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Because people on hemodialysis must receive treatment 2-3 times/week, reliable transportation is essential to ensure that hemodialysis patients have access to their treatment centers. According to the US Renal Data System, the majority of hemodialysis patients rely on others to transport them to and from the clinic, with 66.8% of patients being driven by others, including by ambulance. Only 25.3% drove themselves or walked. Waiving NEMT to the expansion population enrolled in Medicaid through premium assistance will increase transportation barriers to dialysis services leading to poor health outcomes, increased hospitalizations, and increased transplantations or even deaths. Moreover, waiving NEMT may lead to increased use of more expensive ambulance services for medical emergencies.