The Medicaid program is the federal government’s largest provider of human services transportation (HST), spending between $2 and $3 billion annually on non-emergency medical transportation (NEMT). The successful coordination of federally funded human services transportation is affected by the extent to which resources for NEMT are coordinated with and complement public transit and human services transportation. Because the Medicaid program is administered by states, which are able to set their own rules and regulations within the Centers for Medicare and Medicaid Services (CMS) framework, coordination of NEMT with public transit and human services transportation is highly dependent on state Medicaid agencies’ policies and priorities.
Over the past decade, many states have made significant progress coordinating NEMT with other federally funded transportation services, most often by allowing local or regional organizations to broker NEMT trips with numerous other trip types. This approach results in transportation resources and costs being shared across multiple programs and transportation providers.
Medicaid NEMT presents both opportunities and challenges for public transit and human services transportation providers wishing to coordinate more closely the various trips being provided in their service areas. The most frequently cited examples of coordination typically involve NEMT, ADA paratransit (provided by public transit agencies), and human services trips coordinated on a local or regional basis. In recent years, numerous state Medicaid programs have separated their transportation services from local or regionally coordinated transportation systems in order to create a statewide or regional brokerage for all NEMT trips. This approach is often pursued for cost savings, fraud deterrence, and/or administrative efficiency. Transportation coordination and mobility management professionals have expressed concerns about this trend, saying that it leads to less coordination, more service duplication, loss of local revenue for transportation providers, trip shifting, and challenges for transportation of disadvantaged people who may be required to book trips through multiple systems, depending on their type of trip.
Most research conducted on NEMT brokerages has focused on the impacts on the specific Medicaid program and agency. Meanwhile, the broader fiscal, coordination, and customer service effects of statewide Medicaid NEMT brokerages have not been fully studied. As more states consider the statewide or regional brokerage options for NEMT, it is important to determine (1) what the larger outcomes are for human services transportation and public transit, (2) what motivates states to establish separate NEMT brokerages, and (3) what the actual costs and benefits are.
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