Requesting a Medicaid ride

The form at medride.ride.dev requests a ride to a medical appointment covered by Medicaid. You can fill it in for yourself, or for someone else: a child, a patient or a family member.

Have these ready:

• The rider’s Medicaid Member ID, from their Medicaid card.
• The rider’s date of birth and a contact phone number.
• Your email address. A copy of the request is sent to it.
• The appointment date and time, and the address of the clinic or hospital.
• Where the vehicle should pick the rider up, and where to take them back afterwards.
• If the appointment is more than 25 miles away: the name, title and phone number of the provider treating the rider.

If you reload the page or close and reopen the tab by mistake, your answers are kept for 30 minutes, in this browser only.

I am filling this form out on behalf of: choose Myself, A Minor, Patient or Other. Then enter your email, and tick the acknowledgement to continue.

Next, the rider: first and last name, date of birth, Medicaid Member ID and a contact phone number. All are required. Tick Member is not enrolled in any exclusionary program to continue.

Is your trip over 25 miles one way? Answer Yes, No or Unsure. If you answer Yes, an extra step asks for the treating provider’s name and title, their phone, the reason a closer provider won’t do, and the date of the first visit. The form explains: “This form is valid for the identified Member for 90 days from the date of the initial visit to the treating provider.”

The form asks whether the rider has another way to get there. Choose the option that fits, then describe the appointment under What are you being seen for?, in a few words such as “dialysis” or “therapy”.

Then the clinic or hospital: its street address, city, state and ZIP. The name and phone are optional unless the trip is over 25 miles. If the rider is leaving a hospital or facility, answer Yes to Is the member being discharged from a hospital or facility? The facility then becomes the pick-up.

• Is a wheelchair vehicle needed? Answer Yes or No. Special requests is for a service animal, pick-up directions or anything the driver should know.
• Date of appointment and Time of appointment. Dates you can’t book online are greyed out (see the deadlines below).
• Trip type: One-time, Recurring (subscription) for a repeating schedule, or Specific dates picked on a calendar. A repeating or multi-date request can cover up to 3 months.
• The pick-up address. Tick One-Way if the rider doesn’t need a ride back. Otherwise give the return address (or use the pick-up address) and the return time. Tick Will Call if the return time isn’t known yet and the rider will call when ready.
• Escorts and children: say whether anyone rides along. If so, choose the reason and add each rider’s name, up to 6.

If an address is outside the area MedRide serves, the form tells you, and what to do next.

The form shows these rules, and won’t accept a date that breaks them. Times are Mountain Time.

1. Online ride requests submitted Monday–Friday require at least 24 hours' notice.
2. Trips on Saturday, Sunday or Monday must be requested online by no later than Thursday at 11:59PM.
3. Online ride requests submitted on Friday, Saturday or Sunday will NOT be processed for trips occurring on Saturday, Sunday or Monday.
4. Online ride requests submitted on Saturday or Sunday for trips occurring on Tuesday–Friday require at least 48 hours' notice.

Too late to book online? Call the number on the form.

Start typing an address and pick a suggestion. That address search uses Google Maps, which only loads if you allow it in the cookie banner (see below).

Can’t find the address, or declined Google Maps? Select Can’t find it? Enter manually and type it in. “Manually entered addresses are double-checked by our team before the trip is approved.” Either way works.

The last step shows everything you entered. Use Edit on any part to change it.

Tick both consent boxes: one about using the appointment details to arrange the ride, and one accepting the Terms & Conditions and Privacy Policy. A security check runs on its own; you don’t need to click anything. Then select Submit request.

You’ll see Request submitted. MedRide confirms within 24 hours, and a copy of your request goes to your email.

A sent request can’t be changed or canceled online. Call MedRide at 719-545-3333, Monday to Friday, 7am to 7pm Mountain Time.

The first time you open the form, a banner asks about cookies. The form has no advertising or analytics trackers.

• Accept turns on the Google Maps address search.
• Reject keeps only the required security check. You type addresses yourself.
• Preferences lets you turn Google Maps on or off. You can change your choice later from the page footer.

Call MedRide at 719-545-3333, Monday to Friday, 7am to 7pm Mountain Time. The number is also at the top of the form.