Transportation for people with disabilities can be a complex issue. One of the more confusing areas is Medicaid Transportation, also referred to Non-Emergency Medical Transportation Services (NEMTS), which may also have a different name, depending on which state you live in. Each state has Medicaid transportation programs, transportation covered as a part of an individual state’s particular Medicaid Waivers, including managed care (long term, behavioral or other types) and also reimburses Medicaid recipients for use of private vehicles for allowable expenses under NEMT. We wish to provide some basic information here.
What it is: The Kaiser Foundation and CMS – The Centers for Medicare and Medicaid Services (PDF) provide explanations of program, particularly how benefits may vary among states. Contact your state’s lead agency on Medicaid for further information.
Who is eligible: See pages 3 (included parties) and 12 (excluded parties) in CMS Guide (PDF) and the links above for your state. Medicaid covers low income populations of all ages and many people with disabilities. Advocates should also check with their individual state for further specifics, since CMS grants some measure of flexibility on covered benefits. One recent change that states have been struggling with and the impact on overall transportation costs is still unclear is the Medicaid Expansion to additional populations (PDF) under the Affordable Care Act, which would increase the number eligible consumers for a Medicaid Transportation benefit.
What it covers: Medicaid transportation benefits covered under your state’s Medicaid Plan, which must be approved by CMS. See general information on states and contact your state’s designated Medicaid agency.
Areas not covered under NEMT: Employment, education, recreation, health activities not approved for reimbursement under your state’s Medicaid plan. Get more information from the agency in charge of your state’s Medicaid populations. To verify if this benefit is under Medicaid managed care, you should also reach out to the managed care organization (MCO) health management organization (HMO) for specific guidelines and appeal rights. Each state’s services have to meet minimum program integrity standards and definitions set by CMS. NEMT is separate from the transportation covered under state Medicaid Waivers. Some states also have behavioral health services, also referred to Psychiatric Rehabilitation that is also separate from NEMT.
NEMT and Mileage Reimbursements: There is some guidance related to the Federal False Claims Act, but flexibility for states on reimbursement rate standards.
Funding sources: States get Medicaid funding from CMS and also from a state budget appropriations, which usually comes from a state’s Department of Human Services for services. State’s Federal Medicaid Assistance Program (FMAP) matching funds were increased initially under the Affordable Care Act but have since gone back to prior levels (just above 50%). Funding for vehicles may come from a variety of sources, including Federal DOT 5310 or other grants for low income, senior and disability populations, state funds, county or other local public and private funding sources. There may also be some co-pays for consumers.
Consumer Rights: See information from CMS on consumer rights (PDF) or contact your state’s lead agency on Medicaid.
Barriers / areas of confusion: What is considered ‘waste, fraud and abuse’, distinction between other transportation programs (shared ride for people with disabilities and seniors), who is responsible for funding and oversight, covered services / benefits, mileage reimbursement rates for use of private vehicles (tend to be low) and where ‘emergency’ transportation is covered benefit (PDF), crossing county and state lines. NEMT providers tend to provide transportation to the closest provider of medical services which may or may not cross county lines and limit choice.
Governmental entities overseeing program: CMS, State Medicaid Entity (state departments of human services or aging), county governments and others depends how an individual state has set up Medicaid Transportation (NEMT).
Medicaid Transportation Providers: Check with your state or county for Medicaid transportation service providers. There are also provider guidelines set forth by CMS.
Who should be at the table addressing barriers: From a disability perspective, CILs / other providers of physical disability services, mental health organizations, Intellectual Disability focused entities and other disability groups (blind, deaf, etc.). Since Medicaid covers other populations, organizations such as seniors and low income organizations- local / state AARPs, Community Action and other grassroots organizations supporting ‘vulnerable populations’ should be at the table who receive Medicaid-children, adults and seniors. Stakeholder groups around Medicaid transportation exist on federal, state and county levels.
Transportation Networking Companies (TNCs-Uber, Lyft and others) role: All levels of government are looking to reduce costs and generally improve services. State Medicaid agencies and other transportation entities are starting to subcontract with TNCs to better address these issues. The disability community has been involved in some instances, but not to the degree that most advocates would like.
Where to contact for more information in your state and address issues of concern: Individuals should contact the leading agency in their state in charge of that state’s Medicaid program, county agencies or entities privately contracted to provide the services to address issues. As a last result, folks can contact CMS (PDF – see page 5) if their concerns aren’t getting addressed. Each state also has contracted with community organizations to provide legal representation for individual using NEMT.
Additional Public Policy Background: Other helpful information on Medicaid Transportation / NEMT.
