Tessa Quinn
Medicaid is a US program that offers free transportation to and from medical appointments for millions of Americans. This service is available for hospital and office visits, as well as other trips related to covered health services. Non-emergency medical transportation (NEMT) is frequently offered through Medicaid, and beneficiaries use it to access behavioral health services, preventive health services, and care for chronic conditions. Rideshare services have also been proposed as an alternative to traditional NEMT, offering greater convenience and lower costs. While the impact of these transportation benefits on healthcare use and costs is still being studied, there is evidence that they may increase outpatient visit attendance and reduce the need for more expensive care.
| Characteristics | Values |
|---|---|
| Transportation subsidy for Medicaid patients | Non-emergency medical transportation (NEMT) benefits |
| Types of transportation | Rideshare services, app-based ridesharing programs, traditional transportation services |
| Cost of NEMT in 2014 | $28 per trip |
| Average cost per trip for rideshare | $8.10 |
| Average cost per visit for rideshare | $13.71 |
| States with greater utilization of NEMT for preventive services | Nevada, New Jersey, Texas |
| States with NEMT waivers | Iowa, Indiana |
| Impact of NEMT on healthcare use | Increased per-person outpatient visits, no impact on inpatient admissions or emergency department visits |
| Impact of transportation barriers | Decreased access to care, increased costs of care, potential need for more expensive care |
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What You'll Learn
Non-emergency medical transportation (NEMT) benefits
Non-emergency medical transportation (NEMT) is a vital benefit that provides transportation for Medicaid and Medicare members who need assistance getting to and from medical appointments. Nearly four million Americans miss or delay medical care each year due to a lack of transportation. NEMT services help to overcome this issue, enhancing health outcomes and leading to dramatic cost savings.
Federal regulations require state Medicaid programs to provide NEMT for eligible members without alternative means of getting to healthcare services. The level of coverage and service models vary by state and health plan. Transportation options include rideshare, public transit, wheelchair-accessible vehicles, and non-emergency ambulance transport.
NEMT brokers, such as MTM Health, partner with health plans and government agencies to coordinate safe, efficient, and compliant transportation solutions. They leverage technology and automation to manage transportation benefits and ensure members receive the most appropriate transportation for their needs.
Modivcare, another NEMT provider, focuses on removing barriers to accessing care. They utilize specialized transportation providers, ride-sharing, and public transit to optimize costs and experiences. Their technology-enabled approach includes AI-scheduling and autonomous vehicles, aiming to meet members' needs and improve access to care.
A pilot program in West Philadelphia offered rideshare-based transportation to Medicaid patients, resulting in a potential increase in show rates for primary care appointments. While the average cost per trip was $8.10, the potential cost savings from improved attendance and reduced unused appointments could benefit healthcare providers.
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Rideshare services as an NEMT alternative
Rideshare services like Uber and Lyft have been proposed as a potential alternative to NEMT (Non-Emergency Medical Transportation) services. They offer greater convenience and lower costs, which could increase show rates for primary care appointments among Medicaid patients.
However, rideshare services have some significant drawbacks that make them unsuitable for certain patients. Firstly, rideshare drivers are not medically trained and are therefore unable to assist with medical situations or mobility issues. NEMT staff, on the other hand, are trained to manage medical conditions, assist with medication, and help passengers get in and out of the vehicle. NEMT crews usually consist of multiple people, with one person driving and the other assisting with medical needs, whereas rideshares typically only have one driver.
Secondly, rideshare vehicles are not equipped to accommodate passengers with physical limitations or specialized equipment like wheelchairs or stretchers. NEMT vehicles, in contrast, are specifically designed for medical purposes and have features like ramps or lifts for wheelchairs and space for medical equipment, ensuring a safe and comfortable ride.
Additionally, while rideshare services offer curb-to-curb transportation, NEMT providers offer door-to-door assistance, often including medical support throughout the trip. NEMT providers cater to specific medical needs and operate under strict federal and state regulations, including ADA (Americans with Disabilities Act) requirements. They prioritize safety and reliability, conducting extensive background checks on their staff to ensure the person transporting the patient is fully trained and trustworthy.
While rideshare services may be ideal for independent patients without medical assistance needs, NEMT providers are better equipped to handle complex medical transportation requirements. For simpler trips or routine check-ups, rideshares may suffice, but for specialized care, NEMT is the preferred choice. Some rideshare companies are collaborating with NEMT providers to combine the convenience of modern booking platforms with the expertise required for medical transportation. However, navigating healthcare transportation regulations while maintaining service quality is a complex task.
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Outpatient visit attendance
Transportation to primary care is a well-documented barrier for patients with Medicaid. Non-emergency medical transportation (NEMT) is a required benefit in the Medicaid program to ensure beneficiaries have access to transportation to and from medical care. However, this has not always been effective, with some patients reporting that rides never arrived, or that they were unsafe, with wheelchairs not properly secured.
