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Assurance of Transportation

Featured Resources

Assurance of Transportation: A Medicaid Transportation Coverage Guide (SMD 23-006)   (PDF, 284 KB)

Initial Non-Emergency Medical Transportation Report to Congress, 2022 (PDF, 5.8 MB)

Expanded Non-Emergency Medical Transportation Report to Congress, 2023 (PDF, 13KB)

Longstanding federal regulations require state Medicaid agencies to specify in the state plan that they will assure necessary transportation for clients to and from providers and describe the methods that the agency will use to meet this requirement. Division CC, Title II, Section 209(a)(4) of Consolidated Appropriations Act, 2021 (Section 209), adds the assurance of transportation to Medicaid statute; and limits Federal Financial Participation (FFP) for non-emergency medical transportation (NEMT) expenditures unless the state plan provides for methods and procedures that ensure payment for such services is consistent with efficiency, economy, and quality of care. Medicaid agencies are also required to offer and provide recipients of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services with necessary assistance with transportation. States may pay for transportation services as an administrative expense or as an optional service. Many states combine the two methods in order to provide maximum access.

Medicaid Transportation Coverage Guide

CMS issued guidance in the form of a State Medicaid Director Letter (SMD 23-006) that introduces the Medicaid Transportation Coverage Guide. This guidance serves as a consolidated and comprehensive compilation of Medicaid transportation policy, providing a one-stop source of federal requirements and state flexibilities.  

The Medicaid Transportation Coverage Guide includes new policies to help bolster access to necessary transportation services, including when beneficiaries may encounter extended wait times and long-distance trips. Medicaid transportation is a critical service that assists beneficiaries with accessing covered Medicaid services and has a direct impact on health outcomes. CMS encourages states to use this guide as an aid when developing and updating policies and procedures that facilitate robust transportation programs.

Minimum Requirements for Drivers – Section 209

Section 209 also adds a NEMT provider and driver requirement. Specifically, Section 209 added Section 1902(a)(87) of the Social Security Act (SSA) requiring the Medicaid state plan to provide for a mechanism which may include an attestation that ensures any provider including transportation network companies and individual drivers meet specific minimum requirements. Those minimum requirements are assurances that:

  1. Each provider or individual driver is not excluded from participation in any federal health care program (as defined in section 1128B(f) of the Act) and is not listed on the exclusion list of the Inspector General of the U.S. Department of Health and Human Services;
  2. Each individual driver has a valid driver’s license;
  3. Each provider has in place a process to address any violation of a state drug law; and,
  4. Each provider has in place a process to disclose to the state Medicaid program the driving history, including any traffic violations of each individual driver employed by the provider.

Congress also made corresponding amendments to section 1937(a)(1) of the SSA, adding a new paragraph (F) applying substantially the same assurance of transportation requirements for benchmark and benchmark equivalent coverage, also known as Alternative Benefit Plans (ABPs). Prior to this amendment, the assurance of transportation in ABPs was required by regulation under 42 CFR § 440.390, which references the state plan assurance of transportation requirement in 42 CFR § 431.53.

NEMT Initial and Expanded Reports to Congress

Under Section 209(b)(5), CMS was required to issue a Medicaid Non-Emergency Transportation Report to Congress.

In June 2022, an initial Medicaid Non-Emergency Medical Transportation (NEMT) Report to Congress provides state- and national-level information on the number of Medicaid beneficiaries who used Medicaid NEMT overall and among different beneficiary subgroups, as well as the types of services they accessed using NEMT.  The report examines T-MSIS data for calendar years 2018 through 2020 where states cover such services as a medical service expenditure.

In July 2023, a second, expanded Medicaid Non-Emergency Medical Transportation in Medicaid, 2018–2021 Report to Congress provides T-MSIS data for an additional calendar year (through 2021). The report also includes an extensive analysis of Medicaid coverage of NEMT such as the types of medical services accessed when using NEMT by beneficiary subgroup, monthly trends in the use of NEMT versus telehealth services, and a comparison by delivery model of the volume of NEMT services used by states.

Stakeholder Listening Sessions

As required by Section 209, CMS held a series of stakeholder meetings to obtain input and shared learning about the leading practices for improving Medicaid program integrity for NEMT. Sessions were focused on the expertise and perspectives offered by the stakeholder group. A link to the recording and transcript of each of these sessions is provided below.

Section 209 Stakeholder Listening Sessions