified by your health care provider.
Please note, MTM does not schedule ambulance trips unless the member is traveling out of state. Prior approval will be required for these trips. Healthcare providers should submit a Specialized Transportation Form for any out-of-state ambulance trips.
We may be able to reimburse you, a friend, or a family member to drive you to your appointments. Ask us about this program when you call to set up your trip.
You may share a ride with another member who is traveling to and from the same area as you. Shared rides with other Medicaid members are allowed. If there are special health circumstances which prevent you from sharing a ride with other individuals, please tell us when you call to schedule your ride. We may consult your health care provider.
- Be ready for your ride at least one hour before your appointment time.
- If you scheduled a ride back, your driver should pick you up within 30 minutes after your visit is over. Call MTM if your driver is late or does not pick you up.
- If your visit is over and you did not schedule a ride back, call MTM. The driver should arrive within one hour. Call MTM back if you have waited longer.
Call MTM at 1-855-478-7350 if you need to cancel or reschedule your ride, or if you need to make changes to your ride. Please call as soon as possible.
Call MTM at 1-855-478-7350 if you:
- Have waited more than 15 minutes after the pick-up time scheduled during the original ride request. For the return trip, please allow your driver at least 30 minutes to arrive, and one hour to arrive if the trip was scheduled as a will call.
- Have waited more than one hour after calling MTM to schedule a return ride, if a return ride was not scheduled during the original request.
- Cannot reach the driver.
MTM cannot guarantee your provider of choice. The provider must be in our network. MTM does not assign trips to out-of-network providers.
Every effort is made to continue to operate transportation services during bad weather. However, delays and cancellations may occur due to unsafe travel conditions. If there is a snowstorm or bad weather, check with your health care provider to make sure their office is open. If you do not feel it is safe to travel, call us at 1-855-478-7350 to cancel your ride.
Children will not be transported to after-school treatment programs if the schools in the town they live in are closed, or if the schools in the town the program is located in are closed.
- Transportation for routine appointments can be scheduled up to 30 days in advance.
- Repeating trips can be scheduled up to 90 days in advance.
- If the trip request is received with less than two business days’ notice and the appointment is not urgent, you may need to reschedule your appointment.
- When scheduling your trip, please keep in mind that the driver may drop you off at the healthcare facility right at your scheduled appointment time. If it is a large facility or you need to arrive before the appointment time, please make sure to factor this in when scheduling the trip.
We always want to provide excellent service. Call MTM’s We Care Line at 1-866-436-0457 if you have a complaint. You can also make suggestions about how we can serve you better. You may also use our convenient online form. We will follow up on all complaints.
Yes, service animals are permitted to accompany members at all times. Please help drivers keep vehicles clean for all riders by bringing a crate or blanket to reduce the risk of damage or mess.
A parent, legal guardian, or caregiver is required to travel with any child under 16 years of age. Parents must fill out, sign, and return a consent form before child between 12 and 15 years old will be able to ride alone. Any child who behaves inappropriately while riding alone will need to be accompanied by an adult for all future rides.