Alaska Medicaid Travel Request Form
This form is for new travel requests that are 48 hours and beyond. We will respond within 24 hours.
New Requests Only:
Any requests to refax/email a copy of an itinerary must be called through the office, not submitted via this online tool. The same applies for any changes to travel.
PA Number Required:
If you are an eligible Medicaid Recipient and do not have a Prior Authorization (PA#), please contact your Health Care provider first prior to securing travel arrangements. If you are a Health Care Provider, you must have a PA# in advance of utilizing the online travel request form.
To request a reservation please fill in the required fields below and submit your information with the button at the conclusion of the form.
Indicate your desired method (fax or email) to receive a copy of a completed travel itinerary. If you have complicated travel arrangements, please don't hesitate to call the USTravel Medicaid Office at 1.800.514.7123.
Ferry travel requests must be submitted by 4pm on Friday for travel over the weekend or Monday before noon.
Alaska Airlines' Club 49 program provides Alaska residents 2 free checked bags on each flight. As a result, the State of Alaska will not cover baggage fees.
Sign up for Club 49 - it's free!
Under the Secure Flight Rule, in order to book or hold a reservation the following information is required for each passenger (including approved escorts):
- name as it appears on government-issued ID
- date of birth
For infants and children under the age of 16 who are traveling domestically and do not have a government issued ID, the full name, date of birth and gender are still required.
What this means for you:
USTravel will be unable to hold or book your reservation without this required information. Please provide the required information when submitting your request.