As a practicing physician and the head of Anthem's CareMore Health, I know from experience that people miss or delay medical care every day because they lack accessible or reliable transportation. That's why CareMore has always provided non-emergency medical transportation to our patients.
A rule change under consideration by the CMS would allow states to opt out of the requirement that they provide non-emergency medical transportation, or NEMT, to Medicaid beneficiaries. Unfortunately, this change has the potential to increase the cost of care, severely limit access to care for millions, and, most distressingly, lead to negative health outcomes.
NEMT has been a mandatory benefit for eligible patients since 1966, when the Medicaid program was implemented. Under the program guidelines, state Medicaid programs are required to provide necessary transportation for beneficiaries to and from providers. States determine how to administer that benefit, and many states rely on third-party brokers or managers to deliver the services.
Research into the NEMT benefit has consistently shown that it has improved health outcomes for consumers. Studies show that it helps individuals access preventive care, including pre- and post-natal visits, and treatment for chronic conditions like asthma and heart disease. In a recent study, 58% of beneficiaries surveyed reported that they would not be able to make any medical appointments without NEMT. Moreover, 10% of beneficiaries surveyed reported that they “would die or probably die” if they did not have the transportation services they currently receive.
The fact is, millions of Americans live in areas where medical care is simply out of reach. This is particularly true for the poor, elderly and chronically ill populations for whom routine access to ambulatory and preventive care is most important. If we are going to commit ourselves to address systemic barriers to care that directly link to health outcomes, we must provide beneficiaries with transportation.
Additionally, as many healthcare organizations, including Anthem, have determined, NEMT is not only cost-effective, it pays for itself. One study demonstrated that Medicaid saves more than $40 million per month by providing transportation for 30,000 patients to attend regular dialysis treatments and diabetic wound care treatments versus not providing the benefit.
Currently, three states—Iowa, Indiana and Kentucky—have received waiver approval to eliminate transportation benefits for most of their state's Medicaid expansion population. After studying the issue in Indiana, our parent company made the decision to continue the benefit despite the reimbursement loss, recognizing the impact that reduced access to care can have on patient outcomes. That's because missed medical appointments lead to non-adherence with clinical guidelines which, in turn, leads to complications and expensive medical services.
Moreover, the proposed rule change comes as the rapid growth of ride-hailing programs (e.g., Uber and Lyft) is changing the dynamic of medical transportation and bringing new efficiencies to the marketplace. At CareMore, Lyft now provides 7,000 rides per month to our patients. Our studies show that, after we started our Lyft partnership, wait times for rides decreased by 45%, on-time arrivals increased to 92%, and patient satisfaction shot up to 98%. Also, Lyft-based rides cost CareMore 39% less, on average, than other options. The savings have allowed us to invest in our members and increase NEMT benefits. It therefore puzzles me why we would eliminate a benefit that, by all accounts, is both becoming better and less expensive.
As one of the leaders of a healthcare organization that supports almost 40 million Americans, across multiple lines of business and in diverse states and communities, I believe it is critical that NEMT continue to be available for all Medicaid beneficiaries with no other means to access healthcare. As one patient told me early in my clinical training, “You may have the best programs and doctors—but if I can't get to them, they're no good to me.”