How Does A Client Get Approved? 

The client's attending Physician, Physician's Assistant, Nurse Practitioner, Therapist, or Licensed Healthcare Professional must complete and sign the Medical Certificate of Transportation Service from.

If a client lives beyond 25 miles from the Medical Provider then an additional form must be filled out.



Once I have submitted all appropriate forms and have received notice that I qualify for this benefit, how do I schedule service?

You will call 719-544-3231 or email goldengatemanor1@aol.com and provide the following information at least 48 hours before your scheduled appointment.

Eligible Clients

 To receive NEMT services, the client must:

• Be a current Colorado Medicaid client; and 

• Be determined to not have access to other means of transportation including free transportation;

• Require transportation to obtain a      non-emergency Colorado Medicaid covered service.

May not be within the following eligibility groups:

• Qualified Medicaid Beneficiary Only (QMB)

• Special Low Income Medicare Beneficiary (SLMB)

• Medicare Qualifying Individual-1 (QI-1)

• Old Age Pension- State Only (OAP-state only)

Note: CHP+ is not a Medicaid program and, therefore, is not an eligibility group.

This service requires NO COPAYMENT 





To apply for this program the following documents will need to be submitted: 

• Medical Certificate of Transportation Services, completed, signed and dated by your attending physician, physician assistant, nurse practitioner, therapist or licensed healthcare professional, along with Medical Transportation Request Declaration form signed by you.

• If you require care outside of your County the Medical Certificate of Transportation Services beyond 25 Miles form must also be completed.

If you have any questions or concerns you can contact our office at: (719) 543-3231