# Medicaid Eligibility Verification for NEMT Trips: When to Check and What It Tells You

Canonical URL: https://nemtguide.com/glossary/eligibility-verification/ · Updated 2026-09-28

Medicaid eligibility verification is checking the state's records to confirm a rider has Medicaid on the date of the ride, and which plan and benefits apply. Check on the day of every trip through the state's provider portal, phone line, or a 270/271 electronic inquiry. A Medicaid card alone does not prove coverage, and a claim for a rider who was not covered that day is denied.

- Check eligibility on the date of every ride, including each ride on a standing order.
- The response tells you who pays: the state, the state's broker, or the rider's health plan.
- Some Medicaid coverage has no ride benefit, such as QMB-only and emergency-only coverage in Indiana.
- Save proof of each check: a portal screen print or the phone system's verification number.
- From January 1, 2027, expansion adults are renewed every six months and retroactive coverage gets shorter.

A rider can have Medicaid one month and lose it the next. Eligibility verification is how you find out before the van leaves, and it also tells you who pays for the ride.

## What eligibility verification tells you

The state checks eligibility on every claim. Under 42 CFR 447.45(f), the state's review before payment must confirm the member was in its eligibility file and the provider was allowed to give the service on that date. Your own check, done first, keeps you from driving a ride that will be denied.

States run these checks through their Medicaid claims system, the MMIS. The response shows more than yes or no.

| What to look at | Why it matters for the ride |
|---|---|
| Coverage on the ride date | No coverage that day means no payment. New York lists it first among the reasons Medicaid will not pay for a ride |
| The benefit plan | Some coverage has no ride benefit. Indiana's transportation module (August 19, 2025) lists plans without rides, including Emergency Services Only, the Family Planning Eligibility Program, and QMB-only and SLMB-only coverage |
| The health plan, if any | Tells you whether to bill the state, its broker, or a plan. See [fee-for-service Medicaid](https://nemtguide.com/glossary/fee-for-service-medicaid/) and [Medicaid managed care organization](https://nemtguide.com/glossary/managed-care-organization/) |
| Other insurance | Medicaid pays last. When the state already knows of other coverage that is likely liable, it generally rejects the claim and returns it so the other payer is billed first (42 CFR 433.139). See third party liability |
| Restrictions | New York does not pay when a member restricted to a primary provider has a claim naming a different ordering provider |

Coverage types vary by state. New York's eligibility manual (October 2025) lists a family planning extension response that excludes transportation. Georgia's NEMT manual (July 1, 2026) says members with QMB-only coverage are not eligible for rides unless they also have full Medicaid. See dual eligible.

## How to check eligibility in your state

Each state below offers a provider portal and a phone line. New York and Indiana also accept the standard 270/271 electronic inquiry, and Texas takes batch requests through its EDI system.

| State | Online | Phone | Notes |
|---|---|---|---|
| New York (MEVS manual, October 2025) | ePACES, free with an eMedNY ETIN | 1-800-997-1111 | Batch 270 files hold up to 5,000 inquiries per transaction set. Questions go to the eMedNY Call Center, (800) 343-9000 |
| Texas (section 4, September 2026) | TexMedConnect, TMHP EDI, or the Medicaid Client Portal for Providers | 1-800-925-9126, the Automated Inquiry System | Up to 5,000 requests per EDI transmission. Form H1027 counts as proof of eligibility |
| Illinois (handbook, March 11, 2024) | MEDI, or the Recipient Eligibility Verification system | 1-800-842-1461, the Automated Voice Response System | Check on the day of the trip, before each ride |
| Indiana (eligibility module, September 1, 2026) | IHCP Provider Healthcare Portal | 800-457-4584, option 2, the GABBY virtual assistant | Customer Assistance staff do not give eligibility information |
| North Dakota (manual, January 2026) | ND Medicaid MMIS Portal | 1-877-328-7098, the Automated Voice Response System | The member must be eligible on the date of service |
| Georgia (NEMT manual, July 1, 2026) | The state's Medicaid web portal at mmis.georgia.gov | 770-325-9600 or 1-800-766-4456, the Medicaid Eligibility Inquiry System | The state's NEMT broker uses these before scheduling |

## When to check eligibility

1. **At intake.** Look the rider up when the trip is booked, so you know who to call for approval. See NEMT trip intake.
2. **On the day of the ride.** Indiana requires providers to verify eligibility on the date of service. Illinois says it is the provider's responsibility to check in MEDI or by phone on the day of the trip, before each transport. Its ride approvals do not include an eligibility decision.
3. **For every ride on a standing order.** Indiana's system cannot verify future dates, and it notes eligibility changes are most likely at the start of each month.
4. **After a change is expected.** Indiana's system is updated daily, but a caseworker's change takes about two days to show up, and three days when it is made on a Friday.

Save proof of each check. Indiana accepts a portal screen print with its time and date stamp, or the verification number from its phone system, when a claim is disputed. Texas asks providers to document the check in their records when a client has no card.

## Broker trips: who checks

Many brokers check eligibility when they book. WellTrans's Indiana agreement (revised October 16, 2025) says WellTrans verifies each rider's eligibility and schedules the trips. Georgia requires its NEMT broker to verify eligibility through the state's portal or phone system before arranging a ride.

That check does not end your risk. New York and Illinois both say prior authorization does not guarantee payment when eligibility rules are not met. On repeat trips booked weeks ahead, coverage can end before the ride. Check the rider yourself in the state system on the ride date, and follow your broker agreement if coverage has ended. See [how to bill NEMT brokers](https://nemtguide.com/guides/how-to-bill-nemt-brokers/).

## What happens when a rider is not eligible

The claim is denied. Texas cannot pay for services given before coverage starts or after it ends, and payment must be settled between the provider and the client. The rules on billing the rider differ:

- **Indiana:** you may bill a rider who was not eligible if you told them and they agreed in writing to pay. If coverage is later approved back to that date, you must bill Medicaid and refund the rider.
- **Texas:** you may decline Medicaid for a retroactive eligibility period, but only if you apply that policy to every such client and tell them before the service.

Coverage can also be approved after the ride. Under 42 CFR 435.915, coverage must reach back as far as the third month before the month of application for someone who got covered care in that time and would have qualified. For applications made on or after January 1, 2027, Public Law 119-21 section 71112 cuts that to one month for expansion adults and two months for everyone else. See the retroactive coverage cut.

| State | What to do when coverage comes through late |
|---|---|
| New York | Watch the eligibility system. Submit the trip attestation up to 120 days after eligibility is established. Later requests are denied |
| Texas | For a client approved but not yet given a Medicaid number, the 95-day filing deadline starts on the add date, when eligibility reaches the TMHP file |
| Indiana | Brokered rides are payable if the retroactive date is on or before the ride. Contact Verida for fee-for-service claims, and refund any payment from the rider |

Indiana says most eligibility denials come from details that should have been checked before the service. See [NEMT claim denials](https://nemtguide.com/guides/nemt-claim-denials/) and [timely filing limits](https://nemtguide.com/glossary/timely-filing-limit/).

## What changes in late 2026 and 2027

Public Law 119-21, enacted July 4, 2025, changes who is covered, how often coverage is renewed, and how far it reaches back.

| Change | Starts | Who it affects |
|---|---|---|
| Renewals every six months (section 71107) | Renewals scheduled on or after January 1, 2027 | Expansion adults |
| Work or community engagement requirement (section 71119) | No later than January 1, 2027, unless CMS grants a state an exemption that cannot run past December 31, 2028 | Expansion adults who are not exempt |
| Shorter retroactive coverage (section 71112) | Applications made on or after January 1, 2027 | Everyone, one month for expansion adults and two for others |
| Limits on federal payment for some immigrants (section 71109) | October 1, 2026 | Members outside the listed citizen and immigrant groups |

See [six-month Medicaid renewals](https://nemtguide.com/news/medicaid-six-month-renewals/) and [Medicaid work requirements](https://nemtguide.com/news/medicaid-work-requirement-rule/).

## Frequently asked questions

### Is a Medicaid card proof that the rider is covered?

No. New York's permanent benefit card has no expiration date, and the state says eligibility must still be verified in its system. Indiana says viewing a member ID card alone does not ensure eligibility. Use the card to look the rider up, then check coverage for the ride date.

### How often should I check eligibility for a rider on a standing order?

Before every ride. Illinois makes it the provider's responsibility to verify eligibility on the day of the trip, before each transport. A rider can have gaps in coverage, and Indiana notes that changes are most likely at the start of each calendar month. A check the day before cannot tell you about tomorrow: Indiana's system will not verify future dates.

### Does the broker check eligibility for me?

Many do when they book the ride. WellTrans's Indiana agreement says WellTrans verifies each participant's eligibility, and Georgia requires its NEMT broker to check eligibility before scheduling. An approval is still no promise of payment: New York and Illinois both say prior authorization does not guarantee it when eligibility rules are not met.

### Can I bill the rider if they turn out not to have Medicaid?

Only under your state's rules. Indiana lets you bill a member who was not eligible on the date of service if you told them and they agreed in writing to pay. If Indiana later approves retroactive coverage, you must bill Medicaid and refund what they paid. Texas lets you refuse Medicaid for a retroactive period only if you apply that policy to every such client and tell them before the ride.

### What if the rider's Medicaid is approved after the ride?

You may still be paid. Federal rule 42 CFR 435.915 covers up to three months before the month of application. For applications starting January 1, 2027, federal law cuts that to one month for expansion adults and two for others. New York allows a trip attestation up to 120 days after eligibility appears, and in Texas the 95-day filing clock for a newly approved client without a Medicaid number starts when eligibility is added to the state's file.

## Official resources

- [eMedNY: MEVS and DVS Provider Manual (New York)](https://www.emedny.org/ProviderManuals/5010/MEVS/MEVS_DVS_Provider_Manual_(5010).pdf)
- [TMHP: Section 4, Client Eligibility (Texas)](https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-09-september/1_04_client_eligibility.pdf)
- [IHCP: Member Eligibility and Benefit Coverage module (Indiana)](https://www.in.gov/medicaid/providers/files/modules/member-eligibility-and-benefit-coverage.pdf)
- [Illinois HFS: Handbook for Providers of Transportation Services](https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/transportationhandbook.pdf)
- [eCFR: 42 CFR 435.915, Retroactive eligibility](https://www.ecfr.gov/current/title-42/section-435.915)