New Year, Newly Improved Medicaid Program – NEMT Strengthened in Year-End Omnibus/Relief Bill

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The year-end omnibus appropriations/COVID-19 relief funding bill has come under a lot of scrutiny for being too little, too late. However, there is one silver lining that the health care advocacy community is excited about – the codification of non-emergency medical transportation (NEMT) as a statutorily-mandated Medicaid benefit. The protection and strengthening of this Medicaid benefit has been a longstanding priority of Community Catalyst’s Center for Consumer Engagement in Health Innovation (the Center), so we’re very excited by this advocacy victory!

"Codifying” Medicaid NEMT means that it’s further solidified in law as a mandatory Medicaid benefit. Initially, NEMT was the only Medicaid benefit required only by regulation, not legislation. This means that the Executive branch of the federal government, rather than Congress, was responsible for ensuring all states provided NEMT. Therefore, while all states have always been required under federal law to provide NEMT to Medicaid enrollees, the benefit has also always been at risk of being made optional at the will of an administration. And that’s exactly what the Trump administration expressed a desire to do several times throughout its tenure – by putting language in several budgets regarding making the benefit optional. The administration also published notice that it intended to change the regulation to give states “greater flexibility” over their NEMT programs. As this all became clear early in the Trump presidency, NEMT advocates sprang into action to protect the benefit, including finding Congressional champions to put forward legislation making the benefit mandatory by statute. Eventually, the bill made its way into the “health extenders” portion of the year-end omnibus/COVID-19 relief package that became law just before the end of 2020.

The Center strongly supports this development because we've prioritized protecting and strengthening Medicaid NEMT. Why? NEMT is often the only way certain Medicaid enrollees can get to the medical care they need, including older adults and individuals with chronic health conditions. Medicaid NEMT is also cost-effective, because helping individuals get to their routine medical appointments helps them receive preventive care and adhere to treatment regimens that, in turn, avoid medical emergencies and hospitalizations. Lastly, NEMT allows the Medicaid program to directly address a key social determinant of health – transportation – and  potentially alleviate inequities caused by lack of access (and its root cause – racism).  Without NEMT, many Medicaid enrollees would not be able to fully live, work and thrive in their communities as healthy individuals.

While codifying NEMT is certainly a positive step forward, there is no shortage of work to be done to make sure the benefit is delivered effectively and efficiently across states. Over the years, the Center has worked with state-based NEMT advocates, including legal aid organizations, disability rights organizations, older adult advocates and grassroots organizers, in fifteen states, to monitor the delivery of NEMT and make sure it’s meeting the needs of those it is intended to serve. All of these organizations were an important part of what has made this victory on NEMT possible. We look forward to continuing to work with our partners to ensure Medicaid NEMT is as strong as it can be.

The year-end omnibus appropriations/COVID-19 relief funding bill has come under a lot of scrutiny for being too little, too late. However, there is one silver lining that the health care advocacy community is excited about – the codification of non-emergency medical transportation (NEMT) as a statutorily-mandated Medicaid benefit. The protection and strengthening of this Medicaid benefit has been a longstanding priority of Community Catalyst’s Center for Consumer Engagement in Health Innovation (the Center), so we’re very excited by this advocacy victory!

"Codifying” Medicaid NEMT means that it’s further solidified in law as a mandatory Medicaid benefit. Initially, NEMT was the only Medicaid benefit required only by regulation, not legislation. This means that the Executive branch of the federal government, rather than Congress, was responsible for ensuring all states provided NEMT. Therefore, while all states have always been required under federal law to provide NEMT to Medicaid enrollees, the benefit has also always been at risk of being made optional at the will of an administration. And that’s exactly what the Trump administration expressed a desire to do several times throughout its tenure – by putting language in several budgets regarding making the benefit optional. The administration also published notice that it intended to change the regulation to give states “greater flexibility” over their NEMT programs. As this all became clear early in the Trump presidency, NEMT advocates sprang into action to protect the benefit, including finding Congressional champions to put forward legislation making the benefit mandatory by statute. Eventually, the bill made its way into the “health extenders” portion of the year-end omnibus/COVID-19 relief package that became law just before the end of 2020.

The Center strongly supports this development because we've prioritized protecting and strengthening Medicaid NEMT. Why? NEMT is often the only way certain Medicaid enrollees can get to the medical care they need, including older adults and individuals with chronic health conditions. Medicaid NEMT is also cost-effective, because helping individuals get to their routine medical appointments helps them receive preventive care and adhere to treatment regimens that, in turn, avoid medical emergencies and hospitalizations. Lastly, NEMT allows the Medicaid program to directly address a key social determinant of health – transportation – and  potentially alleviate inequities caused by lack of access (and its root cause – racism).  Without NEMT, many Medicaid enrollees would not be able to fully live, work and thrive in their communities as healthy individuals.

While codifying NEMT is certainly a positive step forward, there is no shortage of work to be done to make sure the benefit is delivered effectively and efficiently across states. Over the years, the Center has worked with state-based NEMT advocates, including legal aid organizations, disability rights organizations, older adult advocates and grassroots organizers, in 15 states, to monitor the delivery of NEMT and make sure it’s meeting the needs of those it is intended to serve. All of these organizations were an important part of what has made this victory on NEMT possible. We look forward to continuing to work with our partners to ensure Medicaid NEMT is as strong as it can be.