NEMT (Non-Emergency Medical Transportation)
NEMT, or non-emergency medical transportation, is the Medicaid benefit that gets eligible people to and from covered medical care when they have no other way to travel. Federal rules require each state Medicaid agency to ensure necessary transportation, and states arrange it directly, through a broker or through managed care plans.
Key takeaways
- A Medicaid benefit for planned rides to covered care, not an emergency response
- 42 CFR 431.53 requires each state to ensure necessary transportation
- States arrange rides directly, through a broker or through managed care plans
- Levels of service include ambulatory, wheelchair and stretcher trips
- Each trip needs a record that proves eligibility, the ride and the level of service
What NEMT means
The federal basis is short. A state plan must say that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers, and describe how it will do so. Covered transportation includes related travel costs, such as meals, lodging and an attendant when one is needed.
Who arranges the ride varies by state. Some agencies schedule trips themselves, others contract a broker chosen through competitive bidding, and some fold NEMT into managed care contracts so the health plan arranges it. Transportation providers then run the trips: taxi and van companies, wheelchair van operators and stretcher services.
Agnotic Technologies builds trip intake, scheduling and billing software for NEMT providers, brokers and health plans. Choosing a platform and designing dispatch are covered on our NEMT buyer's guide and dispatch software pages.
How does an NEMT trip move from request to payment?
Every trip follows the same path, whoever arranges it. Each step leaves a record the next one depends on.
- Request: the member or clinic asks for a ride, giving the appointment, address and any mobility needs.
- Eligibility: the broker, plan or agency checks Medicaid enrollment and that the appointment is for covered care.
- Scheduling: the trip goes to a provider and vehicle that match the level of service.
- Pickup and drop-off: the driver records times and locations, or a no-show or cancellation.
- Proof of service: the trip record is closed with a signature or electronic confirmation.
- Billing: the provider bills the broker, plan or state, using the trip record as evidence.
How is NEMT different from emergency ambulance transport?
Emergency transport responds to a medical emergency. NEMT is planned travel to scheduled care, such as dialysis, therapy or a clinic visit. An NEMT trip can still use a stretcher van or an ambulance when the person's condition requires it, but it is booked in advance, not dispatched to an emergency.
Which levels of service does NEMT use?
State contracts name and define these levels in their own terms, so check each contract. The broad split looks like this.
| Level of service | Vehicle | Attendant | What the trip record must carry |
|---|---|---|---|
| Ambulatory | Sedan, taxi or van | Not usually; an approved escort may ride along | Pickup and drop-off times and addresses, mileage and member confirmation |
| Wheelchair | Wheelchair-accessible van with a lift or ramp | Driver trained to secure the wheelchair | The ambulatory fields plus the mobility device and how it was secured |
| Stretcher | Stretcher van or ambulance | Often a second crew member | The wheelchair fields plus the reason a stretcher was needed and the crew on board |
Facts and primary sources
A state Medicaid plan must specify that the agency will ensure necessary transportation for beneficiaries to and from providers, and describe the methods it will use.
Source: eCFR, 42 CFR 431.53Medicaid transportation includes travel expenses the agency finds necessary to secure medical examinations and treatment, including ambulance, taxicab or common carrier costs, meals and lodging, and an attendant when necessary.
Source: eCFR, 42 CFR 440.170A state may run an NEMT brokerage program covering wheelchair vans, taxis, stretcher cars, bus passes and tickets, and secured transportation for people who need access to medical care and have no other means of transportation.
Source: eCFR, 42 CFR 440.170(a)(4)An NEMT broker must be selected through competitive bidding and have oversight procedures to monitor member access and complaints and ensure transportation is timely.
Source: eCFR, 42 CFR 440.170(a)(4)
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