Frequently Asked Questions

What is non-emergency medical transportation?
Non-emergency medical transportation (NEMT) is a benefit that ensures people without access to transportation can travel to necessary health care appointments. NEMT is a required benefit in the Medicaid program, where a large number of low income, disabled, and elderly beneficiaries do not have access to reliable transportation. NEMT helps manage the health of these beneficiaries and prevents them from requiring far more expensive forms of care, such as hospitalizations or institutionalization, that would likely result if they missed their appointments. Other programs, including some Medicare Advantage plans and healthcare providers directly, provide access to transportation for beneficiaries in need.
Who can receive NEMT services?
Medicaid beneficiaries without access to transportation to their medical appointments are eligible for NEMT. Most states that have expanded Medicaid under the Affordable Care Act (ACA) have chosen to offer NEMT to their Medicaid expansion population as well. States work within the broad federal requirements to establish the specifics of their own NEMT programs.
Why is medical transportation required?
If beneficiaries cannot reliably travel to and from their medical appointments, their overall care will suffer and they will likely end up incurring higher health care costs through hospitalizations and other more intensive services. This would be a disservice to the beneficiary and to the federal and state taxpayers that fund the Medicaid program.
What types of transportation are provided?
The level of service required varies based upon a beneficiary’s needs and circumstances. States are required to provide the least costly but most appropriate method of transportation to eligible beneficiaries. For most patients, transport by public transit or in a simple car or van suffices. But NEMT also provides wheelchair-accessible transportation options as well as stretcher vans (often called ambulettes) and even ambulances for those needing that level of transport. But most trips are provided using non-specialized vehicles.
What types of appointments are patients traveling to and from?
NEMT covers a wide array of medical visit types as long as the services being provided are Medicaid compensable. Some of the most common medical needs of the Medicaid population that require NEMT are:

  • Dialysis services for patients with End-Stage Renal Disease (ESRD)
  • Substance abuse counseling sessions
  • Behavioral health or mental health appointments
  • Visits with primary care physicians or specialists
  • Chemotherapy or other recurring infusion treatments
How much does NEMT cost?
NEMT is a relatively small component of the Medicaid program. In 2014, total Medicaid spending on NEMT was estimated to be $3 billion, which accounted for less than one percent of total Medicaid spending that year.[1]

[1] Transit Cooperative Research Program, Impact of the Affordable Care Act on Non-Emergency Medical Transportation: Assessment for Transit Agencies at 2 (Oct. 2014), available at: http://onlinepubs.trb.org/onlinepubs/tcrp/tcrp_rrd_109.pdf.

How much does a single trip cost?
The cost of a trip varies based on a number of factors including time/distance from a patient’s home to the appointment and back, the mode of transportation required, and the availability of transportation options in a given area. For example, a lengthy trip to a dialysis center for a non-ambulatory or wheelchair-bound patient in a rural area of the nation will be more expensive than a short trip to a primary care provider for an ambulatory patient in a suburban community. States that employ NEMT brokers usually pay a set per-beneficiary fee to the brokers who provide necessary transport to Medicaid beneficiaries using the most clinically appropriate and cost-effective transportation option.
What are the economic benefits of NEMT?
A number of third-party studies over the years have validated the positive impact of NEMT services. A 2008 study by Florida State University found that Florida’s investment in NEMT for low-income, elderly, and disabled residents yielded a 1,108 percent return on the state’s investment. This calculation was based on a conservative estimate that one out of every 100 trips (1 percent) prevents a one-day stay in a hospital.[1] Additionally, when Congress established the NEMT brokerage option through the Deficit Reduction Act (PL 109-171), the Congressional Budget Office (CBO) estimated this model would reduce federal Medicaid spending by $235 million over 10 years.[2]

[1] Florida Transportation Disadvantaged Program, Return on Investment Study at 6 (Mar. 2008), available at: http://tmi.cob.fsu.edu/roi_final_report_0308.pdf.

[2] See: https://www.cbo.gov/sites/default/files/109th-congress-2005-2006/costestimate/s1932conf0.pdf, Page 36

What services does an NEMT broker provide?
The majority of states now use one or more brokers to administer their NEMT Medicaid benefit. Brokers take on full responsibility for managing a defined beneficiary population, making sure beneficiaries have access to the most appropriate means of transportation delivered by transportation providers with records of safety. Brokers also help prevent fraud and abuse through a host of program integrity measures.

