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Medicaid Coverage of Non-Emergency Medical …

May 2019 Advising Congress on Medicaid and CHIP Policy Medicaid Coverage of Non-Emergency Medical Transportation Lack of transportation can be a barrier to accessing health care, particularly for elderly, disabled, or low-income individuals. To address this concern, federal Medicaid regulations require that states ensure transportation to and from providers, a benefit known as Non-Emergency Medical transportation (NEMT).1 Although the scope of the benefit varies by state, NEMT generally covers a broad range of transportation services including trips in taxis, buses, vans, and personal vehicles belonging to beneficiaries and their family or friends. Recently, policymakers at the state and federal levels have begun to reexamine the use of the NEMT benefit.

States may limit the benefit based on medical necessity or utilization control (42 CFR 440.230(d)). For example, some states require prior authorization from the state for trips or place limits on the number of trips Medicaid will cover. For example, Indiana limits the benefit to 20 trips per 12 months (FSSA 2019). Others charge co-payments.

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