The George Washington University School of Public Health and Health Services department of health policy’s Center for Health Policy Research, released a policy brief that examines Medicaid’s non-emergency medical transportation assurance and the role played by the assurance as policymakers debate national health reform. The brief reviews the origins and evolution of the assurance and presents the results of a 2009 survey of state Medicaid programs regarding the current state of Medicaid transportation.

"The results of our analysis underscore Medicaid’s unique capacity to pay for both medical care and the services and make health care a reality for the poor and underserved," said Ms. Sara Rosenbaum, a report co-author and chair of the department of health policy. "Our findings underscore Medicaid’s importance as a health reform building block."

Among the brief’s key findings:

• While non-emergency medical transportation represented one percent of total Medicaid spending in FY 2006 (slightly more than $3 billion), Medicaid expenditures for transportation make the program the second largest federal funder of public transportation, behind only programs administered by the United State Department of Transportation. As such, Medicaid-funding is crucial to the availability of medical transportation services for receipt of medically necessary health care.
• The assurance of medical transportation is one of several basic program features that set Medicaid apart from traditional concepts of health insurance. The non-emergency transportation assurance has been part of Medicaid since its enactment and is one of the features that sets Medicaid apart from traditional health insurance for the poor.
• As of 2009, nearly all states recognize non-emergency medical transportation as a fundamental program component, but three states, have eliminated non-emergency transportation, as part of their "benefit flexibility" programs under the Deficit Reduction Act (DRA). An important issue in this regard is the recent proposal from the federal Centers for Medicare and Medicaid Services (CMS) to reconsider 2008 regulations permitting the elimination of non-emergency transportation option, as well as changes to the state benefit flexibility option that were enacted by Congress in 2009 as part of CHIPRA.

The DRA also permits states to use transportation brokers, and state use of brokers has grown by 18 percent since the Act’s passage in 2006.

"No outpatient strategy for Medicaid can possibly be effective without good transportation for its patients and this study provides a valuable analysis of how recent legislation has affected state implementation of the benefit," said Mr. Dale Marsico, executive director of the Community Transportation Association of America (CTAA).

"This analysis highlights the importance of protecting Non-Emergency Medical Transportation for Medicaid beneficiaries by enacting what, up until this point, has been a regulation and not part of permanent law.

Access is an essential part of enabling the poorest amongst us to receive quality healthcare and I will continue to fight to make sure this access is not denied," said U.S. Representative John Olver (D-MA).

"Medicaid’s Medical Transportation Assurance: Origins, Evolution, Current Trends and Implications for Health Reform" is available here.