Does the CDHS have a duty to assist a Medi-Cal recipient in obtaining nonmedical transportation to and from Medi-Cal covered medical appointments if there is no medical necessity for medical transportation?

A state Medicaid plan (Medi-Cal) must specify that the Medicaid agency will ensure necessary transportation for recipients to and from providers and describe the methods the agency will use to meet this requirement. (Title 42, Code of Federal Regulations (CFR) §431.53)

Yes, CDHS does have a duty to assist a Medi-Cal recipient in obtaining nonmedical transportation to and from medical appointments even if medical transportation is not medically necessary if the recipient does not have accessible transportation. If the Medi-Cal recipient has a car or access to transportation, (e.g., a bus route running between the recipient's home and the doctor's office) and the judge determines that medical transportation is not necessary, there would be no obligation for CDHS to assist with nonmedical transportation.

Assisting the claimant requires the CDHS to do more than mail a list of low cost transportation providers if the claimant requires additional assistance.

A judge who concludes that the claimant does not need medical transportation, but needs assistance with getting nonmedical transportation may order the CDHS to assist the claimant in obtaining such nonmedical transportation.

A sample order where the judge denies medical transportation but orders the CDHS to assist the claimant with nonmedical transportation might read as follows: