Non-emergency medical transportation

Benefits

Non-emergency medical transportation (NEMT) is a required Medicaid benefit designed to provide transportation to and from medical appointments for enrollees who have no other means of transportation (42 CFR 431.53). States are also required to provide assistance with transportation to children and their families as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit (42 CFR 441.62).

The NEMT benefit covers a broad range of transportation services including trips in taxis, buses, vans and personal vehicles belonging to the enrollee and his or her family or friends. States pay for trips to and from medical appointments and reimburse enrollees or friends and family for mileage on a personal vehicle. Use of public transportation for NEMT purposes varies considerably across states and even within states as public transportation is not available in all areas.

States differ in how they deliver NEMT services:

  • The most common delivery model is a third-party broker, established as a state option under the Deficit Reduction Act of 2005 (DRA, P.L. 109-171) (TCRP 2014). Under this model, states contract with a transportation broker who arranges transportation services for Medicaid enrollees under a capitated payment. States must choose the broker through a competitive bidding process. As of August 2013, 25 states were using a brokerage model (TCRP 2014).
  • Under a fee-for-service (FFS) model, the state coordinates and approves the trips and reimburses for the cost of each trip. Some states, such as Michigan and Texas, use a mixed model of brokerage and FFS.
  • States may also contract with managed care plans to provide transportation for their enrollees (GAO 2016).

States’ decisions on which model to use may reflect whether beneficiaries are enrolled in managed care and their eligibility pathway.  For example, some states provide NEMT only to mandatory eligibility groups.

States also vary in how they administer the NEMT benefit. Some states require that beneficiaries pay a nominal copayment to use NEMT services. For example, in Arizona, adults without dependent children in certain parts of the state must pay a $2 copayment for taxi services for each one-way trip (Arizona demonstration fact sheet). States may also limit the number of trips that are permitted. For example, New Hampshire limits the number of wheelchair van trips to 24 per year (NH DHHS 2014, Recipient information about: Transportation). In addition, some states, such as Illinois, require prior approval by the state Medicaid agency to authorize the transportation (KFF 2016).