HMA Weekly Roundup

New HMA Report Provides Insights on Strengthening State Medicaid NEMT Contracts

This week, our In Focus section reviews insights from a new Health Management Associates (HMA) report, State Medicaid Non-Emergency Medical Transportation Contracts: Key Provisions, Standards, and Considerations. States are required to provide non-emergency medical transportation (NEMT) as part of their Medicaid programs, and NEMT can help improve health outcomes by reducing barriers to care, particularly for individuals with chronic conditions, disabilities, or living in rural areas.

States have considerable flexibility in the design and operation of their NEMT programs. As a result, states vary widely in their NEMT procurement and contract standards, metrics, reporting, and enforcement of requirements for NEMT brokers, managed care organizations (MCOs), and transportation providers.

This article reviews HMA’s analysis and identified strategies that states and their partners can adopt to enhance the quality and efficiency of their NEMT programs.

NEMT Landscape

Federal statute requires states to provide NEMT services to Medicaid enrollees who are without access to other transportation options to visit providers of medically necessary healthcare services. Though states must meet certain minimum federal requirements, they have flexibility to develop NEMT models that reflect local and regional dynamics and needs. States use different administrative models, including statewide brokers, regional brokers, and managed care carve-ins. ​Each model has unique strengths and challenges.

Figure 1 breaks down the models that states use for their NEMT programs.

Most states contract with NEMT brokers directly to manage the benefit or carve NEMT services into their contracts with Medicaid MCOs. MCOs with the NEMT benefit carved into their contracts usually subcontract with NEMT brokers, but some may also contract directly with transportation providers. Brokers manage call centers, ride scheduling, quality control, and build provider networks through agreements with local transportation providers. Some states manage NEMT in-house, and many states use a combination of approaches for different Medicaid populations.

Key Findings about NEMT Programs

HMA’s analysis of NEMT contracts, Requests for Proposals (RFPs), and programs across multiple states revealed the following:

• Critical Contract Elements: Stakeholders emphasized the importance of contract provisions that prioritize rider safety, robust network adequacy, reasonable call center metrics, and positive rider experiences.
• Challenges: Common issues include transportation provider shortages, late pickups, driver and rider no-shows, insufficient payment rates, and rider complaints. ​
• Technology Integration: States and brokers are increasingly leveraging technology, such as GPS tracking, mobile apps, vehicle cameras, and artificial intelligence (AI) to improve efficiency, program integrity, and rider experience. ​
• Program Integrity: Fraud, waste, and abuse remain concerns, particularly for mileage reimbursement (for Medicaid beneficiaries who drive themselves or have family/friends drive them to appointments) and high-utilization services (such as recurring trips to methadone clinics). States are implementing trip verification tools and other innovations to address these issues. ​
• Emerging Trends: States are expanding the use of transportation network companies (TNCs) like Uber and Lyft but acknowledge that guardrails for the use of TNCs for NEMT are needed. National standards for certain aspects of NEMT contracting and quality control in development.

Considerations for NEMT Procurements and Program Operations

State Medicaid agencies ultimately are responsible for providing their members with safe, timely, and efficient transportation. The HMA report identifies several areas for improvement and key considerations for states, including the need to balance standardized contract and program features with flexibility to innovate and respond to local needs. Leveraging contracts as a strategic tool, states may:

• Use standardized contract provisions to reduce administrative burden on NEMT brokers while tailoring requirements to state-specific needs, including urban and rural distinctions​
• Ensure adequate payment rates that enable brokers to maintain robust provider networks, including flexibility to offer higher rates for rural areas ​
• Define clear contract performance metrics and enforcement mechanisms that prioritize rider safety and on-time performance
• Educate beneficiaries about mileage reimbursement options, assist healthcare facilities with their own vehicles to participate in NEMT, and encourage brokers and MCOs to use creative solutions, such as TNCs and volunteer drivers, to address transportation provider shortages
• Use procurements to encourage or incentivize brokers to adopt innovative technologies like AI, reloadable debit cards for public transit fare, and member-facing apps to improve access, efficiency, and program integrity
• Strengthen collaboration among states, brokers, transportation providers, healthcare facilities, and Medicaid beneficiaries to address challenges and improve program outcomes

All Medicaid stakeholders, including states, MCOs, brokers, transportation and healthcare providers, beneficiary advocates, technology innovators, and other interested organizations, have critical roles in shaping Medicaid NEMT programs. NEMT stakeholders can:

• Stay informed about federal Medicaid policy developments shaping state approaches to the NEMT benefit
• Engage with state policymakers, particularly state Medicaid agency leaders, to understand their state and local landscapes
• Collaborate with other stakeholders to identify challenges and solutions
• Educate and advise policymakers and partners on the adoption of innovative technologies that enhance enforcement strategies, program efficiency, and integrity
• Support assessment of the impact of NEMT strategies and innovations on access, safety, timeliness, and cost-effectiveness

Connect with Us

HMA offers expertise in Medicaid policy, program design, and evaluation to help states and stakeholders optimize their NEMT programs and advance their organizations’ goals. Our experts support clients in design and development of programs and RFPs that balance standardization, flexibility, and state-specific needs.

