Rideshare transportation to health care: evidence from a Medicaid implementation

Objectives: Some managed care companies are testing rideshare services as an approach to providing transportation to health care for Medicaid enrollees. The objective of this study was to assess whether more rideshare transportation to health care was associated with improved self-reported ride experiences and fewer late/failed passenger pickups for Medicaid enrollees. Study Design: We surveyed a random sample of Medicaid enrollees in a northwestern US state on their experiences with nonemergency medical transportation (NEMT) in the past year. We linked survey responses to administrative data on NEMT utilization from the state’s transportation broker to obtain an objective measure of rideshare utilization. Methods: We used bivariate tests and multivariable logistic regressions to examine associations between enrollee perspectives on the quality of and access to health care and rideshare use, defined as none, some, or many NEMT trips through rideshare services. Results: More than 35% of respondents received NEMT from rideshare services at least once. Perceptions of the ride experience, driver, and vehicle did not differ based on the proportion of rideshare trips received. Having more rideshare trips was associated with reporting late and failed pickups. In multivariable regression, the statistical significance held for failed pickups. Sensitivity analyses showed similar results. Conclusions: This study suggests that rideshare to health care programs can meet similar goals of quality compared with traditional NEMT services but may have implications for health care access for Medicaid enrollees. Future evaluations need to include the perspectives of enrollees and explore potential differences among different Medicaid subpopulations.