Non-Emergency Medical Transportation in Medicaid, 2018–2021

Non-Emergency Medical Transportation in Medicaid, 2018–2021

Expanded Report to Congress
Published: Jun 20, 2023
Publisher: Centers for Medicare and Medicaid Services
Associated Project

Providing Data Analytics and Data Quality Support for Medicaid and CHIP Business and Information Solutions

Time frame: 2015-2026

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services

Key Findings
  • Overall, between 4 and 5 percent of Medicaid beneficiaries used NEMT in each study year (2018 – 2021). However, certain subgroups of Medicaid beneficiaries with substantial health care needs used NEMT at higher rates than the average. These subgroups included Money Follows the Person (MFP) participants, participants receiving home and community based services through Section 1915(c) waivers, and dually eligible beneficiaries. Beneficiaries eligible for Medicaid on the basis of a disability and those eligible on the basis of age (65+) also used NEMT at rates higher than the average.
  • NEMT played a key role in enabling access to care for beneficiaries with certain types of physical health conditions, mental health conditions, and substance use disorders (SUDs), who used the benefit at substantially higher rates than the average. They included beneficiaries with a diagnosis of chronic kidney disease (CKD) with end-stage renal disease (ESRD); opioid use disorder (OUD); any SUD; intellectual disabilities or other developmental delays; and beneficiaries with any mental health condition. These results suggest that NEMT plays an important role in enabling beneficiaries with chronic physical and mental health conditions and SUDs to access medically necessary care.
  • Beneficiaries most often used NEMT to access preventive health care services, services related to the evaluation and management (E&M) of acute and chronic conditions, lab and imaging services, and behavioral health services.
  • Rates of NEMT use changed dramatically during the COVID-19 Public Health Emergency. At the start of the COVID-19 PHE, NEMT use dropped sharply as many services shifted to telehealth, and providers and beneficiaries delayed non-urgent medical care. Use of NEMT gradually increased in May through October 2020, but declined again in October 2020 through February 2021, which coincided with a resurgence in COVID-19 case levels. On average, the monthly number of NEMT ride days in 2021 remained about 30 percent below pre-PHE levels, and the number of beneficiaries using NEMT remained 23 percent below pre-PHE levels.

This Report to Congress presents an analysis of Medicaid beneficiaries’ use of Non-Emergency Medical Transportation (NEMT). Specifically, the report presents insights about overall number and percentage of Medicaid beneficiaries who used NEMT annually and monthly in 2018 – 2021. The report also examined the relative frequency and volume of NEMT service use across different beneficiary subgroups, including beneficiaries in each major Medicaid eligibility category (children, adults, adult expansion beneficiaries, beneficiaries eligible for Medicaid on the basis of a disability, and beneficiaries eligible on the basis of age [65 and older]), beneficiaries living in different geographic areas, and among beneficiaries with different physical and behavioral health conditions. Finally, the report examined the types of medical services Medicaid beneficiaries accessed when using NEMT, monthly trends in the use of NEMT versus telehealth services before and during the COVID-19 Public Health Emergency, and compared of the volume of NEMT services used by type of state NEMT delivery model. The report leveraged T-MSIS data covering calendar years 2018-2021.

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