Dispatch and operations
NEMT Advance Notice: How Far Ahead Medicaid Riders Must Book, by State
NEMT advance notice is how far ahead a Medicaid rider must book a routine ride. The state or broker sets it: 48 hours in Louisiana, two business days in Texas and Indiana, three in Georgia, and five in Virginia. Florida and North Carolina cap what can be required. Urgent care and hospital discharges need no notice and often must be picked up within three hours.
- Routine rides need from one day to five business days of notice in the programs here, and out-of-state trips can need more. The state or broker sets the number, not federal law.
- Some states cap the notice: Florida at three business days, North Carolina's health plans at two, and Colorado bars notice that unreasonably limits access.
- In the programs on this page, urgent care and hospital discharges skip the notice rule, with pickup deadlines near three hours.
- Business days usually count weekdays only. Georgia counts the day of the call and skips six holidays.
- The notice rule decides how far ahead you see your schedule, so plan staffing and turnbacks around it.
Advance notice is the first rule a Medicaid ride meets. It decides whether a trip gets booked at all, how early it lands on your schedule, and which trips come to you at the last minute. The number comes from your state or broker. Federal NEMT rules set no booking deadline.
What advance notice means
Advance notice is the minimum time between a rider’s request and the appointment for a routine, non-urgent ride. It gives the broker time to confirm eligibility and the appointment, pick the right level of service, and find a provider.
Federal guidance leaves the number to the states but sets the tone. CMS’s Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says the scheduling and rescheduling process should be administratively simple for members. It also says states should be able to bring in replacement providers on short notice when a scheduled provider fails to show.
Transit paratransit works on a fixed federal rule instead. Under 49 CFR 37.131(b), an ADA paratransit service must give a ride in response to a request made the day before, and may take reservations up to 14 days ahead. See paratransit vs NEMT.
Advance notice rules by state
These are the published rules for routine trips, as of September 2026. Your broker agreement and your state manual are the ones you follow.
| Program | Routine trips | Source |
|---|---|---|
| Georgia Medicaid | At least 3 business days before the appointment, counting the day of the call but not the day of the appointment | DCH manual, July 1, 2026 |
| Virginia Medicaid fee-for-service | 5 business days | DMAS member manual, June 2026 |
| Texas Medical Transportation Program (fee-for-service) | At least 2 business days, or 5 business days for travel beyond the rider’s county | TMPPM, September 2026 |
| Indiana Medicaid fee-for-service | At least 2 business days. Shorter notice needs the health care provider to confirm the appointment with the broker. | IHCP module 6.1, August 19, 2025 |
| Louisiana Medicaid | At least 48 hours, but the broker must make a reasonable attempt with less | Chapter 10, issued July 14, 2025 |
| Pennsylvania MATP paratransit | At least 1 day and up to 14 days ahead, with same-day rides for certain urgent requests | DHS broker study, June 25, 2026 |
| Washington Apple Health, out-of-state trips | Requests reach the state at least 7 business days before travel | WAC 182-546-5800 |
Some states limit how much notice anyone can demand:
| Program | The cap | Source |
|---|---|---|
| Florida Medicaid | Providers may not require reservations more than 3 business days before the appointment, and may not require any for unscheduled or urgent care trips | Coverage policy, November 2019, under Rule 59G-4.330 |
| North Carolina Medicaid health plans | Plans may not require requests more than 2 business days before the appointment, or 5 days for trips at a greater distance, and may not require requests in person | NEMT managed care policy, amended January 1, 2025 |
| Colorado Medicaid | The broker may encourage booking at least 2 days ahead, but must accept same-day and next-day requests and make reasonable efforts to fill them. It may not require notice that would unreasonably limit access to care, and must allow single and recurring bookings. | HB26-1328, effective July 1, 2026 |
For more on each program, see our state guides, such as Georgia, Texas, and Florida.
How to count business days
A business day is usually a weekday that is not a holiday. Georgia spells it out: Monday through Friday, excluding New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. Its 3-day count includes the day of the call but not the day of the appointment.
| Appointment in Georgia | The 3 business days | Last day to call |
|---|---|---|
| Friday, October 9, 2026 | Tuesday, Wednesday, Thursday | Tuesday, October 6 |
| Friday, November 27, 2026 | Monday, Tuesday, Wednesday (Thanksgiving does not count) | Monday, November 23 |
Other states count differently, and some count hours instead of days, like Louisiana’s 48 hours. Use your program’s own definition.
