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Form for medical practitioners to request regularly reoccurring (three or more times per week, for 3 or more months duration) reservations for transport to a Medicaid covered service

Authorization for a minor to travel with a different adult than parent/guardian (Español)

Authorization for a minor to travel with a different adult than parent/guardian

Authorization for a minor to travel without an attendant

To determine that the requested service meets program coverage guidelines, that the client is utilizing the closest approved medical provider and most appropriate type of service

Introduction letter for LogistiCare’s management of Non-Emergency Medicaid Transportation

Request Form to Setup an Administrator Account for Requesting Transportation Online

Texas HHSC Medicaid Covered & Non-Covered Services