NEMT Medical Necessity Forms: Who Signs Them, When You Need One, and How Long They Last

Medicaid pays for the lowest-cost ride that safely meets a rider’s needs. Illinois approves the least expensive mode adequate to the rider’s need, New York expects riders to use the same kind of travel they use for daily activities, and Indiana pays for the least expensive transportation that meets the member’s medical needs. When a rider needs more, such as a wheelchair van or a stretcher, a medical necessity form is the proof.

What a NEMT medical necessity form does

The form is a statement from the rider’s medical provider. It describes the condition that keeps the rider from using a bus, car, or taxi, and the level of service the rider needs. The broker or state uses it to decide which level to approve.

It supports the prior authorization. It does not replace it. New York’s Form-2015 policy (effective June 6, 2022) says so directly: the form is used together with the prior authorization to support the requested mode.

A diagnosis alone does not qualify. New York may reject a Form-2015 that lists only a diagnosis or diagnosis code without describing the rider’s ability to walk or travel. Medi-Cal’s ground transportation manual says a diagnosis such as multiple sclerosis or stroke will not satisfy its requirement for ongoing trips.

Medical necessity forms by state

Program	Form	When it is needed	Who can sign	How long it lasts
New York Medicaid	Form-2015, Verification of Medicaid Transportation Abilities, submitted in the transportation manager’s online portal since June 6, 2022	Wheelchair and higher levels. Also for taxi when the rider lives within half a mile of transit in New York City or three quarters of a mile elsewhere	Physician, physician assistant, dentist, registered nurse, nurse practitioner, occupational or physical therapist, LMSW, LCSW, or mental health counselor	Renew at least yearly, at the end date on the form, or when the rider’s condition changes
Illinois fee-for-service and HealthChoice Illinois plans	HFS 2270 Physician Certification Statement for rides from a hospital or long-term care facility. HFS 2271 Certificate of Transportation Services for rides from home	Wheelchair van (medicar), service car, and non-emergency ambulance. Not private auto	PCS: MD or DO, PA, clinical nurse specialist, RN, NP, discharge planner, long-term care medical director, LPN, LVN, social worker, or caseworker. CTS: MD or DO, PA, clinical nurse specialist, RN, NP, discharge planner, LCSW, or LPN	Up to 180 days for repeat wheelchair van and service car rides, 60 days for ambulance. A discharge PCS covers that date only
Ohio fee-for-service	ODM 03452, Certification of Necessity for Transportation by Wheelchair Van (rule 5160-15-27, effective August 1, 2026)	Wheelchair van rides not deemed necessary under the rules. Ohio health plans may use their own process	The practitioner, or someone with authority signing for them who adds the practitioner’s name and their own designation, such as MD, DO, DPM, RN, APN, PA, or LSW	Temporary, up to 90 days, or ongoing, one year, starting on the earlier of the signature date or first ride
Medi-Cal fee-for-service	A prescription, or an order sheet signed by the physician for facility residents, sent with the treatment authorization request	Every NEMT ride except acute hospital to nursing facility level A or B	Physicians, podiatrists, dentists, PAs, NPs, certified nurse midwives, physical, speech, and occupational therapists, and mental health or substance use disorder providers	The trip frequency or dates on the prescription. Ongoing trips also need a treatment plan

Other programs use their own forms and triggers:

• Georgia. Under its NEMT manual (July 1, 2026), the broker must have a Medical Necessity Certification or Letter of Medical Necessity in place before the third scheduled stretcher trip, and a letter must come with every stretcher standing order request. A trip beyond the state’s normal travel distance needs either a physician’s statement of medical necessity, when care is not available closer, or a health care provider’s referral. See the stretcher van entry.
• North Dakota. When a hospital arranges a ride at discharge, its staff checks eligibility and completes the Medical Certificate of Transportation Services (SFN 249), and a copy goes to you (manual updated January 2026).
• Texas. The Medical Transportation Program lists a Health Care Provider’s Statement of Need, where it applies, among the details a rider gives when booking a fee-for-service ride (handbook, September 2026).

Ohio shows another way to define need. For a wheelchair van, rule 5160-15-22 requires that the rider’s mobility device come along, that the rider ride in or on it between the van and the appointment, and that a standard car or common carrier be ruled out. A cane, crutch, or walker alone does not qualify.

Who can sign, and who cannot

The rider’s medical team signs, and the list is wider than doctors. Nurses, physician assistants, therapists, social workers, and discharge planners qualify in at least one of the programs above. Check your state’s list before you accept a form, because a form signed by the wrong title can be rejected. New York may also reject forms that are not signed and dated with the provider’s own NPI.

The ride company never signs. Ohio’s rule bars anyone employed by, under contract with, volunteering for, or otherwise associated with the transportation provider from certifying its rides. It also calls false certification Medicaid fraud, for example certifying a wheelchair van for a rider who never uses a mobility device. See NEMT fraud.

How long a form lasts and when to renew it

1. Track the end date for each rider. Put it on your schedule the day the form arrives.
2. Ask for a new form before it expires. Repeat trips such as dialysis run on standing orders, and an expired form can stop them. MAS, New York’s broker, schedules standing orders for up to 6 months, and they do not renew on their own. Since October 1, 2020, only the rider’s medical provider can request them. See NEMT standing orders.
3. Ask for a new form when the rider changes. Illinois, Ohio, and New York all require one when the rider’s condition or level of transport changes.
4. Drive only the level on the form. Ohio pays nothing for rides during a certification period that do not meet its criteria, such as a wheelchair van trip with no mobility device.

What to do when the form is missing

Keep proof of every request. When you ask Illinois’s vendor for approval, it accepts your documented attempt in place of a missing form, such as a signed U.S. Postal Service return receipt, a fax receipt, or an email receipt. It requires the hospital or nursing facility to provide a missing PCS free of charge within 10 calendar days of your request. It also allows the ride to go first when waiting would harm the patient.

Ohio sets its own path. You need a completed, signed, and dated form before you bill, and its signature date may be no more than 180 days after the later of the first ride or the day you learned the rider had Medicaid. If the practitioner does not answer after three attempts, with at least 30 days after each, you may bill with the incomplete form. Copies, faxes, and electronic copies count as originals. The form never extends your timely filing limit.

File each form with the trip records it supports. See NEMT trip documentation.