By Dan Reid, President, The Transportation Alliance
When we think about core healthcare services, what often comes to mind are direct patient care elements like doctor appointment, medical consultations, surgery, or emergency room visits. Yet, there’s another equally vital aspect of healthcare that often goes overlooked: transportation. Non-Emergency Medical Transportation (NEMT) plays a crucial role in ensuring access to healthcare services for millions of people who face transportation barriers. Far from being a secondary service, NEMT is a core healthcare component that keeps people connected to the care they need to lead healthier lives.
What is NEMT?
Historically Non-Emergency Medical Transportation, or NEMT, referred to transportation services provided to individuals needing assistance getting to and from medical appointments, treatments, or therapies and who do not need medical attention during their transportation. Recently however, NEMT has also included all healthcare-related trips, such as those addressing social determinants of health needs. It is typically used by patients who face transportation barriers such as lack of access to transportation or are unable to drive due to other factors including age or disabilities. NEMT Services were codified in 2021 as a mandatory benefit under Medicaid for people who lack reliable transportation. NEMT is also offered under a growing number of Medicare Advantage Plans, and many facilities and individuals contract directly for NEMT services through what is commonly called “private pay” or “contracted” services. Whether through Medicaid, MA plans, private pay or contract pay, NEMT offers a reliable solution to bridge the transportation gap for people in, rural areas, low-income individuals, individuals with disabilities, seniors, and those lacking access to adequate transportation.
Why is NEMT Essential to Healthcare?
NEMT has a direct and profound impact on health outcomes, particularly for individuals with chronic conditions, seniors, and low-income populations. Here are some reasons why NEMT is, and should be recognized as, a core healthcare service:
1. Improving Access to Care
Access to healthcare is not just about having insurance or being able to afford care, it also includes physically getting to appointments. Without reliable transportation, many people delay or skip critical medical visits, putting their health at risk. A 2023 study by the Urban Institute reported that more than one in five adults without access to a vehicle or public transportation said they had forgone healthcare needs because of difficulty finding transportation. 1 NEMT enables these individuals to reach primary care providers, specialists, rehabilitation, and mental health services. For those living in remote areas or urban centers with limited public transportation, NEMT can be the difference between managing health proactively or dealing with severe consequences later.
2. Supporting Vulnerable Populations
That same Urban Institute study pointed out that while 5 percent of nonelderly adults did not get needed health care in the past 12 months due to difficulties with finding transportation, the numbers are significantly higher for certain populations. The number rose to 14 percent for low income families, 17 percent for adults with disabilities, and 13 percent for adults without household access to a vehicle.2 These populations face multiple barriers that prevent them from easily accessing healthcare, with transportation often a primary challenge. NEMT services provide a lifeline for these groups, allowing them to maintain regular healthcare appointments, access life-sustaining treatments, and manage ongoing health conditions.
3. Reducing Healthcare Inequities
Transportation is a social determinant of health (SDoH), i.e., a factor outside of direct medical care that influences a person’s well-being. The World Health Organization estimates that SDoH accounts for between 30-55% of health outcomes3. In addition to being a SDoH, safe and reliable transportation is also crucial to addressing the many other SDOH factors, such as job security, education, access to healthy food options, community engagement, and, obviously, the health care system. Lack of access to transportation widens health inequities, disproportionately affecting marginalized communities. By ensuring NEMT is available, healthcare systems can work towards leveling the playing field, enabling all individuals to access healthcare, regardless of socioeconomic status or geographic location.
