For many people, making it to important medical appointments is not a simple process. These transportation barriers prevent them from accessing the care they need. This is where non-emergency medical transportation (NEMT) plays a crucial role for patients and the medical facilities that provide their care.
For patients enrolled in Medicaid, the Code of Federal Regulations has long required that states make sure that eligible and qualified Medicaid beneficiaries have NEMT to take them to and from their medical appointments, and Congress clarified the statutory requirement for this benefit in 2021.
NEMT companies pick up, deliver and then return home patients from medical appointments for non-emergency care. Federal regulations and guidelines for NEMT companies cover everything from the criteria for drivers and vehicles used to defining the differences between emergency and non-emergency care needs. However, states have some flexibility in how they provide NEMT services.
Generally, Medicaid patients are qualified to receive NEMT if:
They don’t hold a valid driver’s license.
Their household has no working vehicle available.
They’re unable to travel or wait alone for their medical care.
They lack money for gas.
They have a physical, mental, developmental and/or cognitive limitation.
The Medicaid program is the largest federal program for human services transportation, spending approximately $3 billion annually on NEMT, the Transportation Research Board, a part of the National Academies of Sciences, Engineering and Medicine, reports.
Additionally, NEMT is seen as a growth industry as the American population ages. By 2030, Americans over the age of 65 will make up 21% of the population, up from the current 15%. And by 2060, 25% of Americans will be 65 and above, with the number of people 85 and older tripling.
Clinic-ology knows firsthand that NEMTs provide a critical service to patients and healthcare providers. But first, what exactly is non-emergency medical transportation? It’s transportation for medical reasons that don’t put the patient’s health and life at risk. Rather, it’s for when the patient’s medical needs are not immediate and the symptoms not severe.
NEMT is not for life-threatening events like uncontrolled bleeding, heart attack, car accidents “or other serious trauma [that] may cause the symptoms,” according to guidelines from the Centers for Medicare & Medicaid Services (CMS).
While NEMT regulations may vary from state to state, in general:
NEMT providers need to have a signed contract with Medicaid to offer their services to Medicaid patients.
Billing Medicaid for “no-shows” is not allowed and is considered fraud.
Additional payment for wait times is not covered.
States may require preauthorization for NEMT services.
States may require a small copayment, usually from $0.50 to $3.50.
States may be granted a waiver that can limit NEMT services.
States may contract with a third-party broker, use Medicaid’s managed care contracts or manage its NEMT program directly.
NEMT providers may use wheelchair vans, taxis, stretcher cars, and buses. In appropriate situations, air transportation or an ambulette may be used.
But there are also non-Medicaid patients who may use NEMT services. The Veteran’s Administration and some private insurers have and do offer NEMT to their patients.
“Although hospitals and health systems traditionally have not focused on transportation issues within their purview of care delivery, there is a growing recognition that improving transportation access and support for patients can help improve health outcomes and lower health costs,” a 2017 American Hospital Association (AHA) report noted.
For patients with extreme barriers to transportation to medical appointments, NEMT can mean the difference between health and illness and even life and death. But how do you access NEMT services provided by your state?
Reach out to your provider to request the service.
Use software designed to connect you with your local NEMT provider.
A NEMT broker, if used in your state, acts as the central hub, matching drivers with riders.
NEMT doesn't only benefit patients. In 2019, Becker’s Hospital Review reported that 3.6 million adults “miss or delay non-emergency medical care annually due to transportation barriers, and these patient no-shows result in serious financial consequences for health systems each year.”
Clinic-ology assists NEMTs in creating, implementing and managing their operating systems, knowing that in order for healthcare clinics to provide the appropriate patient care and for patients to receive the care they require the first step is for the patient to arrive on time for their next appointment.