MedicaidCoverageMedium impact
[Ohio] Non-Emergency Medical Transportation (NEMT) Update
CareSource·OH·Provider Bulletin
Effective date
Apr 15, 2026
We identified it
May 9, 2026
Summary
CareSource is reducing Ohio Medicaid NEMT (Non-Emergency Medical Transportation) benefits effective April 15, 2026. General transportation trips under 30 miles decrease from 30 round trips (60 one-way) to 15 round trips (30 one-way) per calendar year, while unlimited trips remain for critical care services like dialysis, prenatal care, NICU visits, and pediatric appointments. Billing teams must update member benefit verification processes to reflect the new limits.
Action Required
By April 1, 2026: Billing and verification teams must update benefit lookup tools and member communication templates to reflect the new NEMT trip limits (15 round trips/30 one-way trips vs. previous 30 round trips/60 one-way trips for trips under 30 miles). Verify which services remain unlimited (dialysis, prenatal, NICU, pediatrics, EPSDT, hospital admission/discharge, wheelchair van, child wellness). Update pre-authorization or eligibility verification workflows to deny requests exceeding the new 15 round trip annual limit for standard transportation, except for the carve-out services listed. Ensure front desk and authorization staff are trained on the distinction between limited general trips and unlimited critical care trips. Post the new benefit structure on patient education materials and the provider portal. Failure to enforce the new limits may result in claim denials or member confusion about covered transportation.