Impact of the Affordable Care Act on Non-Emergency Medical Transportation (NEMT): Assessment for Transit Agencies

Abstract

This digest seeks to: (1) assess the potential impact on a state-by-state basis of implementing the Affordable Care Act (ACA) on the provision of non-emergency medical transportation (NEMT), and (2) gather information that can be used to inform the transit community on how public transit and NEMT providers have in the past and can in the future integrate or effectively use their respective resources and services. The authors conclude that analysis of any potential impact of the ACA on public transportation is hindered by events that have transpired since passage—in particular, a U.S. Supreme Court decision that created a scenario whereby states could reject Medicaid expansion. In those states that elect to not participate, it is anticipated that there will be little impact on existing NEMT services. Expansion in Medicaid in the participating states is estimated to generate 6.16 million newly eligible individuals. Based on the experience gleaned from waiver demonstration states documented in this synthesis, the newly eligible population is not as transit dependent as the traditional Medicaid population. Thus, it is projected that about 185,000 to 616,000 individuals in the newly eligible category will require NEMT. To meet this need, it is estimated that NEMT spending will need to increase by about $100 million per year (for the low estimate range). While the impacts on direct service delivery are projected to be modest, other institutional changes in the way states will be encouraged to use coordinated care approaches in the Medicaid program may result in infrastructure changes at the state and local level that will impact existing NEMT delivery models. Additionally, transportation providers must be aware of the intense pressure from all quarters to reduce costs in the Medicaid program, including transportation.