One of the starkest daily reminders of the COVID-19 public health emergency has been less traffic on the road. As the public follows stay-at-home orders, road-rage inducing traffic jams have suddenly become a non-issue. With many – but not all – able to work from home, public transportation buses and trains have become hollowed vessels, occupied by only a few brave souls and a transit employee.
With less traffic, both literally and figuratively, public health systems have been able to move at unprecedented speed to save lives during the most challenging global health crisis of a lifetime. The response efforts are evolving daily to meet the myriad needs of Americans affected by the virus.
Despite the news of states reopening, COVID-19 has had devastating impacts on the overall economy and population health in ways that will take years or even decades to overcome. Growing numbers of people are unemployed, under or uninsured or unable to pay for health care. Consequently, our largest safety net programs for coverage and care, Medicaid and Community Health Centers (“health centers”), have been under enormous and mounting pressure to fulfill their critically important roles in the response to the public health emergency.
Medicaid provides health and long-term care coverage for over 70 million adults and children, or 1 in 5 Americans. States and the federal government fund the program jointly. Health centers serve as the primary care safety net for over 29 million adults and children, including 1 in 5 of Medicaid beneficiaries. By mission and mandate, they provide health care and enabling services to individuals regardless of their ability to pay. Medicaid financing ensures that health centers are able to provide high-quality care to vulnerable populations, including a state’s Medicaid enrollees.
The Medicaid and health center programs have been partners at the forefront of addressing population health needs for well over 50 years. While testing, contact tracing and other hot topics are top of mind right now, in this time of crisis, there are other vital Medicaid services that are both available right now and ripe for enhancement to ensure the accessibility of services during and after the COVID-19 emergency. A primary example is non-emergency medical transportation (NEMT).
What is Non-Emergency Medical Transportation (NEMT)?
During the COVID-19 emergency, lack of transportation frustratingly reemerged as a barrier to care for low-income Americans. When the pandemic struck, patients lost their personal vehicles due to financial difficulties. Many others avoided the risks of ride-sharing or public transit options, which have also been substantially reduced. Finally, technology barriers make the use of telehealth especially challenging. Taken together, health centers were among the many providers to experience a steep decline in patient visits
Fortunately, the Medicaid program has long recognized lack of transportation as a barrier, which is why state Medicaid agencies are required to ensure necessary transportation to and from providers via NEMT. In addition to providing the benefit, states must describe how they will deliver the NEMT benefit in their Medicaid state plan. Some states choose to deliver NEMT directly, while others may deliver the benefits through a broker program or under contract with individuals or entities.
Ways to Enhance the Medicaid NEMT Benefit
Coverage is complex and access to care is highly susceptible to one’s comprehension of the coverage labyrinth. The Medicaid NEMT benefit is often overlooked despite its demonstrable need and proven value. Some practical steps that health centers can take to help ensure the availability of NEMT services, working with their partners at state Primary Care Associations (PCAs) and Health Center Controlled Networks (HCCNs), include:
- Reviewing the Medicaid state plan to understand how your state makes operational the NEMT assurance requirement
- Obtaining written guidance from the state on how Medicaid beneficiaries can access NEMT
- Sharing up-to-date information about the Medicaid NEMT benefit on your FQHC website and ensure that outreach and enabling services staff are equipped with and sharing that information
- Working cooperatively with your state Medicaid agency to resolve NEMT access issues for FQHC users
- Monitoring state proposals to waive NEMT through 1115 waiver demonstrations, and section 1135 COVID Emergency state plan amendments
- Working with your state to determine NEMT flexibilities it would be willing to offer through an 1115(a) waiver demonstration and/or section 1135 Medicaid Disaster Relief for the COVID-19 National Emergency State Plan Amendment
Forge Ahead with Existing Tools and Space for Innovation
As safety net programs and providers continue to step up to address the mounting challenges before us, it is critical that we first ensure existing tools are fully maximized, such as NEMT. NACHC has developed guidance and materials to help health centers, PCAs, and HCCNs understand the Medicaid authorities for vital services as well as strategies to ensure the continued, if not enhanced, availability of those services during the COVID emergency.
To learn more about other important Medicaid services (e.g., dental services, pediatric vaccination, or maternal health) and options for obtaining enhanced payments during and after the COVID-19 emergency, reach out to NACHC State Affairs at firstname.lastname@example.org.
Mary Cieslicki, MHS, contributed to this article.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00 with 0% of the total NCA project financed with non-federal sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.