Innovative programs are seeking to overcome these barriers by using rideshare services, which offer greater convenience and lower costs. These programs often use smartphone application-based ridesharing services, which are marketed as offering more affordable and scalable implementation than traditional transportation services. The premise of these programs is to increase attendance for outpatient medical appointments, with the idea that improving outpatient visit attendance could reduce inpatient admissions, emergency department visits, and healthcare costs.
A pilot program in West Philadelphia offered rideshare-based transportation to all eligible Medicaid patients. The results suggest that offering a rideshare-based transportation service may increase show rates for primary care appointments among Medicaid patients. However, the low uptake among individuals who agreed to participate may reflect poor acceptability of the service, either due to concerns regarding the use of ridesharing vehicles or a preference for other transportation methods.
A study of a non-emergency medical transportation benefit offered to members of a Medicare Accountable Care Organization found that participation in the transportation program was associated with greater per-person per-year outpatient visits (9.2, 95% confidence interval [CI] 0.2 to 18.2). However, there was no difference in inpatient admissions or emergency department visits, and the program was not cost-saving.
Another study offered free rideshare services to 394 Medicaid beneficiaries for scheduled clinic visits and compared this to 392 other clinic patients as a control group. This study found no difference in emergency department visits at seven or 30 days, and only 20% of eligible patients in the intervention group used the rideshare service.
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Medicaid transportation eligibility
Transportation to primary care is a well-documented barrier for patients with Medicaid, despite access to non-emergency medical transportation (NEMT) benefits. Rideshare services have been proposed as an alternative to NEMT, offering greater convenience and lower costs.
A pilot program evaluated the impact of rideshare-based medical transportation on Medicaid patients' attendance at scheduled primary care appointments. The study population included adult residents of West Philadelphia who were insured by Medicaid and were established patients at two academic general internal medicine practices in the same building. At one of the practices, all eligible Medicaid patients were offered rideshare transportation, while the other practice provided usual care.
The results of the pilot program suggested that offering a rideshare-based transportation service may increase show rates for primary care appointments among Medicaid patients. The average cost per trip was $8.10, and the average cost per visit was $13.71.
The New York State Department of Health also offers a Medicaid Transportation program. They contract with a transportation broker, Medical Answering Services (MAS), who schedules trips, manages contact centers, conducts utilization reviews, and performs other administrative functions. If patients are dissatisfied with the transportation services, they can file a complaint directly with MAS or the Department.
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NEMT waivers
Non-emergency medical transportation (NEMT) is a well-documented barrier for patients with Medicaid. Despite having access to NEMT benefits, transportation to primary care remains an issue. NEMT waivers have been sought by some states to cut costs. The Trump administration urged states to consider Medicaid waivers to cut costs by imposing work requirements, which could result in beneficiaries losing their insurance coverage.
Section 1115 Medicaid demonstration waivers allow states to test new approaches that differ from federal statutes. These waivers provide states with additional flexibility in how they operate their programs. Iowa and Indiana implemented time-limited NEMT waivers as part of their Section 1115 demonstrations to expand Medicaid. Iowa's initial NEMT waiver was approved for 2014, and Indiana's for 2015-2016. Arizona has a pending application with CMS for a one-year waiver of NEMT for expansion adults. NEMT waivers were also part of the Medicaid expansion proposals in Utah and Tennessee, although no applications have been submitted.
Arkansas, a Medicaid expansion waiver state, initially sought to limit NEMT but ultimately established a prior authorization process. They decided to keep NEMT in place due to its cost-effectiveness. A federal lawsuit was filed against Arkansas' work requirements, and a separate lawsuit halted Kentucky's Medicaid waiver, causing them to drop NEMT for a time.
While NEMT spending is a small portion of overall Medicaid spending, advocates emphasize its high returns for patients and payers. A study found that NEMT saves Medicaid over $40 million per month for every 30,000 beneficiaries. Rideshare services have been proposed as a more cost-effective alternative to NEMT, with an average cost per trip of $8.10.
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Frequently asked questions
To ensure that people who cannot afford transportation can still attend necessary medical appointments.
Almost all Medicaid beneficiaries are eligible, provided they meet the requirements in their state.
Non-emergency medical transportation (NEMT) is covered by Medicaid. This includes trips to hospitals, medical offices, urgent care centers, and other medical or dental providers.
Beneficiaries contact a transportation company and provide their Medicaid ID number. After the trip, the transportation company bills Medicaid for the service.
Yes, a pilot program in West Philadelphia found that offering a rideshare-based transportation service may increase show rates for primary care appointments among Medicaid patients. Additionally, a study of a non-emergency medical transportation benefit offered to members of a Medicare Accountable Care Organization found that participation in the program was associated with greater per-person per-year outpatient visits, but there was no difference in inpatient admissions or emergency department visits.
