In 2005 the Iowa Department of Human Services (DHS) received a federal Real Choices Systems Transformation Grant. The grant was designed to address a number of community living barriers for Medicaid members, including transportation. As a result, the Public Policy Center conducted a study titled Iowa Medicaid Non-Emergency Medical Transportation (NEMT) System Review and Options for Improvements. The study examined the adequacy of transportation options for Medicaid members, which had been identified as a major issue by health professionals, most notably in rural Iowa. The study also evaluated the feasibility of establishing a transportation brokerage to benefit Medicaid members in need of satisfactory transportation. The study tasks were: 1) the assessment of transportation needs 2) an inventory of available transportation services 3) a gap analysis, and 4) specification of the functional requirements for transportation brokerage services.
Participating Medicaid members were divided into three groups (adults with disabilities, those 65 years and older, and the remaining adult Medicaid members). They were also classified by geographical area (urban area with fixed route transit, urban area without fixed route transit, and rural area without fixed route transit). During the study, members were asked about their experiences with Medicaid-funded transportation. Some of the questions dealt with what transportation modes they used, whether they were reimbursed for their expenses, whether they getting where they needed to go, and whether they and their case managers understood the Medicaid rules and benefits to which they were entitled. As a result of the study, the PPC learned that transportation services do not appear to be a major problem for most Medicaid members. Nearly 93 percent of the members as a whole stated they have not missed a medical service due to lack of transportation. However, that is not evenly distributed across geographic areas and across different sub-groups. The main concern is the limited knowledge Medicaid consumers have of the transportation rules and regulations. Medical care is missed because neither consumers nor transportation providers have a good understanding of the process for arranging rides. Medicaid members also expressed a high acceptance of the concept of a NEMT brokerage.
The main recommendation of the study is that it is feasible to create a transportation brokerage for NEMT through the new federal provisions under the 2005 Deficit Reduction Act. This brokerage system would replace the current system of reimbursing Medicaid members for transporting themselves and/or reimbursing providers for transporting individuals. The brokerage would be expected to 1) establish a network of transportation providers; 2) maintain a call center; 3) ensure compliance with Medicaid regulations related to eligibility of the individual and trip; 4) arrange and pay for the trips; and 5) monitor services and transportation providers for compliance and quality. In general, the estimated 21 states that have established brokerages have experienced an increase in the number of trips and a reduction in the cost per trip.