In the Driver’s Seat: Improving and Protecting Non-Emergency Medical Transportation

The Medicaid Non-Emergency Transportation (NEMT) benefit, which has been part of Medicaid since the program’s inception 1965, provides low-income consumers who would otherwise miss medical appointments due to lack of transportation with a ride to and from such appointments. Without access to reliable transportation, Medicaid beneficiaries with complex health and social needs regularly miss outpatient medical appointments. The results are predictable: worsening health, emergency room visits and expensive inpatient hospitalizations. 

Despite the necessity and cost effectiveness of NEMT, the benefit is under threat on multiple fronts. On one hand, across the country consumers often experience very poor customer service. Drivers that never show up or show up hours late is the most common complaint, to the point where consumers can experience real threats to their health as a result. At the same time, for largely fiscal and/or ideological reasons, access to the service is being attacked by policymakers who wish to restrict the service or even eliminate it entirely.

For example, in October of last year the Trump administration signaled that it would attempt to make NEMT an optional, rather than mandatory, Medicaid benefit. Though the administration has postponed those efforts until 2021 the sword of Damocles has been merely delayed, not removed. Furthermore, the customer service problems that are ubiquitous across the country must be addressed, both to improve health outcomes for Medicaid enrollees and to protect the benefit in the long term. The best defense of the Medicaid NEMT benefit would be a service that operates well and helps people stay healthy.

Enter the Center’s Consumer Voices for Innovation 2.0 Grant Program (CVI 2.0)! CVI 2.0 funds advocacy organizations in seven states to build an engaged base of consumers to advocate for policies and programs that expand how the health care sector addresses three social and economic drivers of health: food security, housing security and transportation. Advocates in three states – Colorado, Georgia and Pennsylvania – are focusing their CVI 2.0 program exclusively on improving and protecting the NEMT service in their respective states.

In Colorado, Together Colorado is teaming up with the Center for Health Progress to ensure that the state’s NEMT system actually meets the needs of the community. They will organize recipients of the NEMT service and others to advocate that the state enact robust internal oversight of the NEMT vendor, including the creation of an independent community advisory board. The advocates will pursue a new digital organizing program and an on-the-ground organizing effort to expand and activate a base of grassroots community leaders who are affected by this issue. “Our vision for success,” said Together Colorado Lead Organizer Meghan Carrier, “is that all Medicaid recipients in nine counties who qualify for NEMT have access to safe, accessible and timely transportation services to and from their appointments by trained professionals.” 

In Georgia, the state Medicaid agency will open a bidding and contracting process this year to select its NEMT vendors. CVI 2.0 partners Georgians for a Healthy Future and The Arc of Georgia will take advantage of this timely opportunity to secure consumer-focused changes to the NEMT program so that it works better for people with disabilities and other Medicaid-covered individuals and families. “Our plan,” says Laura Colbert, executive director of Georgians for a Healthy Future, “is to identify and develop grassroots health leaders who have personal experience with the short-comings of NEMT and partner with them to educate and mobilize their communities so that transportation no longer stands as a barrier to health care for any Medicaid-covered Georgian.” 

Finally, in Pennsylvania the Pennsylvania Health Access Coalition (PHAN) will expand and mobilize a base of Medicaid consumers to improve, protect and expand Medicaid-provided transportation even as the state pursues significant changes in the delivery of the service. Advocates have already convinced the state to delay any changes by six months and to require a robust public engagement and comment process during the delay to better inform the state’s next steps. “We want to build support for Medicaid-provided transportation as a key social determinant of health and a wise investment for the Legislature to continue making, regardless of what cuts are encouraged at the federal level,” said PHAN Consumer Engagement Coordinator Jessy Foster.

The Center provides technical assistance to CVI grantees and other advocates across the country who are working to both improve and protect their state’s NEMT services. As advocates in a number of states continue to make significant progress on NEMT, we are excited to see what our partners in Colorado, Georgia and Pennsylvania will be able to accomplish!

Many thanks to the Georgians in the Driver’s Seat Coalition, which inspired the title of this blog! This is the second in a series of blogs about the Center’s Consumer Voices for Innovation (CVI 2.0) program. Click here to see the first blog in the series, and watch this space for the final installment.