Nonemergency Medical Transportation vs. Ambulance Services: What's the Difference?
From taxis to critical care ambulances, California's medical transportation system serves vastly different patient needs. A recent Medi-Cal audit and the veto of AB 1328 show why those distinctions matter.
In October 2026, the California State Auditor identified nearly $31 million in improper Medi-Cal transportation payments.
More than 130 transportation providers had received payments at mileage rates intended for nonemergency ambulances, even though the trips involved other vehicles, including taxis and wheelchair vans.
The audit raised serious questions about billing practices and state oversight. It also highlighted a distinction that can get lost in healthcare policy discussions: not all medical transportation is the same.
NMT vs. NEMT vs. EMT
California's Medi-Cal program provides transportation to help patients access healthcare. But the type of transportation depends on the patient's needs.
The California Department of Health Care Services distinguishes between two broad categories:
Nonmedical Transportation (NMT) helps eligible patients get to healthcare appointments when they lack another means of transportation. Despite its name, NMT is used for medical purposes. It generally involves ordinary vehicles, including passenger cars and taxis.
Nonemergency Medical Transportation (NEMT) is for patients whose medical or physical conditions prevent them from using ordinary transportation. This category includes wheelchair vans, litter vans, and ambulances.
Nonemergency ambulance transportation falls within NEMT, but it requires a different level of service. Ambulances provide transportation for patients whose medical conditions make less intensive options inappropriate.
Emergency Medical Transportation (EMT) Responds to 911 emergency calls and to patients who need immediate care and transportation.
These distinctions matter. Medi-Cal requires transportation to be appropriate for the patient's needs, with reimbursement generally based on the least costly adequate option.
When Does a Patient Need an Ambulance?
For Royal Ambulance, much of our work happens outside the traditional 911 system.
Every day, our teams transport patients between hospitals and other healthcare facilities. This is known as interfacility transport, or IFT.
Some patients need basic medical supervision provided by two EMTs. Others require advanced monitoring, medication administration, or specialized clinicians throughout their journey.
At the highest level, our critical care transport (CCT) teams include registered nurses caring for seriously ill patients who need ongoing treatment and monitoring in a specialized ambulance that functions as a mobile intensive care unit (ICU).
Some of these patients are the sickest of the sickest and require immediate transportation for emergency care
Not every interfacility transport is classified as nonemergency, and not every patient needs critical care. But these services demonstrate why an ambulance is more than a vehicle moving someone between facilities.
For some patients, the journey itself is part of their medical care.
What California's Medi-Cal Transportation Audit Revealed
The State Auditor's October findings illustrate why accurate transportation billing matters.
The report identified nearly $31 million in excess mileage payments during fiscal year 2024–25, involving claims billed at ambulance rates for trips using other vehicles.
The findings do not establish that every improper payment was fraudulent. They do, however, underscore the importance of distinguishing between transportation services and ensuring providers bill appropriately.
Strong oversight protects public resources and helps preserve access to medically necessary care.
Why AB 1328 Matters for Ambulance Reimbursement
In September 2026, Governor Gavin Newsom vetoed Assembly Bill 1328, legislation that would have increased Medi-Cal reimbursement for qualifying nonemergency ambulance transportation to 80% of Medicare rate. The current rate is significantly below our cost of service and has not increased since the late 90s.
Newsom cited concerns about costs and the possibility of encouraging ambulance use when other transportation options would be more appropriate.
Those concerns deserve consideration. California needs to ensure that patients receive the right transportation for their needs.
But it also needs to recognize the clinical resources required when an ambulance is medically necessary.
What California Policymakers Should Know
In 2027, California's next governor and Legislature will have an opportunity to revisit questions about ambulance reimbursement, transportation oversight, and access to care.
At Royal Ambulance, we believe those conversations should begin with understanding the services being provided.
From basic ambulance transportation to critical care transfers between hospitals, our crews provide an important connection within California's healthcare system.
We welcome elected officials and healthcare leaders to visit our operations, meet our crews, and see firsthand the work taking place inside ambulances.
Good policy begins with understanding the services it governs.
