Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination (2018) / Chapter Skim
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Pages 13-22
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13 Medicaid is a joint federal and state program that provides health coverage for individuals and families with limited income and resources. Understanding NEMT starts with learning about Medicaid.
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14 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination to eligible persons. The federal and state expenditures for Medicaid in FY 2015 were $334 billion and $198 billion, respectively, for total federal and state expenditures of $532 billion (8)
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Medicaid 15 What Do I Need to Understand About Medicaid? In the Medicaid program, NEMT is a benefit for eligible Medicaid beneficiaries who need transportation to an authorized medical service.
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16 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Minimum Federal Requirements for Medicaid While Title XIX of the Social Security Act gives states considerable discretion over Medicaid program administration and design, the law establishes a series of federal requirements that participating states must satisfy. Each state must have a state Medicaid plan that meets the following: • Statewide availability.
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Medicaid 17 expense, NEMT is subject to additional federal guidelines, including statewideness, comparability, and freedom of choice of providers. Reimbursement for NEMT as an administrative expense caps the federal match at 50 percent, like other administrative expenses.
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18 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination • Fee for service. Under the fee-for-service method, providers (doctors, hospitals, and other service providers such as NEMT)
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Medicaid 19 States Have the Option to Expand Eligibility The ACA created the opportunity for states to expand Medicaid to cover nearly all lowincome Americans under age 65. Eligibility for children was extended to at least 133 percent of the federal poverty level (FPL)
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20 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Source: Center for Medicaid and CHIP Services, Data as of December 2016. Note: Data represent 48 states and the District of Columbia.
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Medicaid 21 Impacts of ACA Expanded Eligibility The comparisons illustrated in Figure 6 show the important impacts of ACA expansion: • Prior to ACA, implemented in 2014, about 57 million Americans were enrolled in the Medicaid programs in the 48 states that reported relevant data and the District of Columbia -- 18 percent of the population. Connecticut and Maine are not included because they did not report pre-ACA data to CMS (10)
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From page 22... ...
22 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Summary Understanding NEMT starts with learning about Medicaid. Medicaid is a shared federalstate program.
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