Transportation is a key factor for accessing health care services and may ultimately impact health outcomes. Many people face barriers to transportation, such as lack of access to vehicle or driver’s license, inability to use public transportation, need for a specialty vehicle or wheelchair van, inability to afford the cost of transportation and difficulty finding rides to appointments.
To facilitate access to healthcare services, state Medicaid programs are required to provide necessary transportation to and from providers as a Medicaid benefit, known as nonemergency medical transportation (NEMT). The most common service destinations for NEMT rides include physician offices, diagnostic or therapeutic sites, residential facilities, dialysis facilities and hospitals.
State Medicaid agencies have flexibility in how they administer NEMT benefits to enrollees. Four models for delivery include:
- In-House: Paying for NEMT on a fee-for-service basis.
- Managed Care: Contracting with managed care plans to provide NEMT and other services.
- Broker: Arranging for transportation brokers to manage the benefit.
- Mixed: Combination of in-house, managed care and broker models within one state.
State Medicaid agencies may administer NEMT benefits themselves at the state, regional or county level. States using this model typically contract on a fee-for-service basis with NEMT providers.
In Minnesota, NEMT services are provided as one-way or round trips and may be provided by private automobiles (personal mileage), volunteer drivers, bus, taxicab, dial-a-ride, light rail or other commercial carriers (assisted or unassisted). In 2021, Minnesota authorized monthly public transit passes for Medicaid recipients for NEMT needs. Individuals who receive a monthly transit pass are not eligible for other modes of nonemergency medical transportation unless an unexpected need arises that cannot be accessed through public transportation.
Managed care models are designed to manage health care cost, use and quality. State Medicaid agencies may contract with managed care organizations (MCOs) to seek improvement for a specific population of Medicaid beneficiaries, such as those with chronic and complex conditions, while managing the cost of care. MCOs may integrate NEMT into physical and behavioral health services into the state Medicaid plan.
The majority of Iowa Medicaid beneficiaries receive NEMT services administered by the state’s managed care program, IA Health Link, while some beneficiaries continue to receive services through Iowa Fee-For-Service. Beneficiaries receive NEMT services through different brokers depending on eligibility status and whether coverage is provided through an MCO or fee-for-service. Each MCO selects an NEMT transportation vendor and members contact their assigned vendor directly to schedule NEMT services.
The brokerage model is the most common delivery model for NEMT benefits. In 2015, 34 states used brokerage models to administer an NEMT benefit. Research shows that the brokerage model may be cost effective for some states by ensuring Medicaid only pays for eligible and appropriate rides, which may deter fraud and abuse. The brokerage model can take many forms. Third-party brokers may be a private or nonprofit organization. Some state Medicaid agencies contract with one broker to provide NEMT services statewide, centralizing call centers, eligibility determination and trip authorization. Other states contract with regional brokers that may operate in one or several regions.
Kentucky has operated under a regional broker system, the Human Service Transportation Delivery program, since the 1990s. Regional Transportation Brokers operate in 16 regions, and each broker operates a call center for NEMT eligibility determination and trip authorization. The broker system is supported through capitated funding. Each broker receives a lump-sum of funding based on the Medicaid consumer headcount of each region.
Wisconsin transitioned to a statewide brokerage model in 2013. The state’s NEMT broker is required to provide the least costly type of ride based on the beneficiary’s medical transportation needs. Of the state’s approximately 300,000 NEMT trips each month in 2020, the top three transportation modes included ambulance, mileage reimbursement or public transportation.
Some states may use more than one of the models above to provide NEMT.
In Missouri, NEMT services are delivered through both a managed care and fee-for-service models. Medicaid beneficiaries enrolled in the managed care program are provided NEMT under individual health plans. Missouri’s Department of Social Services operates a statewide full-risk brokerage to assure NEMT services for fee-for-service medical services.
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $813,543 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.