Congress is investigating the impact of Medicaid's approval of waivers to states looking to end coverage of non-emergency transportation. Advocates say the move to stop coverage could prevent people from getting to dialysis, chronic-care visits or mental health appointments.
Federal law requires coverage of necessary transportation to and from providers. But, in recent years as Medicaid expands under the Affordable Care Act and costs increase, states have been asking to waive the requirement for non-emergency transportation.
While the CMS has approved only a few waivers, only a few states, mostly Republican-led, have asked for them. There is no record of the agency denying a waiver request and the CMS keeps renewing those it has approved, despite complaints.
That's led Sen. Ron Wyden (D-Ore.) and Sen. Frank Pallone, (D-N.J.) to ask the Government Accountability Office to investigate the impact of the waivers. A spokesman from the office said a report is expected this month.
“The implications are pretty far reaching and troublesome,” Andrea Callow, senior policy analyst at Families USA, an advocacy organization, said of CMS letting states not offer the benefit.
The move to approve the waivers may be a political one during the continued push to expand Medicaid, policy insiders say.
“It appears there's more of a political rationale for getting this concession from the federal government, versus a policy one,” said Sean Miskell, research fellow at Center for Children and Families at Georgetown University.
A CMS representative didn't immediately respond to a request for comment.
To date, the CMS has granted such approvals only to Iowa and Indiana. Pennsylvania also received the permission, but a change in the governor's office affected the expansion plans and state officials chose not to use it. Arizona has a pending request to provide prior authorization and Arkansas has a similar waiver that's been extended.
The CMS usually requires a beneficiary survey follow-up after a waiver has been approved to determine if care will be affected.
Last year, a survey in the state of Iowa (PDF) showed some beneficiaries with incomes under the poverty level did not have transportation to or from a healthcare visit. Others said a lack of transportation could prevent them from getting a physical exam in the coming year.
In the most recent extension notice sent to Iowa in July, the CMS noted the cases of negative impact were not statistically significant to warrant not extending the waiver.
Indiana's survey was due Nov.1, 2015, but the deadline has been repeatedly moved as the state and the CMS have not been able to agree on how the data will be collected, according to federal records.
The survey is now due Feb. 29, 2016, the agency said in its waiver renewal letter to the state.