Researchers who study transportation programs have found that capabilities like computer-aided scheduling and tight controls on eligibility – all common services provided by NEMT brokers – can increase the capacity of available service by reducing average trip length, transporting multiple passengers simultaneously and decreasing the number of ineligible trips, thereby reducing average trip cost and allowing the program to run efficiently.[1]

[1] Wallace, R., P. Hughes-Cromwick, H. Mull, and S. Khasnabis, Access to Health Care and Nonemergency Medical Transportation: Two Missing Links, Transportation Research Record Journal of the Transportation Research Board, January 2005, available at: https://www.researchgate.net/publication/39967547_Access_to_Health_Care_and_Nonemergency_Medical_Transportation_Two_Missing_Links

What percentage of NEMT services are provided to the Medicaid expansion population?
Distinguishing between the traditional Medicaid population and the expansion population is often difficult to assess in many markets given how states file and record such information. However, based on the experiences of major NEMT brokers, utilization by expansion population members has steadily increased month over month as more members become aware of the benefit for the first time. Having never been eligible for transportation services in the past, this steady increase in ridership is considered natural.

Both expansion population members and traditional Medicaid beneficiaries use NEMT services for Mental Health/Substance Abuse visits as their top two treatment needs. Data reflects that the expansion population uses NEMT services to access most of the same targeted and non-repetitive medical care services as the traditional Medicaid population. When looking at preventative care trips specifically, the expansion population uses NEMT services to access preventive care on average 65 percent more than the traditional population. This data reflects pent up demand and underscores the benefits of providing access to primary and preventative health services rather than acute or critical care.

Are more hospitals and providers offering NEMT as part of the transition to value based care?

Yes. As more hospitals and providers embrace value-based reimbursement models based on a lump sum payment for an episode of care, free transportation to follow up appointments is increasingly common. But there are regulatory barriers to limit how and when providers can offer transportation. MTAC hopes to work with HHS Secretary Robert F. Kennedy Jr., CMS Administrator Dr. Mehmet Oz, and other stakeholders to reassess regulations that limit the provision of NEMT by healthcare providers.

Have states pursued limits to NEMT for the core Medicaid population?
While some states have pursued or are pursuing waivers to provide NEMT to the Medicaid expansion population, research by MJ Simon & Company indicates that no states have pursued waivers limiting NEMT to the core Medicaid population. MTAC believes this is because states largely recognize the return-on-investment of well-managed NEMT to help beneficiaries manage their healthcare needs and prevent them from needing more intensive and more expensive healthcare services.
What safeguards protect NEMT from fraud, waste, and abuse?

States, are required to provide the least costly but most appropriate method of transportation to eligible beneficiaries. States often manage program integrity concerns by using broker models, which place the responsibility for monitoring and addressing fraud and abuse at the Medicaid managed care plans and brokers through capitated payments. Other important measures include proper screening and credentialing for NEMT providers, and the adoption of GPS and live tracking for rides and utilization.

How would federal Medicaid cuts affect access to NEMT overall?

Medicaid cuts force states to make tough choices about their programs. With less funding, states must reduce spending by either cutting eligibility, cutting benefits, cutting provider payment rates, or some combination thereof.

  • Cutting eligibility: reduces the number of people who would have access to NEMT, a lifesaving and cost savings benefit.
  • Cutting benefits: States can still restrict the amount, scope, duration of mandatory benefits, and they can impose burdensome hurdles like prior authorization or ride limits, which would hit patients with frequent medical needs in particular (like people in need of dialysis, chemotherapy, or SUD treatment).
  • Cutting payment: Cutting provider rates will reduce access to NEMT and lead to longer wait times, especially for people in rural areas.
How would Medicaid work requirements affect access to NEMT?

Work requirements could have a harmful effect on access to care for some of the Medicaid beneficiaries who rely on NEMT the most. For example, an individual with ESRD in need of dialysis three times per week, or frequent treatment for opioid use disorder, may not be able to remain employed due to their health conditions, and not all work requirement proposals have clearly delineated exemptions for people with serious health conditions that render them unable to work. In fact, NEMT itself supports employment by allowing beneficiaries to attend appointments and services they need to remain as healthy as possible and continue working, and by allowing caregivers to continue to work rather than having to take time off to transport loved ones to appointments.

Why is it so important to preserve NEMT?

Reliable transportation prevents missed appointments, reduces costly emergency department visits and hospitalizations, and improves healthcare provider efficiency. In 2017, 5.8 million Americans delayed medical care due to transportation barriers, driving up costs and worsening health outcomes. NEMT ensures that Medicaid beneficiaries can get to appointments, stay healthy, and remain employed. NEMT is a critical service that should remain in the Medicaid program nationwide, across all eligibility groups.