Non-Emergency Medical Transportation (NEMT)
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1 Non-Emergency Medical Transportation (NEMT) Medicaid and CHIP Payment and Access Commission Kirstin Blom December 6, 2018
2 Overview Introduction to Medicaid s NEMT benefit Benefit structure, financing, and delivery models Who uses NEMT and how much does it cost? Policy issues December 6,
3 Medicaid NEMT benefit States must ensure necessary transportation to and from providers Mandatory benefit that all states must cover Specified in regulation; new rulemaking expected in 2019 Designed to remove barriers to accessing care About 6% of non-institutionalized adults on Medicaid/CHIP delayed medical care in FY 2017 compared to about 1% of people with private coverage December 6,
4 Benefit structure and financing Covers transportation to medical appointments; may include wheelchair vans, taxis, stretcher cars, or bus passes and tickets States may charge nominal copayments or limit the number of trips States can claim federal match at administrative rate (50%) or medical assistance rate (ranges from 50 to over 76%) Generally, if NEMT claimed as medical assistance, state must offer beneficiaries choice of providers December 6,
5 Delivery models Brokerage model is most popular model States contract with brokers through competitive bidding Broker manages the benefit and receives a capitated payment States claim federal match at regular Medicaid matching rate Other Medicaid guidelines (such as freedom of choice of provider) do not apply Other models Managed care plan manages the benefit under a capitated arrangement State pays for services directly on a per-ride basis State coordinates with local health departments or other programs to provide transportation December 6,
6 Who uses NEMT? Lack of transportation can limit access to care, especially for the elderly and people with complex health care needs who may not be able to provide or pay for their own transportation, referred to as transportation disadvantaged MACPAC case studies of Indiana and Vermont found that over 50% of NEMT users were aged or disabled Behavioral health, end stage renal disease and diabetes among most common diagnoses associated with NEMT trips December 6,
7 How much does NEMT cost? NEMT spending difficult to quantify because much of it occurs in brokerage or managed care arrangements where spending is subsumed in a capitation payment Fee-for-service spending on NEMT was just over $2 billion (federal + state) in FY 2017 based on CMS-64 data December 6,
8 Policy issues Program integrity Government Accountability Office considers NEMT a high risk for fraud and abuse U.S. Department of Health and Human Services Inspector General found inadequate oversight and improper payments for trips Brokerage models may be less prone to fraud and abuse because payment is capitated under the contract December 6,
9 Policy issues Eliminating NEMT for certain groups under waivers Indiana, Iowa and Kentucky waive the NEMT benefit for the new adult group Other states (Arkansas and New Hampshire) provide NEMT to certain individuals in the new adult group as a wrap-around benefit meaning that the state will provide it if the beneficiary s private plan does not Waiver evaluations should shed light on effects Exploring the role of rideshare services such as Lyft and Uber in providing NEMT benefit December 6,
10 Non-Emergency Medical Transportation (NEMT) Medicaid and CHIP Payment and Access Commission Kirstin Blom December 6, 2018
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