Frequently Asked Questions
What is non-emergency medical transportation?
Who can receive NEMT services?
Why is medical transportation required?
What types of transportation are provided?
What types of appointments are patients traveling to and from?
- 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?
[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?
What are the economic benefits of NEMT?
[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?
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?
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?
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.