Disruptive Innovation in Medicaid Non-Emergency Transportation

Brief
Key Questions Answered
  • What are the different models that states use for Medicaid’s non-emergency medical transportation (NEMT) benefit?
  • What are the biggest challenges for the program?
  • What are some opportunities to address these challenges?
  • What are some examples of promising innovations?
Key Themes and Takeaways

For Medicaid beneficiaries, a lack of reliable transportation is a major barrier to receiving health care services. The NEMT benefit provides beneficiaries with transportation to and from medical appointments, through taxis, vans, ambulettes, and public transit. This resource examines the current state of the NEMT benefit, explores key challenges, and highlights opportunities for improvement.

 

  • NEMT services often adequately meet needs for regularly scheduled appointments, but fall short in addressing time-sensitive needs.
  • Challenges in administration include customer service concerns, lack of strong quality assurance monitoring and reporting mechanisms to prevent fraud and abuse, and outdated approaches to providing and tracking services.
  • Several states and health plans have begun looking at transportation network companies (TNCs), similar to Uber, to enhance responsiveness.
  • To address its shortage of transportation providers in rural areas, Colorado recently passed legislation creating a new type of license to expand the number and type of vendors that can provide NEMT services.
  • San Francisco Health Plan has partnered with FlyWheel, an app-based TNC that employs taxicabs. The health plan chose taxicabs over the private citizen–driver model Uber uses because taxis have no rating systems or surge pricing, and because taxi drivers must undergo more extensive background checks than private citizen drivers.
  • State NEMT programs should consider requiring brokers, vendors, and/or health plans to use more technologically advanced data collection systems to improve program oversight and quality assurance.
Authors
Adam Ganuza
Rachel Davis
Population Addressed
Adults Under 65 with Disabilities
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Expert Opinion
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