Low-Income Iowans Lose Transport Benefit

By Chelsea Keenan

Dec. 09--More than 140,000 low-income Iowans will continue to not have a service that provides rides to and from doctors' appointments, dialysis and other nonemergency medical services.

The Centers for Medicare and Medicaid Services in late November approved a waiver request from the state of Iowa that eliminated non-emergency medical transportation -- NEMT -- services for adults enrolled in the Iowa Health and Wellness Plan starting Jan. 1, 2017.

Iowa Department of Human Services spokeswoman Amy McCoy said the decision to eliminate that service was done in an effort to create a sustainable, efficient Medicaid program that offers quality medical, prescription and behavioral health services.

The state expanded its Medicaid program in 2014 to include those living in up to 138 percent of the federal poverty level -- about $16,242 a year for an individual.

That means Iowa now has more Medicaid beneficiaries than ever -- almost 600,000 -- but the budget has not kept up, McCoy said.

"More than one in five of the state's population is on Medicaid," she said. "We need to find ways to make the most medically necessary services available."

The waivers were created to aid in that challenge by allowing states flexibility when expanding Medicaid, according to consulting firm PwC, which follows Medicaid issues. Iowa and Indiana were granted approval, PwC said, which means seven states now limit covered transportation for beneficiaries.

Arizona still is waiting for waiver approval, PwC said.

In addition, McCoy said, studies have shown that eliminating transportation services doesn't impact the quality of care that Medicaid recipients receive.

But a February 2016 issue brief by the Kaiser Family Foundation pointed to several studies touting the benefits of NEMT. One estimated that at least 3.6 million people miss or delay medical care each year because they lack available or affordable transportation while another found that adults who lack transportation to medical care are more likely to have chronic health conditions that can escalate to a need for emergency care if not properly managed.

The three managed-care organizations providing services to the majority of the state's Medicaid population spent about $7.6 million from April through September on nonemergency transportation costs for those in traditional Medicaid, Hawk-i and the Iowa Health and Wellness plan, according to DHS reports. Nationwide, transportation cost Medicaid $3 billion per year, or 1 percent of total Medicaid spending, according to PwC.

Copyright 2016 - The Gazette, Cedar Rapids, Iowa