Economic Justice

In early August, the Center for Consumer Engagement in Health Innovation (the Center) submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) regarding Iowa’s request to extend its waiver of Non-Emergency Medical Transportation (NEMT) benefits from its state Medicaid demonstrations (Iowa Wellness Plan and Marketplace Choice Plan). The waiver excludes coverage for NEMT services, a benefit that is standard in non-waiver Medicaid programs.

NEMT provides access to and from medical appointments for consumers who do not have other means of transportation. Reimbursed services can include shared van programs, taxis or public transit. Many in need of NEMT are lower-income beneficiaries, often older adults or people with disabilities. A high proportion of these individuals live with multiple chronic conditions such as end-stage renal disease, cancer or chronic obstructive pulmonary disease. Monitoring and treatment for these conditions require frequent medical appointments and limited transportation options may prevent access to timely, life-sustaining care.

Transportation barriers can have a “domino effect” on health outcomes and cost of care. Missed or delayed appointments can worsen health conditions and end up necessitating expensive ambulance services and costly emergency department visits. This is why NEMT has proven to be highly cost-effective.

For individuals in need of behavioral health services, NEMT is particularly critical. One study found that the largest proportion of adult beneficiaries who use NEMT do so to access mental and behavioral health services. More than 40 percent of NEMT trips in New Jersey and 30 percent of trips in Nevada were used to access mental health or substance use treatment appointments.  

The Center is concerned that several states have sought to exclude NEMT for some of their Medicaid beneficiaries. These actions reveal the need for consumer advocates to ensure that other states do not follow suit.