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Approximately 3.6 million Americans miss or delay medical care because they lack appropriate transportation to their appointments. Many low-income Americans lack the disposable income necessary to have access to adequate transportation, and may lack public transit options to get transported back and forth to medical appointments. Some government health benefit programs provides patient transport services benefit that pays for the least costly and appropriate way of getting people to their appointments whether by taxi, van, public transit or mileage reimbursement.


This brief provides an overview of the different ways states are dealing with the increase in people who need wheelchair transportation because of  age, chronic conditions or income

The Increasing Need for Non-Emergency Medical Transportation Services

Medicaid funds are the single largest transfer of federal money to states, representing an average of 44 percent of all federal revenue received. The transportation component is about $3 billion of that yearly fund transfer, making up less than 1 percent of total Medicaid expenditures. Though a small percentage of Medicaid overall, consistent transportation assistance to healthcare helps enhance the medical outcomes of Medicaid recipients and leads to cost-savings.

With more medical care provided on an outpatient basis, and an increasing number of people with enduring conditions,access to medical appointments are a key component of a sustainable healthcare system. Non-emergency medical transportation (NEMT) provides trips to and from scheduled procedural appointments, return trips from emergency clinics and transfers between hospitals for people without access to transportation. By providing reliable and efficient access to healthcare management appointments, states can save money by helping these individuals avoid expensive emergency medical transportation trips or emergency room visits.

Medicaid Expansion

Under the Affordable Care Act, the population of people eligible for Medicaid is expanding. Based on projections from the 25 states where coverage expansion is underway, it is estimated that 9 million people will be added to the Medicaid program; Medicaid and the Children’s Health Insurance Program (CHIP) have more than 6 million new enrollees as of April 30, 2014. Because the expansion includes people who are 133 percent of the federal poverty rate, they are expected to have relatively fewer NEMT transportation needs. A study from the Transportation Research Board estimates that only 270,000 new enrollees will require NEMT, which nevertheless could potentially strain systems in some states.

Providing Health Care Access

Non-emergency medical patient transportation is essential for disadvantaged Medicaid recipients, those who are older, or have disabilities or low incomes who have no means to get to access healthcare services.

Medicaid recipients who own a car or can provide their own transportation may receive travel service reimbursement for costs related to getting to their care, including gasoline, car maintenance or repair, cost of vehicle modifications for adaptive technologies and other financial stipends to support ongoing transportation needs. For those who are unable to provide their own transportation, because of income, age or disability, other methods of NEMT service delivery are necessary.

Growth of Chronic Conditions

Many people with ongoing conditions, which include arthritis, asthma, cancer, cardiovascular disease, chronic obstructive pulmonary disease and diabetes, need medical services frequently. Treatment of chronic conditions account for most of all U.S. healthcare spending. As of 2009, the Centers for Disease Control estimate that over 3/4ths of the adult population over 55 has at least one of these chronic conditions. Additionally, estimates are that state enrollment will add more than a half million adults who have serious behavioral health issues that impair their everyday functioning to the Medicaid population. These people will need NEMT to access life saving treatments and health maintenance services.

For the nearly 20 million adults with long term kidney disease who get dialysis three times a week, NEMT is a more than adequate solution to get to appointments and avoid going to the emergency room if appointments are missed. Sixty-six percent of dialysis patients rely on others for transportation to their treatments, only 8 percent used public transportation or taxi services, and 25.3 percent drove or walked to the clinic themselves.  A recent study examining Florida’s NEMT costs found that if 1 percent of total medical trips resulted in avoiding an emergency room visit, the state could save up to $11 for each dollar spent in non-emergency medical transportation.