By Marsha Simon, Ph.D.

Two days before the start of the new year, the Centers for Medicare and Medicaid Services sent a letter to Iowa’s Medicaid Director informing her that Iowa’s request to expand Medicaid by using federal funds (provided under the Affordable Care Act) to purchase private insurance was officially approved.  A little noticed piece of that approval was a one-year waiver of non-emergency medical transportation (NEMT) for new Medicaid beneficiaries in the expansion population.

The state requested a waiver of the requirement to offer NEMT services “in order to standardize the benefit package to participates”; presumably believing this standardization would reduce costs in the Medicaid program.

Now, other states “want what they have”.  Arkansas recently amended their original plan and is seeking to drop NEMT benefits and Pennsylvania has submitted a request to do the same.  Utah and Tennessee will likely be the next states applying for a waiver.

A new report, published by the Community Transportation Association of America, details how the decision to drop transportation benefits will lead to worse health outcomes, increased hospitalization, and more preventable deaths for a state’s sickest individuals.

Millions of chronically ill individuals rely on Medicaid-provided transportation to access behavioral health, substance abuse and dialysis services. If CMS approves these waiver requests, new beneficiaries will go without NEMT benefits even as evidence suggests they have a greater need for care because many have never had insurance and have untreated conditions.

Eliminating NEMT will shut out the chronically ill from life sustaining services and will increase future costs for state Medicaid programs through increased hospitalizations and overuse of expensive ambulance services.

Marsha Simon is President of Simon and Company and co-author of “Medicaid’s Medical Transportation Assurance: Origins, Evolution, Current Trends, and Implications for Health Reform“.