Operators and TLPA are becoming increasingly alarmed about a potential threat to funding for nonemergency medical transportation (NEMT). The potential snowball effect this could have across the country is something TLPA is watching closely for its members.
Millions of NEMT trips are paid for by Medicaid each year, costing somewhere around $3 billion a year. Because America’s population is aging, these costs are only going to go up, which is why the federal government wants to try to cut costs.
With that in mind, some states have now used waivers to pursue experimental, pilot or demonstration projects that differ from federal rules. Three states have eliminated the NEMT benefit for subsections of their Medicaid population already: Iowa in 2013, Indiana in 2015, and Kentucky in 2018.
Now, TLPA has learned, at least five additional states are considering similar waivers: Arizona, Arkansas, Massachusetts, New Mexico and Pennsylvania. And two additional states—Florida and Texas—have active legislative bills that would allow companies like Uber and Lyft to provide NEMT service.
Members should know that TLPA is opposed to anything that would weaken access to transportation under this program. That is because numerous studies have shown that missed doctor appointments eventually end up costing more in terms of emergency room visits, ambulance trips or medical flights.
The waiver does not mean the states will not eliminate such transportation altogether for all Medicaid service recipients. But it does mean that they will seek alternative approaches—such as limiting the availability of NEMT service and/or adopting lower-cost ridesharing models that do not meet the current safety standards for participating in the NEMT program.
“This is a serious concern and we need all operators to have it on their radar,” said TLPA President Terry O’Toole. “TLPA is vigorously opposed to reducing support for Medicaid’s vitally needed NEMT service. The people who will suffer most under these waivers are the millions of low-income passengers in America who rely on this transportation for medical appointments. It will gravely affect children with disabilities, low-income adults who need dialysis or cancer treatment, the elderly who need adult day, and others.”
TLPA is not alone in sounding the alarm.
"This is not something to be trifled with lightly," Eliot Fishman, senior director of health policy for Families USA, a nonprofit consumer health advocacy group, told National Public Radio recently. "We're talking about a lifesaving aspect of the Medicaid program." Fishman also happens to be a former Medicaid official.
The good news is that, if you are a TLPA member, you have already received several pieces of information on this threat in our e-newsletters this week. And for those who actively participate in our meetings, this issue will be front and center at TLPA’s Spring Conference & Expo on April 24-26 in New Orleans. We are devoting a special discussion on this topic: “Clear and Present Danger: NEMT Funding Threat & How to Respond.”
So if your company provides NEMT service, there will be no better place to be in the coming weeks than with your peers at the Spring Conference. And there is no better membership to keep you abreast of what we see as a dangerous situation. We all need to be hyper aware of this evolving threat.
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