Non-Emergency Medical Transportation (NEMT) is broadly defined by the Federal Coordination Council on Access & Mobility (CCAM) as any transportation provided to individuals who are not in an immediate, life-threatening emergency, specifically for the purpose of accessing authorized medical care, preventive health services, dental care, mental healthcare, therapies, or pharmacy trips.

In this context, NEMT is a “catch-all” term for rides that can be funded or supported across multiple federal agencies.  This is a helpful definition for policy makers and agency leaders, but for consumers, mobility managers and other professionals working to secure transportation services for their clients, public funding of NEMT services is broken down into two heavily regulated programs:  Medicaid Transportation and FTA Funded NEMT Transportation.

Medicaid NEMT
Medicaid’s definition is strictly regulatory, legally mandated, and tied to an individual entitlement under Title XIX of the Social Security Act and 42 CFR § 431.53.  The Medicaid Definition is a required state assurance ensuring that eligible Medicaid beneficiaries are provided necessary transportation to and from Medicaid-covered services when they have no other viable means of transportation.  Eligibility is strictly limited to enrolled Medicaid beneficiaries traveling to a Medicaid-billable service provided by a Medicaid-enrolled provider. It requires documented medical necessity, prior authorization, and origin/destination billing to verify that an approved healthcare service occurred. In New Hampshire Medicaid Transportation is managed by one of two brokers: Coordinated Transportation Solutions (CTS) and Medical Transportation Management (MTM).  Medicaid plan members or an agent working on his/her behalf, must use and go through the transportation broker assigned to their health plan.

FTA Non-Medicaid Transportation
Under the Federal Transit Administration (USDOT Title 49), “medical transportation” is viewed not as an individual health insurance benefit, but as an eligible trip purpose within general public transit or targeted community mobility networks.  Eligibility is open to the public older adults (65+), or individuals with disabilities regardless of Medicaid enrollment or healthcare insurance status.    These services are coordinated by individual transportation providers and are not tied to Medicaid or other health insurance prior authorization requirements.  This means riders can use FTA-funded fixed or demand-response services to reach any healthcare setting, doctor’s office, pharmacy, wellness center, or adult day center within the agency’s service area.  Please note that FTA funds cannot be used to supplant Medicaid’s obligation to provide qualified NEMT services.