NEMT: Stalled in the Breakdown Lane

  | by Andi Mullin   |  SHARE f t

Let me tell you about a consumer I’ll call Marie.

Marie lives in California and has End-Stage Renal Disease. She needs to get to a clinic three times a week for dialysis. Marie doesn’t have a car or any family to drive her, and she can’t possibly afford a taxi. She could take public transportation, but she would have to take three different connecting buses in each direction. That would take her two hours each way, and she’s just not well enough for that. 

The good news for Marie is that she’s a Medicaid enrollee, and Medicaid has a benefit designed just for her situation. It’s called Non-Emergency Medical Transportation (NEMT), and the purpose of the benefit is to help low-income people get to their medical appointments. The logic behind the benefit is simple. It is more cost-effective and results in better health outcomes if people can get to their primary care and other outpatient appointments, as opposed to letting a health problem fester until it escalates into a crisis and they end up in the emergency room. This is why Medicaid provides transportation services to qualified enrollees to help them maintain their health.

That’s the good news. The bad news is that this service doesn’t seem to be working very well for Marie, and the problems with NEMT benefits transcend state boundaries. At the Center for Consumer Engagement in Health Innovation, we hear from advocates in numerous states who describe consumers struggling mightily to access NEMT benefits. The problems consumers describe are startlingly similar. Difficulty scheduling rides. Drivers who show up hours late, or not at all. Consumers left stranded at a doctor’s office with no one coming to take them home. NEMT is a critically important benefit, but if it’s not working properly, it doesn’t do anyone any good.

Over the last year, the Center and our friends at Justice in Aging have been working on an issue brief that describes the state of NEMT benefits around the country. The brief looks at how we got here and what some of the problems are with the service. Most importantly, the brief offers recommendations for policymakers that could help to improve the service and make sure it works for consumers.

Imagine Marie having to negotiate this service - the late drivers, the drivers who don’t show up at all, the missed appointments - three times per week, every single week! All just to stay alive and out of the hospital. We can do better, for Marie and for other consumers who desperately need this service.

Take a look at our brief! And if you’re a consumer advocate who would like to learn more about the Center’s work on NEMT, please contact Andi Mullin at amullin@communitycatalyst.org