If you could spend $1 to get $11, would you? You might be inclined to scrape together $100,000 so that you could become a millionaire. Maybe even spend your $100,000 again.
Researchers working for the states of Arkansas and Florida have shown that spending $1 on Non-Emergency Medical Transportation (NEMT) saves each state more than $11 on medical expenses. These researchers say the same benefit exists everywhere NEMT is offered. In January, 2018, the Trump Administration provided guidance to state Medicaid directors expanding 1115 waivers, a process that can limit Medicaid benefits or tie those benefits to work requirements. It has gotten easier for states to remove NEMT benefits. Some have done so.
NEMT is a benefit available to Medicaid recipients in 48 states. Iowa and Indiana have gotten waivers. Other states may follow. The analogy of spending a dollar to get eleven doesn’t work very well. When state Medicaid directors look at their overall Medicaid budgets, they want to cut expenses. Their field of expertise is medical care. A car is the last thing they put on before they leave home. Like most of us, when we think about getting from any here to any there, we think of traveling by car. We understand a lack of a car as a temporary thing, solved by getting a rental or loaner. Expecting people whose training and work involve the complexities of spending on medical care to understand, let alone think creatively about, transportation is expecting too much. NEMT is less than 2% of state Medicaid budgets. It is easy to cut.