NEMT Focus Groups – What You Need to Know

It's a fact - every day, hundreds of thousands of Medicaid beneficiaries across the US greatly rely on Non-Emergency Medical Transportation (NEMT). In the absence of other affordable options to access necessary medical care, NEMT is literally a lifesaving benefit for those with low incomes, those seeking preventive services, and those with disabilities and chronic conditions that require regular care.

Recent changes to non-emergency medical transportation (NEMT) requirements via administrative action, have rendered NEMT a mandatory benefit. This is a huge win for the American people! Under this action, states are required to provide NEMT and use the most appropriate form of transportation. The scope of benefit varies by state, but generally covers a broad range of NEMT services through one or more approaches:

• Fee for service (FFS)
• Third party broker
• Medicaid managed care

Nothing Tops Firsthand Experience

To understand the tremendous value of the Medicaid Non-Emergency Medical Transportation (NEMT) benefit to its recipients, Medicaid and CHIP Payment and Access Commission (MACPAC) recently commissioned eight online video focus groups with Medicaid enrollees who are also registered in the NonEmergency Medical Transportation (NEMT) benefit. MACPAC shared their findings in a recent report and here are some high-level results;

Taking a "Before and After NEMT" approach to the focus groups, Medicaid and MACPAC uncovered a heap of obstacles faced by individuals prior to receiving NEMT benefits. They also learned how truly important and often life-saving the benefit is to its recipients.

Before NEMT

Prior to enrolling, research participants reported a variety of transportation barriers to accessing the care they needed:

• Many did not have a car or a driver’s license
• Some were unable to drive or use public transportation due to their medical conditions
• Some required a specialty vehicle such as a wheelchair van
• Many said they could not afford the cost of transportation. This was a particular issue for those living in rural areas and for those in need of frequent transportation to reoccurring appointments (e.g., dialysis, etc.)
• Public transportation was not available or took too long for some
• Participants did not have, or they could not rely on, friends or family to drive them to appointments, or they felt the burden was too great on their loved ones

NEMT In Motion

Across the country, NEMT benefit recipients cited real examples of how they used the transportation service to get the care they need:

• A Georgia woman with quadriplegia used NEMT to go to a spinal care center three days a week. This therapy was critical to maintaining her strength and mental health
• An Arizona man, who was left with a broken femur and hip, among other injuries, following a car accident, used NEMT for physical and occupational therapy to help his mobility recover
• An Indiana woman who has cirrhosis of the liver, neuropathy, and degenerative discs – which has reduced her walking ability – attended physical therapy two to three times a week and other specialists a few times a year
• A Massachusetts woman with ESRD signed up for NEMT when she broke her hip and couldn’t drive herself to dialysis anymore
• A Massachusetts man with SUD used NEMT to go to a methadone clinic seven days a week to assist his ongoing recovery from addiction
• An Arizona mother of a child with autism used NEMT regularly to take her daughter to see developmental specialists. Her daughter also participated in a respite and living skills program that arranged transportation funded by NEMT

The True Value of NEMT

The value of NEMT and the list of benefits to its participants is lengthy. Categorically, the positive aspects of NEMT for its participants can be best summed up in three (3) ways:   

1. It helped them manage their physical health and chronic conditions.
2. It improved the emotional health of those with disabilities or physical limitations.
3. It gave more independence to participants, lessening their reliance on family members.

Many participants, particularly those with serious conditions like ESRD, felt that their continued and regular access to treatments and medical services was lifesaving. Some participants told stories of missing appointments and not being able receive necessary treatment. Many felt their health was worse before NEMT because conditions were unchecked and not managed while others remarked that NEMT added greatly to their quality of life because it helped them maintain their health, improve their mobility, and generally helped them to function and get through the day.

Emotionally, NEMT helped those who might otherwise feel isolated or trapped in their homes. Several participants accounted how NEMT allowed access to mental health or substance use disorder services that were vital for their daily lives. One participant shared that when she was depressed and anxious, just leaving her home and getting on public transportation was too stressful. NEMT was the only solution for her mobility and her sanity!

Just as important to many participants was the freedom the NEMT services provided them. No longer reliant on family members to get them to and from appointments, they felt a sense of independence and being able to control their own lives, which mattered immensely to them. And for some, particularly those with mobility challenges, they appreciated NEMT simply because it enabled them to “get out of the house” and continue with some normalcy to their lives.

Always Room for Improvement

While overall positive about NEMT, not all beneficiaries had consistently glowing experiences. Here are a few examples of bad vibes:

• Drivers arrived too early, too late, or not at all. Some blamed drivers, others blamed dispatch
• Some experienced customer service deficiencies, including rude or unprofessional drivers or call center representatives
• There was a feeling that there was little recourse to hold drivers or transportation companies accountable when there were problems
• Some felt NEMT policies were not practical or fair. Specifically: Policies that required them to share rides or use public transportation even when doing so was not practical; Policies that required them to schedule rides three days in advance; and policies that precluded parents from bringing their children along in rides

Peace of Mind

The results of the online focus groups are telling. While the benefits of NEMT far outweigh any negative experiences, the most impactful revelation came from participants explaining what it would mean to them if they lost NEMT. Many had an emotional response at the thought of losing NEMT and the biggest fear was that they would regress, and their health would deteriorate. Some felt they might even die, while others said there would be mental health consequences.

Aside from sense of independence and the financial relief that NEMT afforded its beneficiaries, the greatest gift of all is the peace of mind NEMT services provides.