NEMT: A Vital Medicaid Benefit

What is NEMT?

Medicaid beneficiaries with complex health and social needs struggle to find safe and reliable transportation to non-emergency medical appointments. For example:

  • A low-income older adult in renal failure needs to go to a clinic for dialysis three times per week.
  • A child with leukemia enrolled in Medicaid may need to go to an oncology clinic every other day.
  • A homeless adult battling a substance use disorder must go to regular behavioral health appointments to reduce the risk of relapse.

Without access to a car or reliable public transportation, people in these kinds of situations will regularly miss outpatient medical appointments. The results are predictable:  worsening health, emergency room visits and expensive inpatient hospitalizations. Missed medical appointments due to lack of transportation also make life infinitely more difficult for the providers who care for these patients. They wreak havoc with clinic schedules, cost health providers up to $150 billion per year in lost revenue, and frustrate providers trying to improve the health of high-need patients.

The Medicaid-funded Non-Emergency Medical Transportation (NEMT) benefit, which has been part of Medicaid since the program was founded in 1965, provides transportation for Medicaid beneficiaries to and from medically necessary appointments and services. Even with the benefit, estimates indicate that nearly 3.6 million people miss or delay medical care each year because they lack available or affordable non-emergency transportation. In addition to being necessary, NEMT is also cost effective. A study of non-emergency medical transportation and health care access found that NEMT benefits are cost-effective or cost-saving for all 12 medical conditions analyzed, such as prenatal care, asthma, heart disease and diabetes. Another study found that NEMT more than pays for itself for people with chronic conditions, “. . . resulting in a total positive return on investment of over $40 million per month per 30,000 Medicaid beneficiaries.”   Additionally, for older adults who need long-term services and supports, transportation to attend medical appointments can mean the difference between aging at home and being forced to move into a far more expensive institution.

NEMT Under Threat

Despite the value and efficacy of this service, NEMT is under threat. Most immediately, the service is often so abysmally delivered that consumers experience real threats to their health as a result. Across the country, consumers trying to use the benefit face an array of startlingly similar problems. These include:

  • Consumers picked up hours late from either their homes or their providers’ offices
  • Consumers never picked up at all or abandoned at their providers’ offices
  • Rude, inappropriate and/or improperly trained drivers
  • Drivers arriving in unsafe vehicles or vehicles that are not accessible for the consumer
  • Lost or missing paperwork
  • Improperly denied services

In addition to poor service, NEMT is also threatened by regulatory and legislative action. For largely fiscal and/or ideological reasons, access to the service is under partisan threat by policymakers who wish to restrict the service or even eliminate it entirely. Some states have successfully sought waivers that eliminate the NEMT service for the Medicaid expansion population and legislation has been introduced in Congress to eliminate the benefit in its entirety. In addition, the Trump administration has used several strategies to signal its intention to make the NEMT benefit optional through regulatory action. In the current health care environment, in which even basic health coverage for low- and middle-income individuals is under threat from the majority party in Congress and the President, NEMT seems particularly vulnerable.

These two challenges reinforce one another. It is difficult to motivate consumers and providers to defend a benefit with a nationwide track record of such poor service. Indeed, only an NEMT service on which users can rely will be able to muster the political support needed to survive in this challenging environment. However, increased national interest in the impact of social determinants of health – like transportation – on health outcomes also creates an opportunity for advocates to increase support for NEMT. There is, for example, strong support for NEMT in Congress, including bipartisan support for making NEMT a legislatively mandated benefit (as opposed to a benefit that is mandated only through regulation). 

Across the country – and with the Center’s help – consumer advocates are working with health care providers and policy makers to improve the NEMT service so that it transports consumers to medical appointments safely, reliably and efficiently.