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Family Member or Associate Transportation

Your medical condition may require you to make frequent trips to and from your doctor’s office or other scheduled medical appointments. If you have a family member or another person close to you who can drive you to these appointments, he or she may be able to enroll with Indiana Medicaid to receive gas mileage reimbursement for these trips.

  • If you are a Traditional Medicaid member, your family member or close friend can enroll and be reimbursed through your transportation broker, Southeastrans.
  • If you are a Healthy Indiana Plan (HIP), Hoosier Care Connect, or Hoosiser Healthwise member, your family member or close friend can enroll, and then you should contact your health plan (Anthem, CareSource, MDwise, or MHS) to find out your coverage as well as the process for receiving gas mileage reimbursement for these trips.

What must you do to get a family member or associate enrolled as a driver?

You will need to complete a Medicaid Family Member or Associate Transportation Services Form. On the form you will need to identify yourself as the Medicaid member who will be getting rides to the doctor and explain how often you need transportation to medical appointments. You will also need to include the name and driver’s license number of the family member or associate who will be enrolling as your driver, as well as a few other pieces of information along with your signature. NOTE: If the family member/associate driver will be transporting more than one Medicaid member in your household to their medical appointments, a separate form must be completed for each member.

The family member or associate listed on the Medicaid Family Member or Associate Transportation Services Form will be considered your preferred driver for most transportation needs.  If your driver is not available to take you to or from an appointment, you can always call your transportation broker to help arrange a ride.

What must the family member or associate do to get enrolled as a driver?

Your driver must complete a Family Member/Associate Transportation Provider Enrollment and Profile Maintenance Packet. The information in this packet will ensure that your family member or associate can receive payment. He or she will need to submit the following documents with the enrollment packet:

Your driver will need to submit all of this information to the following address:

IHCP Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263

Your driver will need to make sure that all of the information in the enrollment packet is accurate and complete. If not, the driver may receive a request in the mail to correct something on the application. NOTE: If you have more than one family member or associate that will be transporting you to medical appointments, each individual must enroll separately to be eligible for gas mileage reimbursement.

How does trip scheduling and gas reimbursement work?

Once your driver’s enrollment is complete, he or she will be contacted by the transportation broker that will be reimbursing his or her gas mileage. The transportation broker will explain what you and your driver needs to do each time you go to a medical appointment.

  • If you are a Traditional Medicaid member, Southeastrans will contact your driver with instructions. BEFORE the appointment, you must contact Southeastrans at 855-325-7586 to get approval for the trip - both the trip to the appointment and the trip back home.  Once you have made arrangements with Southeastrans, you will receive a pre-populated Indiana Gas Reimbursement Form from Southeastrans, along with instructions on how to have the ride reimbursed to the driver. You must take the Indiana Gas Reimbursement Form to your medical appointment and have the medical provider enter his or her name, telephone number, and signature on the form to document the initial leg of the trip (going to the appointment).  You must enter your name and signature on the form for the return leg of the trip (coming back from the appointment).  Your driver must complete the remaining information on the form.  Both the driver and you must sign at the bottom of the Indiana Gas Reimbursement Form.  The complete form can be fax to Southeastrans at 678-510-1352 or mailed to the following address for payment:   

Southeastrans
Attn: Claims
4750 Best Rd. Suite 300
Atlanta, GA 30337

  • If you are a Healthy Indiana Plan (HIP), Hoosier Care Connect, or Hoosier Healthwise member, you should contact your health plan to find out if family member/associate transportation is available and to get information about your transportation broker.

What if I have further questions?

If you are on Traditional Medicaid and your driver needs any assistance, he or she can contact Southeastrans through the following:

If you are on the Healthy Indiana Plan, Hoosier Healthwise, or Hoosier Care Connect and your driver needs assistance, he or she should contact your health plan.  You can find all of the contact information available at the Contact Us webpage.

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