Non-Emergency Medical Transport

Non-emergency medical transportation facilitates access to healthcare services. 

Non-emergency medical transportation (NEMT) is a service for patients to get assistance to and from healthcare services (Centers for Medicaid Services (CMS) n.d.). NEMT can be used for visits with physicians, hospitals, outpatient facilities, or nursing facilities (MO Department of Social Services n.d., Medicaid and CHIP Payment and Access Commission (MACPAC) 2021). Based on Medicaid beneficiary data, the most common modes of transportation assistance are vans and taxis (MACPAC 2021). Access to NEMT services reduces the number of missed appointments, but there is not enough clear data on the impact of NEMT on patient outcomes and costs (Shekelle et al. 2022). 

State Medicaid programs support three different NEMT delivery models. 

Under Medicaid, states cover NEMT through three delivery models, with some states combining different models (Edrington et al. 2018; Figure 1): 

• Fee-for-service: In-house Medicaid providers are paid for each service they perform 

• Managed care plans: Medicaid contracts with a third-party health insurance plan to provide services 

• Transportation broker: Medicaid contracts with a third-party broker that connects beneficiaries with transportation services 

 Six states use fee-for-service, 10 states use managed care plans, 21 states use transportation brokers, and 12 states use a mix of delivery models (National Conference of State Legislatures (NCSL) 2023). 

 States also receive federal support for NEMT coordination. Through the Coordinating Council on Access and Mobility (CCAM), the Federal Transit Administration works to improve access to all transportation services, including NEMT, for people in need. As part of this effort, CCAM also funds programs that (CCAM 2021): 

• Create software to coordinate transportation demand response 

• Dispatch on-demand vehicles 

• Create transportation phone applications 

• Create NEMT scheduling software 

• Coordinate volunteer-based services for NEMT 

• Embed transportation networks into hospital discharge planning 

Figure 1. Medicaid NEMT delivery models in different states. NEMT delivery models include fee-for-service, managed care plans, transportation brokers (state or regional), or a mix of models. Statewide vs. regional brokers indicate whether the agency contracts a single broker for the whole state or multiple brokers for different regions. Figure adapted from NCSL (2023). 

Geographic factors and program rules can impact NEMT usability and efficacy. 

Although states cover NEMT through the three delivery models, on-the-ground implementation and use of services can vary based on several factors. Patients’ geographic locations, such as urban vs. rural areas, can impact how they use NEMT services. Urban areas have more transportation options than rural areas, making it easier for individuals to find transportation on short notice (MACPAC 2021). Additionally, it is more common to use public transportation for NEMT in urban areas, while taxis or mileage reimbursement for personal vehicles is more common in rural areas. 

Program rules and oversight affect NEMT usability (MACPAC 2021). Advance booking policies can limit NEMT usage for impromptu office visits or appointments that change at the last minute. Inability to bring children can impact NEMT usage by parents or guardians that do not have childcare. Some policies also make it difficult to change assigned drivers after negative experiences.  

 For Medicaid, the specific NEMT delivery model can also impact the level of regulatory oversight of the program (MACPAC 2021). For example, with the transportation broker model, the state agency may not have oversight for training or background checks of third-party drivers.  

 Technology such as GPS or transportation applications can be used as an oversight tool or to improve rider experiences (MACPAC 2021, Hains et al. 2011). These technologies can provide data on real-time information on pick-up and drop-off times and allow riders to more easily schedule NEMT services. Generally, the quality of communication, standardization of transport processes, and employee training can influence the time to treatment and quality of service for the patient (Hains et al. 2011). 

Literature Cited 

Centers for Medicaid Services (n.d.) Non-Emergency Medical Transportation. Accessed March 10, 2026. https://www.cms.gov/medicare/medicaid-coordination/states/non-emergency-medical-transportation. 

Coordinating Council on Access and Mobility (2021) Report to the President. Federal Transit Administration. https://www.transit.dot.gov/sites/fta.dot.gov/files/2020-09/CCAM-Report-to-the-President.pdf. 

Edrington S, Cherrington L, Burkhardt J, Raphael D, Collette PW (2018) State-by-state profiles for examining the effects of non-emergency medical transportation brokerages on transportation coordination.Medical Transportation Access Coalition. https://onlinepubs.trb.org/onlinepubs/tcrp/tcrp_rpt_202_companion.pdf. 

Hains IM, Marks A, Georgiou A, Westbrook JI (2011) Non-emergency patient transport: what are the quality and safety issues? A systematic review. International Journal for Quality in Health Care, 23(1): 68-75. https://academic.oup.com/intqhc/article-abstract/23/1/68/1798760. 

Medicaid and CHIP Payment and Access Commission (2021) Report to Congress on Medicaid and CHIP. https://www.macpac.gov/wp-content/uploads/2021/06/June-2021-Report-to-Congress-on-Medicaid-and-CHIP.pdf. 

Missouri Department of Social Services (n.d.) Non-Emergency Medical Transportation. Accessed March 10, 2026. https://mydss.mo.gov/mhd/transportation. 

National Conference of State Legislatures (2023) Nonemergency Medical Transportation (NEMT). https://www.ncsl.org/health/nonemergency-medical-transportation-nemt. 

Shekelle PG, Begashaw MM, Miake-Lye IM, Booth M, Myers B, Renda A (2022) Effect of interventions for non-emergent medical transportation: a systematic review and meta-analysis. BMC Public Health, 22: 799. https://link.springer.com/content/pdf/10.1186/s12889-022-13149-1.pdf.