For many elderly, disabled, or low-income people, non-emergency medical transportation (NEMT) is a necessity. Since these individuals can’t drive themselves and don’t have another reliable way to get around, they depend on NEMT to get to and from doctors appointments, hospitals, pharmacies, and more. Without proper transportation, these groups would quickly see worsening symptoms and conditions and would likely go without treatment. Federal Medicaid regulations make sure that this doesn’t happen. So how much does Medicaid pay for NEMT?
Medicaid Payment Policy
From Colorado and Illinois to Virginia, Medicaid coverage is different in every state. As a general rule, there are two ways states can choose to claim Medicaid payments. If a state reports their NEMT spending as an administrative expense, they’ll receive payment at the federal medical assistance percentage (FMAP), which is 50%. If a state claims the service as a medical assistance expense, they’ll receive payment at their regular FMAP, which ranges from 50%-76.98% as of 2020, according to MACPAC. Although some patients may still find themselves struggling to pay for their transportation services, it’s important to remember that prices vary from one NEMT provider to another. If one is charging more than a patient’s budget allows, there’s likely another one around that will be a better fit.
Covered Services and Delivery Methods
Now that you have an idea of how much Medicaid pays for transportation reimbursement, what services are covered? Once again, coverage can vary from state to state. Transportation by taxi, wheelchair van, private vehicle, and public transportation are typically covered under the NEMT Medicaid benefit. The trip will almost always be covered as long as the transportation is necessary and the patient didn’t have another way to get to their appointment (if a person doesn’t have a driver’s license or is physically or intellectually disabled, they would fall under this category).
It’s up to the state to determine which models they use to deliver NEMT services. In order to meet the needs of different patients in varying geographic areas, states usually use a combination of the following models:
- Paying for NEMT on a fee-for-service (FFS) basis
- Contracting with managed care plans to provide NEMT and other services
- Arranging for transportation brokers to manage the benefit
Most states use brokers to provide NEMT services. Brokers can best be described as the liaison between patient and provider. Patients or healthcare centers get in touch with brokers when they have a trip request, and the broker works to schedule that trip. Often, patients want to schedule more than one trip at a time, usually recurring ones. The broker is responsible for verifying patient eligibility and getting in contact with an NEMT company that can complete the trips.
While NEMT companies use Medicaid billing software to send claims to the payer, brokers rely on NEMT software to seamlessly schedule patients at the right time, on the best routes, in the vehicle most suitable for them. Some patients may need wheelchairs, walkers, or even gurneys, so it’s crucial to make sure the vehicles arrive with all the necessary equipment. Brokers are even able to calculate trip cost and timing, making it simpler for both the patient and the provider at the end of the trip.
Many factors affect NEMT rates including the type of patient, location, length of trip, time of day, and required assistance. That being said, the chart below will give you a general idea of how much you’ll pay for an NEMT trip, depending on a number of factors. These prices are based on the average cost of NEMT trips across the country, so you may pay slightly more or less based on where you are.
|Kind of charge||Weekday fee||Off-hours/weekends fee||Holiday fee|
|Base fee – ambulatory patient||25$ – 30$||30$ – 40$||35$ – 45$|
|Base fee – wheelchair||45$ – 50$||75$ – 90$||85$ – 100$|
|Base fee – gurneys||100$ – 200$||125$ – 225$||150$ – 250$|
|Additional fee for mileage||3$ – 5$ per mile||5$ – 7$ per mile||5$ – 10$ per mile|
|Wait-time fee per 30 min.||15$ – 30$||15$ – 30$||15$ – 30$|
|Additional attendant fee||5$ – 10$||5$- 10$||5$ – 10$|
These prices will give you a rough idea of what you can expect to pay per trip. It’s important to keep in mind that NEMT providers will choose their own unique prices based on geographic location, other competitors in the area, and how much business they conduct.
NEMT services are widely used, and they’re only becoming more popular. As U.S. citizens continue to age, more people require assistance traveling to and from medical appointments. Since people inevitably keep growing older, NEMT services will always be necessary—and will likely become even more widely used in years to come. That’s why it’s so important that both the federal and state governments continue offering aid for this life-enhancing service. At the same time, the right medical insurance billing software will eliminate the paperwork and allow NEMT companies to be more productive and complete more trips, thus helping more people to timely get their medical treatment.