Read the full report here. For more information about Medicaid NEMT program contact report authors Sharon Silow-Carroll, Carrie Rosenzweig, and Jacob Briscoe.

HMA Expert Take: Plan for Changes in the Digital Quality Landscape in Healthcare

Digital quality measures (dQM) are becoming a cornerstone of healthcare operations.  Propelled by federal initiatives and mandates, these measures are designed to enhance interoperability, transparency, and real-time data sharing. As healthcare organizations face increasing pressure to do more with fewer resources, digital innovation is becoming essential for driving efficiency and reducing administrative burden.

There is ongoing speculation about how the Trump Administration and Congress will approach digital healthcare transformation, particularly in areas like digital quality measurement.  Recent indicators suggest they will stay on this course, and perhaps even accelerate the adoption of digital quality measures.

As part of Centers for Medicare & Medicaid Services (CMS) initiatives to transition to a fully digital landscape, for example, the agency is planning to update Medicare’s quality measurement and interoperability programs to prioritize safety and outcomes.  Specifically, the fiscal year 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule includes a request for information (RFI) to gather comments on potential future quality measures, implementing Fast Healthcare Interoperability Resources® (FHIR®), modernizing health reporting, and reducing burden.

Health Management Associates (HMA), national digital healthcare experts, including, Ryan Howells and Cameron Graham, are actively focusing on this hot topic. In their HMA blog post they offer valuable insights and guidance to navigate this dynamic federal policy landscape.

Organizations that proactively adapt to these evolving mandates will be better positioned to improve patient outcomes, streamline operations, and remain leaders in this evolving market. Our experts can help your organization stay on top of compliance requirements and deadlines, as well as financial and legal risks. Our teams also are able to assess organizational readiness to succeed in this quickly changing healthcare landscape.

Get more insights here and learn more about HMA’s approach to dQM.

Senior Senate Finance Committee Staffer Joins Leavitt Partners

Leavitt Partners, an HMA Company, is pleased to announce that Conor Sheehey has joined the company’s team of health policy experts as a director, located in Washington, D.C.

Sheehey most recently served as senior health policy advisor to U.S. Senate Finance Committee Chair Mike Crapo (R-ID). In this role, he advised the Committee on a range of health care policy issues, including prescription drug pricing, telehealth, AI, provider coverage and reimbursement, fraud and abuse, medical devices, and Medicare Parts B and D. Sheehey led several bipartisan legislative efforts, including the development of comprehensive PBM reforms and bipartisan proposals on clinician payment reform and drug shortages.

Prior to his work at the Senate Finance Committee, Sheehey served as deputy legislative director for U.S. Senator Tim Scott (R-SC). Sheehey advised the Senator on all matters related to health care, education, workforce, human services, and retirement security policy before both the Senate Finance Committee and the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee.

Sheehey will advise clients throughout the health care sector on federal health care policy, strategy, and advocacy. He will also develop and manage multi-sector alliances.

“We are pleased to have Conor bring his deep Medicare expertise, bipartisan relationships, and creativity into the Leavitt Partners team,” said Josh Trent, chief executive officer, of Leavitt Partners. “Conor will hit the ground running to help clients across our enterprise who are seeking to navigate policy uncertainty and political processes to improve federal policy and health outcomes for millions of Americans.”

Sheehey joins a team of highly experienced, bipartisan health policy and government affairs consultants. The Leavitt Partners team includes former health policy directors and counsels of the U.S. Senate Budget Committee, the Senate HELP Committee, the U.S. House Energy and Commerce Committee, and other senior congressional staff. Leavitt Partners, founded by former HHS Secretary Michael O. Leavitt, features former senior political appointees in Democratic and Republican presidential administrations, leaders formerly serving in several U.S. Department of Health and Human Services (HHS) agencies, and former leaders in the nonprofit and corporate health sectors.