NC Medicaid Transportation Reimbursement (DMA-2055): Who Files and How

To get paid back for driving yourself or riding with a friend or family member to a Medicaid appointment in North Carolina, you submit a travel verification form signed by the provider’s office to whoever manages your transportation benefit. The NC Medicaid transportation reimbursement form you’ll handle personally is that travel verification form; the DMA-2055 Reimbursement Request Form is filed by your county Department of Social Services on your behalf. Which office you work with depends on whether you’re in a managed care health plan or in NC Medicaid Direct.

Figure Out Which Medicaid Program Covers You

Pull out your health plan ID card before you do anything else. The reimbursement process splits along program lines:

If you’re in a Standard Plan (AmeriHealth Caritas, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, or WellCare) or a Tailored Plan run by an LME-MCO (Alliance Health, Partners Health Management, Trillium Health Resources, or Vaya Total Care), your health plan runs Non-Emergency Medical Transportation and sets its own reimbursement procedure.
If you’re in NC Medicaid Direct or the EBCI Tribal Option, your county DSS handles the trip approval, the paperwork, and the submission to the state.¹

The forms, the phone numbers, and the per-mile rate can all differ depending on which bucket you fall into, so this is the first thing to pin down.

Who Qualifies for Mileage Reimbursement

Under North Carolina’s administrative rules, three things have to be true. You must be currently enrolled in Medicaid, you must have a scheduled appointment for a Medicaid-covered service, and you must have no other means of transportation available to get there.²

That last rule is where people get tripped up. “No other means of transportation” means no free public transit, no volunteer ride, no community service that could get you there at no cost. When those options exist and work for your medical situation, the program expects you to use them first. Driving yourself, or getting a ride from someone you know, is the fallback.

Covered trips include visits to your Medicaid doctor or specialist, pharmacy pickups, mental health appointments, and substance use treatment sessions.¹ Trips to services Medicaid doesn’t cover aren’t eligible for reimbursement.²

If You’re in a Managed Care Plan

Call the NEMT line for your specific plan. Each plan has its own number:

AmeriHealth Caritas: 833-498-2262
Carolina Complete Health: 855-397-3601
Healthy Blue: 855-397-3602
UnitedHealthcare Community Plan: 800-349-1855
WellCare: 877-598-7602
Alliance Health: 855-759-9600
Partners Health Management: 833-577-2309
Trillium Health Resources: 877-685-2415
Vaya Total Care: 888-621-2084

The plan will walk you through its reimbursement form and documentation requirements, which may not match the county DSS process. Request the ride at least two business days before your appointment. Urgent pickups, like a hospital discharge, don’t need advance notice.¹

If You’re in NC Medicaid Direct or the EBCI Tribal Option

Call your county DSS transportation coordinator at least four business days before the appointment.¹ The coordinator decides your eligibility for the trip and tells you what documentation you’ll need. When mileage reimbursement is approved for driving yourself or using a personal driver, you’ll be told to bring back a travel verification form signed at the provider’s office.

What Goes on the Travel Verification Form

This is the form you actually fill out and carry with you. The county DSS office can supply it, and in some counties you can download it ahead of time. The form proves to the state that the appointment happened. Without a signed verification, there’s nothing to reimburse.

Each form needs:

Your full legal name as it appears on your Medicaid card and your Medicaid ID number, so the county can match the trip to your case.
The exact date of service.
The provider’s full name and street address.
A signature or stamp from the provider’s office confirming you attended. Get this done before you leave; coming back later to chase a signature is where claims die.
Mileage: either your odometer reading going and coming, or a printout from a mapping tool showing the shortest route between your home and the provider’s address. Reimbursement is based on the most direct route.

Use blue or black ink. The driver, whether that’s you or whoever drove you, signs the form to certify the trip details. Missing signatures and blank fields come back to you for correction, and that delays payment.

The DMA-2055 Is Filed by the County, Not by You

The DMA-2055 is the Medicaid Transportation Reimbursement Request Form that your county DSS submits to the state.³ You don’t complete it. The county transportation coordinator pulls together your trip information along with other beneficiaries’ claims and files the DMA-2055 monthly. Billing code A0090 on that form is what covers mileage reimbursement for a beneficiary, family member, neighbor, or friend.⁴

Each DMA-2055 covers one calendar month. The county has up to a year from the date of service to submit, but turn your travel verification forms in promptly. Most county offices want them within the same month or shortly after the trip. Hanging onto a stack of them for months creates problems that come back to you as delayed payment.⁴

How Much Per Mile

The per-mile rate is set or approved by the state and can vary by program and by year. Some managed care plans have historically paid at the IRS standard rate. For 2026, the IRS business standard mileage rate is 72.5 cents per mile and the medical-purpose rate is 20.5 cents per mile.⁵

Which rate applies to you, or whether the state has set a different number entirely, depends on your program. NC DHHS issued a rate reduction update in late 2025 affecting NEMT reimbursement for services on or after October 1, 2025. For the exact per-mile amount you’ll receive, ask your health plan or county DSS transportation coordinator. Reimbursement covers the most cost-effective mode of transportation appropriate to your medical needs, calculated on the shortest practical route.²

Mistakes That Hold Up Payment

The claims that get kicked back usually fail for the same handful of reasons:

No provider signature or stamp on the travel verification form. The provider’s office has to sign at the time of the visit.
No mileage recorded. Either odometer readings or a mapping printout; a blank field gives the county nothing to pay on.
Wrong Medicaid ID. A single transposed digit sends the form into an error.
Submitting months of forms at once. Counties can file up to a year late, but your paperwork fares better when it arrives in a steady trickle.
Trip to a service Medicaid doesn’t cover. If the appointment isn’t covered, the ride isn’t either.

Keep copies of every travel verification form you turn in. For NC Medicaid Direct members, once the county processes your claim and files the DMA-2055, allow several weeks for the state to issue payment. Timelines vary by county and by health plan.

If Your Reimbursement Is Denied

You can request a State Fair Hearing to challenge a denial. You have 120 days from the date on the denial notice to file.⁶ Fill out the State Fair Hearing Request form that came with your denial and send it in. You can represent yourself or bring a lawyer, family member, or friend. You can review your case file, bring witnesses, and question the state’s witnesses.⁷

The state generally must issue a decision within 90 days of receiving your hearing request. If the decision goes in your favor, the agency has to correct the action back to the date of the original denial.⁷

1
North Carolina Department of Health and Human Services. Non-Emergency Medical Transportation
2
North Carolina Office of Administrative Hearings. North Carolina Administrative Code 10A NCAC 22F – Non-Emergency Transportation
3
NC Medicaid. Medical Transportation Forms
4
Land of Sky Regional Council. Medicaid Transportation Manual
5
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents
6
NC Medicaid. Decision on Your Request for an Appeal
7
Medicaid.gov. Understanding Medicaid Fair Hearings