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last modified 08/05/2016 - 09:10 AM

Non-Emergency Medical Transportation (NEMT): Medicaid provides transportation to appointments for covered services to members who don't have access to their own transportation.




  • Out-of-Area/Out-of-State Transportation Referral Form (Last updated on 07/01/2014Referral form necessary for transportation request over 60 miles from members residence to a participating provider.
  • Medicaid Transportation Mileage limit for out-of-area referrals change (7/1/2015)  Effective July 1st, 2015 the mileage limit for out-of-area referrals is increasing from 30 miles to 60 miles. Therefore, if a Vermont Medicaid member has a Medicaid-billable appointment at a participating provider 60 miles or greater from their residence, the referring provider will need to fill out and fax the Out-of-Area referral form to DVHA.
  • Public Transportation Exemption Form  (Last updated on 04/30/2015) Form to be filled out by provider’s office if medical conditions warrant the use of any specific mode of transport, or if medical conditions limit which modes may be utilized by the transportation provider.    
  • Transportation Exception Application (05/01/2015) Form to be used if member is requesting that a child under the age of 6 accompany the member to a scheduled appointment. 
  • Vehicle Exception Form (02/18/2016) Form to be filled out by member if vehicle(s) in household are not available for the transport of members to scheduled appointments.
  • Transportation Employment Exception Verification Form (11/19/2015) Form to be filled out by the employer of the member of the household who is unable to transport the member to scheduled appointments.