Future of Non-Emergency Medical Transportation

Members | September 27, 2017 | by

A recent Health Affairs article on NEMT  provides a comprehensive overview of the important role of Non-Emergency Medical Transportation in our health care system, as well as the benefits it provides.LeadingAge is working with stakeholder groups, CMS and the VA concerning the critical issue of providing timely, quality medical and service transportation for older adults and persons with disabilities. 

A recent Health Affairs article on NEMT  provides a comprehensive overview of the important role of Non-Emergency Medical Transportation in our health care system, as well as the benefits it provides.  3.6 million Medicaid beneficiaries “miss or delay care” annually due to transportation problems, even though non-emergency medical transportation (NEMT) is a mandatory Medicaid benefit. We are seeing more incidences where states are limiting its availability through federal waivers.

States deploy several models to manage and finance Non-Emergency Medical Transportation:

  1. Dominant model: brokers and managed care organizations (MCOs). The majority of states have evolved to deliver NEMT through NEMT-focused brokers or MCOs (which typically subcontract with NEMT brokers). In most of these states, the broker or MCO receives a capitated payment to manage the NEMT benefit.
  2. Other models:
  • State entities: A few states rely on government entities such as Departments of Transportation to provide the service and directly fund those entities through an annual contract to reimburse ride providers on a per-ride (fee-for-service) basis.
  • Local service providers: Other states deliver NEMT through county or municipal ride services that may, in turn, fund independent taxi companies—and pay these transportation providers on a fee-for-service basis.

The Department of Veterans Affairs (VA) offers mileage reimbursement and NEMT services for travel to health care and rehabilitation appointments for disabled veterans that meet one of eight qualifying criteria. The VA also provides transportation for family caregivers of veterans when certain criteria are met. LeadingAge is concerned that the local VA Medical Centers are limiting payment for transportation to Adult Day Services in some regions of the country. 

A recent study published in Health Affairs, concluded that several ACOs “view transportation as a barrier for patients to receive timely, high-quality care.” As a result, many ACOs assist patients with transportation to medical appointments by providing transportation subsidies, hiring brokers, or managing NEMT for patients.

Program integrity concerns have negatively impacted NEMT. A 2016 Government Accountability Office (GAO) study noted gaps in NEMT guidance at the state and federal levels and suggested a review by regulators because “NEMT is at high risk for fraud and abuse.” 

LeadingAge is working with stakeholder groups, CMS and the VA concerning the critical issue of providing timely, quality medical and service transportation for older adults and persons with disabilities.