2. Transportation NC Medicaid should offer ridesharing as a form of NonEmergency Medical Transportation (NEMT). Implementation: • NC Medicaid should apply for CMS approval to require or incentivize PHPs to offer ridesharing as a form of NEMT by partnering with companies like Uber or Lyft. • NC Medicaid should offer competitive grants for PHPs to innovate in the NEMT market to provide expanded transportation options, specifically for rural enrollees where ridesharing-based NEMT is not a viable option.
NC Medicaid should provide NEMT tailored to the needs of pregnant and postpartum women. Implementation: • NC Medicaid should require PHPs and NEMT brokers to allow enrollees to bring their children, and possibly an adult attendant if needed, to their appointments in all cases. North Carolina Context
Effective NEMT is critical for enrollees to access either SCD treatment or pregnancy-related care. In North Carolina, Medicaid covers transportation to appointments using personal vehicles, taxis, vans, mini-buses, mountain area transports, and public transportation. Since the transition to managed care, PHPs have each operated their own NEMT systems by contracting with brokers (including Modivcare and OneCall). PHPs may choose to offer additional transportation services, but they are not required or incentivized to do so. Healthy Blue offers all enrollees a $20 Uber gift
card each year.109 Complete Care provides $75 in annual “healthy rewards gift cards,” which can be used for transportation among other uses.110 Currently, all PHPs guarantee that enrollees who use NEMT will not have to arrive at their appointment more than one hour early and will not have to wait more than one hour after their appointment is done to leave.111 However, there are no limits on the amount of time transportation itself will take, as vehicle may pick up and drop off many other enrollees along the way. All PHPs guarantee enrollees that they will be informed about who is allowed to accompany them on NEMT without cost. PHPs allow caretakers and guardians to accompany enrolled children to their appointments. However, PHPs do not include any guarantee or guidance in their contracts, member handbooks, or other enrollee resources explaining their policy on children accompanying their parent to appointments for their parent’s care.112 In interviews, stakeholders reported that many enrollees do not view the current NEMT system as meeting their needs. In particular, enrollees struggle with the long wait times as their NEMT vehicle makes several stops to pick up other enrollees. Further, they often assume or are informed by the NEMT broker or driver that they cannot bring their children on NEMT if the medical appointment is for the parent’s care. This is particularly a problem for women who are breastfeeding, people with unpredictable and inflexible work schedules, and people who do not have stable child care. A MACPAC focus group of Medicaid enrollees across the U.S. also found that “late pickups and driver no-shows are the primary reasons for complaints from [enrollees], providers, and care managers.”113 All of these issues can result in enrollees missing scheduled appointments. One of our interviewees noted that if the “no-show” rate becomes a major problem, some providers become reluctant to see Medicaid patients. This can further reduce access to necessary care.
30 Part I. Recommendations to Improve Both Sickle Cell Disease and Maternal Health Outcomes
