In this two-part blog series, we’ll first look at the growing NEMT-Transit divide and then explore how improving communication through technology between these differing industries can lead to achieving common goals and improving customer access to transit services.
Download the Research Documents
- In this blog post, we’ve condensed some of the main findings from the recent Transit Cooperative Research Program (TCRP) Research Report 202: Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination.
- A companion document was also released, where for the first time researchers surveyed all 50 states to gather statistics about the approach to NEMT in each state.
NEMT for Medicaid
The US federal government requires that states provide non-emergency medical transportation services to Medicaid beneficiaries who need to get to and from medical services and have no other means of transportation. Medicaid serves the nation’s most vulnerable, including: children, families, and seniors with low incomes, and people with disabilities. Medicaid transportation expenses are expected to increase as more individuals are eligible under the Affordable Care Act. In response, states are pushing to reduce NEMT costs. In 2013, Medicaid covered nearly 104 million NEMT trips at cost of $3 billion. More recent data is not available for NEMT costs post-expansion, but with an additional 17.2 million individuals enrolled in the program as of December 2016 (compared to three years earlier), costs can’t go anywhere but up.
State NEMT Service Models
After surveying NEMT models in every state (detailed state-by-state breakdowns can be found in the companion document here), the authors found that states are creating statewide or regional NEMT brokerages that are separated from locally coordinated transportation systems. There has been a significant increase in the use of the broker and MCO models after the Debt Reduction Act was passed, with 86 percent of states employing a broker model in 2017.
There are several legislative incentives towards creating separate brokerages. Additionally, as the US healthcare system evolves from a state-administered, fee-for-service model to a capitated rate model, many states are handing over administration of Medicaid and NEMT services to managed care organizations.
The use of brokerages combined with capitated rates provides states with greater cost certainty and reduced Medicaid agency administration costs. They also have the advantage of fraud, waste and abuse deterrence.
Fragmentation of NEMT and Transit Industries
Experts warn that the trends of separate NEMT brokers and MCOs with carved-in NEMT may lead to less coordination of transportation resources. They say this will also create more difficulties for Medicaid beneficiaries, who will now have to arrange travel with multiple providers depending on the purpose of each trip. Numerous case studies found that transit agencies, especially rural ones, are losing revenue and matching fund opportunities because of this fragmentation.
An example of this fragmentation can be seen in the number of non-profits and agencies offering a patchwork of specialized transportation services for seniors and people with disabilities; whereas urban transit agencies are more centralized and carried out 98% of all passenger trips. On top of these statistics, add the growing network of NEMT providers and brokers.
| Transit Type | Percent of all passenger trips performed in one year | Number of agencies offering transportation services |
|---|---|---|
| Urban transportation | 98 % | 820 transit agencies |
| Rural transportation | 1.5 % | 1,400 transit agencies |
| Specialized transportation for seniors and people with disabilities | 0.5 % | 4,600 non-profits and agencies |
Next Up
How can we blend transit agencies’ need to find additional funding and serve ever-growing communities, with the need for NEMT cost savings? And how can these two industries, with different perspectives, work together to better serve customers? In part two we will explore how technology can help address all of these seemingly disparate problems.
