Nearly 15 million people are covered by California’s Medicaid program, Medi-Cal. Since March 2023, almost 1 million people have been disenrolled from Medi-Cal due to eligibility redetermination, while another 700,000 residents could gain coverage. That’s thanks to a new law making all undocumented immigrants in the state eligible for the low-income health insurance program.
Previously, undocumented residents under 26 and over 50 were eligible for Medi-Cal. The new law will expand that coverage to all adults.
That’s just one of the changes that took effect this year. The California Department of Health Care Services (DHCS), the state’s Medicaid agency, awarded new contracts to managed care plans (MCPs) that will change coverage for an estimated 1.2 million people in 21 counties. And all managed care plans have new contracts with updated language emphasizing prevention and long-term care needs—priorities that are in line with the state’s CalAIM initiatives launched in 2021. The new contracts also require MCPs to invest part of their profits into the communities they serve.
What hasn’t changed this year is the way that non-emergency medical transportation (NEMT) and non-medical transportation (NMT) is administered in the state, with physician approval required for NEMT services.
Strategies to Improve the Medi-Cal Transportation Benefit
In 2020, the California Health Care Foundation released a comprehensive study of the state’s Medicaid transportation benefit. Medicaid enrollees reported that “the availability of NMT is key to the management of their health and believe they would struggle if the service were no longer available,” the study said. “Lacking reliable or affordable transportation options before the implementation of NMT, some enrollees said they missed medical appointments and could not consistently access the pharmacy to obtain prescribed medications.” The concern is borne out by research: More than 5 million people (1.7%) in the U.S. miss or delay medical care because of a lack of transportation.
The report included several recommendations to improve the administration of transportation benefits in the state. Since it was released, just four years ago, there has been a worldwide pandemic, the state launched CalAIM, and technological advances have disrupted the NEMT landscape.
As a leading NEMT/NMT broker in the country, with a technology-first approach and rapid year-over-year growth, SafeRide Health is revisiting some of the foundation’s suggestions and observations through a 2024 lens:
1. “Merge NEMT and NMT into a single comprehensive benefit.”
In California, NEMT refers to transportation to medical appointments for people with limited mobility, including those who need a wheelchair or cannot walk by themselves to a vehicle. The state requires a physician’s certification statement for NEMT services, which is valid for up to a year. NMT refers to transportation to medical appointments via public transport, rideshare, or mileage reimbursement, and it does not require physician approval. In many states, both categories fall under the NEMT bucket, which reduces member and provider confusion and makes it easier to market the service to members.
2. “Require more outreach and communication to providers and enrollees.”
Consumer advocates interviewed for the report said communication challenges were a common concern, mostly due to the typical transportation process: “The enrollee generally contacts the MCP or broker to request the benefit, the MCP or broker communicates with the driver, and the enrollee is cut out of any communication with their assigned driver. When drivers do not have a way to directly communicate with the enrollee, confusion and delays in scheduling rides or resolving issues are often the result. Broker arrangements that allow for direct communication with the enrollee can help mitigate these access issues.”
These historical challenges have led to innovations. SafeRide connects members with their driver so they know who to expect and when—and customer service representatives can track rides as they happen to ensure there are no issues along the way. Many Medicaid members can even schedule rides themselves though SafeRide’s member portal. SafeRide partners with our health plan partners to ensure members know they have a transportation benefit, understand how it works, and get the ride that is best for them. We also ensure the benefit is being used appropriately, given each member’s benefits and circumstances.
3. “Address rural and frontier area barriers to service.”
Providing access to transportation in rural areas requires a creative and nimble approach. SafeRide’s network management philosophy and technology allow us to leverage rideshare, NEMT, and public transit more effectively and efficiently, complementing those modes with community-based and volunteer networks, as well as gas mileage reimbursement programs. SafeRide also pays transportation providers dynamic rates based on differences in urban vs. rural supply and demand. As a result, SafeRide creates a premium incentive for NEMT drivers to accept transportation requests from members in more rural areas.
4. “Evaluate the feasibility of including transportation to social services and supports in the NMT benefit.”
Managed care plans in many states have gotten more creative to ensure their members can access the resources they need to address a range of social determinants of health. Whether it’s a ride to the grocery store or gym, or help with meal and lodging costs, transportation providers can help solve a range of member challenges. SafeRide’s Alternative Transportation (ATP) team manages these types of services.
5. “Explore NMT driver credentialing or other transportation provider oversight.”
Ensuring that members have a safe, reliable, and pleasant ride is core to SafeRide’s mission, whether it’s with rideshare or an NEMT partner. We give rideshare access to the SafeRide platform so we can sync and see all trips in real time—while also taking advantage of rideshare’s on-demand capabilities. This also allows us to access real-time reliability ratings for rideshare supply and estimated pickup times, reducing cancellations and no-shows.
SafeRide checks all NEMT drivers against Medicaid and Medicare exclusions lists and conducts a rigorous background process at the company and driver levels, verifying that all training, licensing, and documentation are available, up to date, and valid. We also automate the process of reminding fleets and drivers to update necessary information as expiration dates come upon any included documents. If a driver, vehicle, or fleet goes out of compliance, we can block them from providing rides to members.
In addition, SafeRide has created a tiered network system that rewards transportation providers for providing the highest level of service. Tier 1 NEMT drivers that maintain certain performance metrics are eligible for additional ride volume and growth opportunities.
6. “Analyze and publish statewide utilization and cost data reported to DHCS.”
Outdated processes and a lack of performance metrics have left many managed care plans and transportation brokers guessing when it comes to performance and utilization. Managed care plans and state Medicaid agencies face barriers to efficiency when they don’t know where there are opportunities to improve.
SafeRide's commitment to building a digitized transportation network enables and ensures transparency and visibility. We track and share countless data points on every ride, so managed care plans understand how many rides are fulfilled and how well they are fulfilled. We establish targeted quality benchmarks based on each plan’s priorities, including on-time rates, on-demand fulfillment rates, call center performance, type of transportation provider, and modality.
With the many changes being enacted in Medi-Cal today, there is no better time to look at the transportation benefit to ensure it is effective and efficient, and that it helps as many vulnerable Medi-Cal members as possible. For some, NEMT and NMT means the difference between seeing their doctor or staying home.