The exceptions: urgent trips and hospital discharges
The programs above treat urgent rides separately, and most set a pickup deadline instead of a notice rule:
| Program | What counts as urgent | Pickup deadline |
|---|---|---|
| Georgia Medicaid | Care that must happen the day of the request and cannot wait until the next day, with no immediate threat to life or limb. Hospital discharges count as urgent. | Within 3 hours of the request |
| North Carolina health plans | Urgent trips are exempt from any notice rule, such as a test the doctor needs done the same day. Hospital and emergency department discharges count as urgent. | Discharges within 3 hours of the request. A discharge scheduled 24 hours ahead gets a ride at discharge time. |
| Louisiana Medicaid | A request by a health care provider for care that cannot be put off, including chemotherapy, radiation, dialysis, and opioid treatment programs. The broker may not deny it only for short notice. | Discharges: by the later of 3 hours after the facility’s notice or 2 hours after the scheduled discharge |
| Texas Medical Transportation Program | Hospital and facility discharges, pharmacy visits, and urgent care | Available with less than 48 hours’ notice |
| Indiana Medicaid fee-for-service | Transfers between facilities, such as a hospital and an extended care facility, are handled as urgent. Hospitals book discharges home on the broker’s facility dispatch line. | Urgent transfers within 3 hours of notice |
| Florida Medicaid health plans | Unscheduled trips | At least 85 percent within 3 hours of the request (contract update July 1, 2026) |
| Virginia Medicaid fee-for-service | The urgent need is confirmed with the treatment facility | Same-day urgent rides may take up to 3 hours. MTM Health’s handbook sets 3 hours from notice for hospital discharges. |
| New York Medicaid (MAS) | Same-day hospital discharge reservations | Within 3 hours of receiving the trip from MAS |
Georgia also lists the “good cause” that excuses a late routine booking: urgent care, follow-up care a provider orders in fewer than 3 days, a specialist opening that would otherwise mean a wait of two weeks or more, and a delay the broker caused. See hospital discharge transportation and same-day NEMT trips.
Short-notice trips can also arrive after the broker closes. In Washington, if the broker is closed and cannot approve an urgent care trip or a hospital discharge in advance, you may give the ride under the broker’s after-hours instructions and request retroactive authorization within two business days, or decline it (WAC 182-546-5200).
What advance notice means for your schedule
The notice rule sets how far ahead you can see work. MTM Health’s Virginia handbook (approved August 10, 2026) shows how a broker turns bookings into offers:
| When | What happens |
|---|---|
| 7 days before the appointment | Trips go to eligible providers in the service area, based on capacity, hours, distance, and credentials |
| 5 days before | The marketplace opens all trips in your service area for you to accept |
| 4 to 5 days before | Dispatchers call providers to confirm open offers |
| At least 24 hours before pickup | The last time to turn back a trip you cannot run |
Build your week around that rhythm:
- Accept only what you can staff. Turnbacks count against you. MTM Health’s Virginia handbook scores providers on returning fewer than 0.5 percent of assigned trips. See NEMT broker trip offers.
- Keep room for short-notice trips. MTM Health’s Virginia handbook expects providers to keep enough vehicles and drivers to answer short-notice assignments, and it will not assign you an urgent trip without asking you first. Open vehicles are what let you say yes to discharge and urgent trips.
- Confirm the day before. Texas health plans require demand response rides to be confirmed with the member 24 hours before pickup, except add-on trips, non-medical transportation, and hospital discharges. Members may not be contacted after 9 p.m. local time, and the provider keeps a record of the contact. MTM Health’s Rhode Island handbook also has providers contact members 24 hours before the ride to confirm the pickup time.
- Put regular riders on standing orders. A dialysis rider three days a week should not have to book every trip. Colorado’s law requires the broker to allow recurring bookings. See NEMT standing orders.
- Send riders to the broker. Indiana members must book through the broker’s reservation line or member portal, not by calling providers directly. They can still ask for you by name.
- Read the pickup rules too. Once a trip is booked, the pickup window decides whether you ran it on time, and the will-call rules decide the ride home.
Frequently asked questions
How far in advance do you have to schedule a Medicaid ride?
It depends on the program. Texas's fee-for-service Medical Transportation Program and Indiana's fee-for-service program ask for at least 2 business days. Georgia asks for 3, and Virginia's fee-for-service member manual (June 2026) asks for 5. Louisiana asks for 48 hours. Trips outside the rider's county or state often need more, such as 5 business days in Texas for travel beyond the county.
Can a Medicaid rider get a same-day ride?
For urgent care and hospital discharges, yes. Georgia honors valid urgent requests within 3 hours. North Carolina's health plans must pick up hospital and emergency department discharges within 3 hours of the request. Texas arranges rides with less than 48 hours' notice for discharges, pharmacy visits, and urgent care. Routine same-day rides depend on the broker having a provider free.
Can a broker require a week of notice for a routine ride?
Not everywhere. Florida's Medicaid transportation policy bars requiring reservations more than 3 business days ahead. North Carolina's health plans cannot require more than 2 business days, or 5 days for longer trips. Colorado's 2026 law lets the broker encourage 2 days but bars advance notice that would unreasonably limit access to care. Other states set their own rules.
What happens if a rider books too late?
The broker may still try, or it may deny the trip. Georgia's manual lets the broker deny a routine trip booked less than 3 business days ahead without good cause. Good cause includes urgent care, follow-up care a doctor orders in fewer than 3 days, and a specialist opening that would otherwise mean waiting two weeks or more. Louisiana's broker must make a reasonable attempt to schedule trips with less than 48 hours' notice.
Should my company take bookings directly from Medicaid riders?
Not for broker trips. In Indiana, members must book through the broker's reservation line or member portal rather than calling transportation providers directly, though they may ask for a preferred provider. In Texas's Medical Transportation Program, for example, a claim without the program's prior authorization is denied. Send riders who call you to the broker, and ask the broker to assign the trip to you.