Transportation barriers for Iowa Medicaid-enrolled adults with and without non-emergency medical transportation services

INTRODUCTION: State Medicaid programs must provide transportation to medical appointments through the non-emergency medical transportation (NEMT) benefit. Iowa is one of a few states not required to provide NEMT for adults in their Medicaid expansion program if not medically exempt or under age 21. 

METHODS: Data from a 2022 survey assessed transportation barriers for 3 adult Iowa Medicaid groups (n = 2181): (1) expansion without NEMT, (2) expansion with NEMT through medical exemption/age, and (3) traditional Medicaid members. Primary outcomes were transportation-related missed health visits, unmet health care needs, unmet transportation needs, and transportation cost concerns. Logistic regression examined transportation barriers by Medicaid group and sociodemographic and health factors. 

RESULTS: Recipients without NEMT reported fewer transportation barriers than recipients with NEMT. For example, 6% of expansion members without NEMT reported transportation-related missed health visits (past 6 months) vs 15% for expansion members with NEMT and 11% for traditional Medicaid members. Few Medicaid group differences remained in adjusted models. NEMT benefit impact was limited by low reported awareness and use of the benefit and higher vulnerabilities in NEMT-eligible populations. 

CONCLUSION: Adults in all Medicaid groups could benefit from transportation services, but innovation is needed to determine more effective ways to meet transportation needs.