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February 2, 2018

States want to cut Medicaid coverage for non-emergency medical transportation. Some experts are firing back.

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    Some policymakers are considering scaling back Medicaid coverage for non-emergency medical transportation (NEMT) as a way to curb the program's costs, but advocates say the reductions could harm beneficiaries' access to care.

    New: 12 imperatives for designing a sustainable Medicaid strategy

    Background on NEMT

    Federal law requires states to provide NEMT services to certain Medicaid beneficiaries via the "most appropriate and least costly form of transportation," Kaiser Health News reports, which can include ambulances, public transportation, and taxis.

    NEMT provides qualifying beneficiaries with transportation to and from medical services, such as visits to specialists, dialysis, and substance use disorder treatment. According to a 2013 estimate, Medicaid covers nearly 104 million NEMT trips annually, costing a total of almost $3 billion.

    Some states reduce NEMT coverage

    However, according to KHN, policymakers at both the state and federal level have considered cutting Medicaid coverage for NEMT in an effort to rein-in the program's costs. At least three states—Indiana, Iowa, and Kentucky—have reduced coverage for NEMT services under federally approved Medicaid waivers. According to KHN, Indiana and Iowa under the waivers still cover NEMT services for certain groups of beneficiaries, including those considered "medically frail."

    Massachusetts also is looking to reduce NEMT coverage under a federal Medicaid waiver application that is pending with CMS, KHN reports, and Joan Alker, executive director of the Georgetown University Center for Children and Families, said she would not "be surprised to see more of these waivers in the pipeline."

    Proponents of the reductions have pointed to a 2016 Government Accountability Office report that found NEMT programs have "a high risk for fraud and abuse." For instance, CMS in 2016 said a Massachusetts NEMT provider was penalized for billing Medicaid for rides provided to beneficiaries who were no longer living. In another example, two Connecticut-based ambulance programs paid nearly $600,000 to settle allegations that they had transported dialysis patients who did not have a medical need for the services.

    Advocates say NEMT cuts could hurt Medicaid beneficiaries' access to care

    But critics of the reductions say they could leave sick and low-income Medicaid beneficiaries without a way to access care. A 2014 CMS survey found that a lack of transportation was the third-largest barrier to care among adult Medicaid beneficiaries with disabilities. According to the survey, 12.2% of such beneficiaries said they did not have transportation to medical appointments.

    Research also has shown that NEMT programs can be cost effective. A 2005 study published by the National Academy of Sciences found that providing NEMT can be cost-effective because Medicaid beneficiaries stayed healthier if they were able to access medical appointments.

    Eliot Fishman, senior director of health policy for Families USA, called NEMT coverage "vital." He said, "This is not something to be trifled with lightly," adding, "We're talking about a lifesaving aspect of the Medicaid program" (Aleccia, "Shots," Kaiser Health News/NPR, 1/27).

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