Getting to Appointments: Access-A-Ride, Medicaid Transportation and Aide Escorts in NYC

Why Getting to the Doctor Gets Harder

For many older New Yorkers the appointment itself is not the hard part. The hard part is the stairs down from a third-floor walk-up, the subway station without an elevator, the long walk from the bus stop, and the wait in a crowded clinic. Missed appointments lead to missed refills, unmanaged blood pressure and avoidable hospital visits.

This guide covers the three tools most NYC families use: Medicaid transportation, Access-A-Ride, and an aide who goes with your parent. For a wider view of keeping a parent independent, see our tips for aging in place in NYC.

Medicaid Transportation for NYC Seniors

New York Medicaid covers non-emergency medical transportation to Medicaid-covered services when a person has no other way to get there. In New York City, the state uses a transportation manager (Medical Answering Services, often called MAS) to approve and schedule these trips. Depending on need, a ride may be public transit reimbursement, a car service (livery), an ambulette with a wheelchair lift, or, when medically required, a stretcher ambulance.

How it usually works

1. Medical justification. For anything beyond public transit, the doctor’s office typically submits a form explaining why your parent needs a car or ambulette.
2. Book in advance. Trips are generally requested a few days ahead. Standing orders can often be set up for recurring care such as dialysis or physical therapy.
3. Confirm the pickup. You get a pickup window. Have your parent ready early, with ID, Medicaid card, medication list and a snack.
4. Arrange the return. Return trips are usually scheduled too, or called in when the appointment ends. Ask how it works for that trip.

If your parent is in an MLTC plan

Many Managed Long Term Care plans include non-emergency transportation as a benefit, so rides may be booked through the plan’s member services instead. Check your parent’s member handbook or call the number on the plan card. If your parent has Medicare and Medicaid together, a Medicare Advantage plan may also include a set number of rides. See Medicare and Medicaid together for dual-eligible New Yorkers.

Access-A-Ride: The MTA’s Paratransit Service

Access-A-Ride (AAR) is the MTA’s paratransit program for people with disabilities or health conditions that prevent them from using accessible buses and subways for some or all trips. It is not limited to medical visits. Your parent can use it to go to the doctor, the senior center, a family gathering or shopping.

• Eligibility. You apply through the MTA and usually attend an in-person functional assessment. Eligibility can be full, conditional (only certain trips, such as in winter weather) or temporary.
• Booking. Trips are typically booked one to two days ahead by phone, online or through the app. Shared rides are common, so trips take longer than a direct car.
• Fare. The fare matches a standard subway or bus fare. Check the MTA site for the current amount.
• Personal care attendant. If the eligibility letter allows a personal care attendant, one attendant can ride with your parent at no extra fare. This is how a home care aide can ride along.
• Door-to-door. Drivers generally assist from the building’s front door to the vehicle, but not up stairs or inside apartments.

Apply early. The approval process can take weeks, and it is much easier to have eligibility in place before a hospitalization or surgery than to rush afterward.

Medicaid Rides vs Access-A-Ride at a Glance

How a Home Care Aide Escorts to Appointments

An aide escort is often what makes the other options work. A ride gets your parent to the clinic door, but someone still has to manage the walker, the elevator, the check-in desk, the bathroom break during a long wait, and the trip back up the stairs at home.

When escort to medical appointments is included in the plan of care, the aide can:

• Help your parent dress, gather documents and get downstairs to the pickup.
• Ride along on Access-A-Ride as an attendant, or on transit or a Medicaid car when permitted.
• Stay with your parent in the waiting room and help with mobility and toileting.
• Bring home written instructions so the family and nurse know what changed.

Aides do not make medical decisions, and they do not interpret test results. It helps if a family member joins by phone for the conversation with the doctor, or sends questions with the aide in writing. Agencies also usually have rules about aides driving clients in personal vehicles, so ask before assuming.

Escort time is part of the authorized home care hours, so tell the plan or agency about regular appointments. During the MLTC nurse assessment, list them all, including dialysis, therapy and specialist visits. Our guide on what happens at the MLTC nurse visit explains how the plan of care is written. Escort is one of the services described in what Medicaid home care covers in New York.

Tips for Appointment Days

• Keep a go-folder. Photo ID, Medicaid and Medicare cards, plan card, medication list, allergies, doctor names and an emergency contact.
• Schedule smart. Late-morning appointments give time for bathing and breakfast. Avoid stacking two appointments in different neighborhoods on one day.
• Plan for waits. Pack water, a snack (if allowed), any needed medication, and a phone charger.
• Confirm the day before. Call the clinic and the ride service. Recheck the pickup address, especially if your parent lives in a large complex with several entrances.
• Use telehealth when appropriate. Some follow-ups can be done by video, with the aide helping set up the phone or tablet.

If your parent lives alone and appointments are becoming a struggle, read our guide on home care for a parent living alone in NYC. For the whole range of support available, start with our complete guide to elderly care at home in NYC.

Related Guides

Home care for dialysis patients · Does Medicare cover home care? · How to get started with home care in NYC