Examining the Effects of Separate Non-Emergency Medical Transportation (NEMT) Brokerages on Transportation Coordination

Federal transportation policy calls for coordination of public transportation with human services transportation to avoid duplicative and overlapping services and to achieve cost savings for all federally funded programs. The Medicaid program is the largest federal program for human services transportation, spending approximately $3 billion annually on non-emergency medical transportation (NEMT). The successful coordination of transportation services is affected by the extent to which resources for NEMT are coordinated with and complement public transportation and other human services transportation programs. Because the Medicaid program is administered by states, which are able to set their own rules, within federal regulations and guidelines set by the Centers for Medicare and Medicaid Services (CMS), coordination of NEMT with public transit and human services transportation is highly dependent on each state Medicaid agency’s policies and priorities. Over the past decade, many states have made significant progress coordinating NEMT with other federally funded transportation services, most often by allowing local or regional transportation providers to coordinate NEMT trips with numerous other trip types. This approach results in transportation resources and costs being shared across multiple programs and transportation providers. Medicaid NEMT presents both opportunities and challenges for public transit and human services transportation providers wishing to coordinate more closely the various trips being provided in their service areas. The most frequently cited examples of coordination typically involve NEMT, Americans with Disabilities Act (ADA) paratransit (provided by public transit agencies), and human services trips coordinated on a local or regional basis. In recent years, numerous state Medicaid programs have separated their transportation services from local or regionally coordinated transportation systems in order to create a statewide or regional brokerage for all NEMT trips. This approach is often pursued for cost savings, fraud deterrence, and/or administrative efficiency. Transportation coordination and mobility management professionals have expressed concerns about this trend, saying that it leads to less coordination, more service duplication, loss of local revenue for transportation providers, trip shifting, and challenges for transportation of disadvantaged people who may be required to book trips through multiple systems, depending on their type of trip. Most research conducted on NEMT brokerages has focused on the impacts on the specific Medicaid program and agency. Meanwhile, the broader fiscal, coordination, and customer service effects of statewide Medicaid NEMT brokerages have not been fully studied. As more states consider the statewide or regional brokerage options for NEMT, it is important to determine (1) what the larger outcomes are for human services transportation and public transit, (2) what motivates states to establish separate NEMT brokerages, and (3) what the actual costs and benefits are. The objectives of this research are to present options for providing Medicaid-funded NEMT services and evaluate the effects of different options for providing NEMT on: (1) access to Medicaid services; (2) human services transportation (in particular, coordinated transportation services); and (3) public transit services, including ADA complementary paratransit services. The key audiences for this research include state-level policymakers and program administrators and other stakeholders affected by the different options for providing NEMT services.


  • English


  • Status: Completed
  • Funding: $300000
  • Contract Numbers:

    Project B-44

  • Sponsor Organizations:

    Federal Transit Administration

    1200 New Jersey Avenue, SE
    Washington, DC  United States  20590

    Transit Cooperative Research Program

    Transportation Research Board
    500 Fifth Street, NW
    Washington, DC    20001
  • Project Managers:

    Schwager, Dianne

  • Performing Organizations:

    Texas A&M Transportation Institute, College Station

    Texas A&M University System
    3135 TAMU
    College Station, TX  United States  77843-3135
  • Principal Investigators:

    Edrington, Suzie

    Cherrington, Linda

  • Start Date: 20140110
  • Expected Completion Date: 20180601
  • Actual Completion Date: 20180601
  • Source Data: RiP Project 38195

Subject/Index Terms

Filing Info

  • Accession Number: 01547340
  • Record Type: Research project
  • Source Agency: Transportation Research Board
  • Contract Numbers: Project B-44
  • Files: TRB, RiP
  • Created Date: Dec 6 2014 1:00AM