Does Medicaid Cover Ambulance Services in Texas?

Texas Medicaid does cover ambulance services when the trip is medically necessary. Emergency transport is covered without any advance approval; non-emergency ambulance rides are also covered, but your doctor, nursing facility, or other requesting provider has to get prior authorization from the state or your managed care plan before the trip. The rules come from the Texas Health and Human Services Commission and the Texas Administrative Code, and the details depend on whether the ride is an emergency, whether you’re in managed care, and whether Medicare is also in the picture.

Emergency Ambulance Rides

For a true emergency, no prior authorization is required. Texas Medicaid pays when your condition needs immediate attention to prevent serious harm or loss of bodily function. The ambulance has to take you to an appropriate facility, meaning one equipped to treat what’s wrong. If the crew takes you somewhere else, Medicaid will only pay what it would have cost to reach the nearest appropriate facility.¹

When the emergency happens after hours, on a weekend, or on a holiday, the provider can file the authorization request on the next business day. Missing that window can get the claim denied.²

Non-Emergency Ambulance Rides

Medicaid also pays for non-emergency ambulance transport when your condition makes other ways of traveling unsafe. This typically covers patients confined to a bed or stretcher, transfers between facilities, discharges from a hospital or nursing home, and scheduled medical appointments where riding in a car or van isn’t medically safe.¹

Prior authorization has to come from your physician, nursing facility, or healthcare provider. The ambulance company can’t request it for you. For a one-time, same-day trip, the requesting provider has until the next business day to file. For ongoing transport, a physician can submit a written statement confirming that other forms of transportation are medically unsafe. That statement must be dated no more than 60 days before the authorization request, and an approved authorization can cover up to 180 days.¹

If Medicaid denies payment because no one obtained authorization, the ambulance company can bill the physician, nursing facility, or other party that ordered the ride. It can’t bill you.¹

What You’ll Pay

For a covered ambulance ride, you shouldn’t owe anything. Ambulance providers enrolled in Texas Medicaid have agreed to accept the Medicaid payment as payment in full and cannot bill you for the balance on covered services.¹

One exception: if the ambulance responds but you aren’t transported, the company can charge you for what it did on scene.

If you have both Medicare and Medicaid, Medicare pays first. Texas Medicaid then acts as the secondary payer. For Qualified Medicare Beneficiaries, Medicaid picks up the coinsurance and deductible. Members classified as MQMB also get Medicaid coverage for services Medicare doesn’t cover or that exceed Medicare’s limits.³

Managed Care vs. Fee-for-Service

Most Texas Medicaid members are in a managed care plan such as STAR or STAR+PLUS. That matters because authorization goes to a different place depending on your coverage.

If you’re in traditional fee-for-service Medicaid, your provider sends non-emergency authorization requests to the Texas Medicaid & Healthcare Partnership (TMHP), which responds within two business days on requests covering 60 days or fewer. If you’re in a managed care plan, your provider sends the request directly to your managed care organization and follows that plan’s procedures.²

STAR+PLUS members who also have Medicare are an exception: their claims go through the fee-for-service authorization process at TMHP, not the managed care plan.

Air Ambulance and Mileage Limits

Texas Medicaid covers air ambulance transport, both helicopter and fixed-wing, along with ground ambulance. Reimbursement for both is the lesser of the provider’s billed charges or the maximum fee set by HHSC.⁴ Mileage is not paid when the patient isn’t actually on board.⁵

On emergency runs, mileage reimbursement is capped at the cost of reaching the nearest appropriate facility, even if the ambulance drove farther. Transfers of 50 miles or more from pickup to destination are covered only when a local facility can’t adequately treat the condition.⁵

Treatment Without Transport (ET3)

Texas Medicaid includes an Emergency Triage, Treat, and Transport (ET3) benefit. When a crew responds to a 911 call and finds the situation is medically necessary but not a true emergency, Medicaid can pay for treatment on the scene or for transport to an alternative location like an urgent care clinic instead of an emergency room.¹

Rides That Aren’t Ambulance Rides

If you need a ride to a Medicaid-covered appointment but your condition doesn’t require an ambulance, that falls under the separate Non-Emergency Medical Transportation (NEMT) program, which arranges bus passes, taxi and van service, gas reimbursement, and paid drivers. NEMT is not part of ambulance coverage and does not include any form of ambulance transport.⁶

If Your Claim Is Denied

You have 90 days from the date on the denial notice or the effective date of the action, whichever is later, to request a state fair hearing. The request can be made orally or in writing.⁷

If you’re in a managed care plan, you generally have to complete the plan’s internal appeal first. Call your managed care organization for its deadlines and process. Hold on to the denial letter, any physician orders, and the ambulance company’s billing records. Most denials trace back to missing documentation, and having the paperwork ready is often what separates a successful appeal from one that fails.⁸

1
Legal Information Institute. Texas Administrative Code 354.1115 – Authorized Ambulance Services
2
Texas Medicaid & Healthcare Partnership. Fee-for-Service Prior Authorizations
3
Texas Medicaid & Healthcare Partnership. Client Eligibility
4
Legal Information Institute. Texas Administrative Code 355.8600 – Reimbursement Methodology for Ambulance Services
5
Texas Medicaid & Healthcare Partnership. Ambulance Services Handbook
6
Texas Health and Human Services. Nonemergency Medical Transportation Program
7
Legal Information Institute. Texas Administrative Code 357.3 – Authority and Right to Appeal
8
Texas Health and Human Services. Time Period for Requesting Fair Hearing