4. Reducing Hospital Admissions, Readmissions, and Healthcare Costs
By providing consistent access to preventive care, NEMT helps reduce the incidence of hospital admissions and emergency room visits. For patients managing chronic diseases like diabetes, heart disease, and respiratory conditions, regular access to care is essential for monitoring symptoms, adjusting treatments, and preventing complications. Studies show that individuals with reliable NEMT access have better outcomes and experience fewer hospitalizations and readmissions, which leads to substantial cost savings for the healthcare system as a whole. A 2008 Florida State University study showed that if only 1% of the trips funded in the State resulted in the avoidance of a future emergency room visit, the payback to the State [Florida] would be 1108 percent!4 An actuarial analysis modeled Medicaid programs savings of $40 million dollars a month ($480 million per year) for every 30,000 beneficiaries who use NEMT to get to all of their dialysis, diabetic wound care, and substance abuse treatment appointment.5 NEMT can be self-financing by lessening avoidable hospital visits and slowing the progression of chronic diseases like diabetes and kidney failure.
5. Enhancing Quality of Life
NEMT helps individuals stay connected to the care they need to live independently, maintain better mental health, and improve overall life satisfaction. For seniors and people with chronic health issues, consistent healthcare access can mean more years spent at home rather than in assisted living or hospitals.
The Challenges Facing NEMT as a Core Service
Despite its importance, NEMT is often underfunded and undervalued within the healthcare system. Some challenges include:
Funding Limitations: Medicaid funds NEMT for its members, but it is often a limited benefit. Lack of adequate funding can indirectly restrict the number of people who can receive NEMT services and impacts the quality of NEMT programs. Often contractual requirements or paying sources require or opt for the “lowest cost provider”. However, a focus solely on the actual cost of trips fails to account for significantly higher costs incurred overall from incurring hospital and emergency room costs that otherwise would have been avoided if more money was spent on higher quality NEMT services in the first place.
Logistical Barriers: Coordinating NEMT can be complex. Inconsistent scheduling, lack of standardization, and communication issues between providers and transportation companies can lead to delays or missed appointments, reducing the program's effectiveness.
Awareness: Many individuals who qualify for NEMT may not even be aware that the service exists, leading to underutilization.
The Path Forward: Strengthening NEMT as a Core Service
To fully realize the potential of NEMT, it needs to be integrated more deeply into the healthcare ecosystem. Here are a few ways to enhance NEMT as a core service:
Expand Coverage and Funding: Expanding NEMT funding and eligibility through Medicare, Medicaid, and other health plans can help more people access this essential service.
Continue to the Adoption of Improved Technology and Logistics: Better use of technology can streamline NEMT services. Paying sources and regulators need to require GPS tracking, automated scheduling, and real-time communication to help ensure patients reach appointments on time, improving both the patient experience and health outcomes. Additionally, attention needs to be paid to standards being created for the industry organizations such as NEMTAC.
Increase Awareness: Public health agencies and healthcare providers can work to increase awareness of NEMT among eligible patients, helping them understand how to access this service and the benefits it provides.
Focus on Overall Cost of NEMT Services: State authorities and paying sources should focus on “overall lowest cost of service”, but they must do so realistically. The cost of no shows and late trips, can drive the overall cost of providing NEMT services when you take into account the increased costs down the road of higher medical costs and emergency room visits resulting from individuals missing necessary healthcare services. Additionally, using NEMT providers with poor quality control and safety standards puts riders at risk, and raises the overall costs in the industry as insurance rates continue to increase to pay for avoidable losses. The concept of value based pay is not a foreign concept in healthcare, it just has been effectively applied to NEMT services.
Recognize NEMT as Preventive Care: By acknowledging NEMT as preventive care, policymakers can help shift funding priorities to support transportation services as a long-term investment in public health.
Conclusion
Non-Emergency Medical Transportation is much more than simple transportation, rather it is a critical part of healthcare that allows individuals to receive consistent and preventive care. For millions of Americans, it represents the difference between staying healthy and experiencing deteriorating health conditions. By valuing and investing in NEMT as a core healthcare service, we can move closer to a more equitable and effective healthcare system that truly meets the needs of all people.
Dan Reid operates NEMT Provider companies in Mississippi and Louisiana. He currently serves as TTA’s President and on NEMTAC’s Board of Directors and Co-Chair of NEMTAC’s Accreditation Advisory Committee and Certification and Standards Advisory Committee.
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