Unwinding of the COVID-19 Public Health Emergency is Unlikely to Impact Medicaid NEMT Utilization

For two and a half years, we’ve been anticipating the end of COVID-19. And although it may stay with us for the foreseeable future, the forthcoming end of the government’s official recognition of COVID-19 as a Public Health Emergency (PHE) will have a significant impact on the healthcare system.

Since 2016, thousands of healthcare organizations have partnered with Lyft Healthcare to reduce transportation barriers and help patients access transportation to healthcare appointments. Even before the pandemic, these organizations recognized how Lyft could benefit patients and providers alike.

Today, we are one of the largest Medicaid non-emergency medical transportation (NEMT) providers across 18 states and DC.

As states faced transportation network constraints during COVID-19, Lyft played an important role in increasing access to healthcare by augmenting transportation networks and expanding our role as a trusted Medicaid NEMT provider. Some states enacted emergency waivers during the PHE that enabled Lyft to better serve Medicaid beneficiaries by providing access to transportation to their medical appointments. As a result, some states have moved to permanently integrate Lyft into their Medicaid NEMT programs.

The end of the federal COVID-19 PHE is on the horizon, and with that comes questions on how significantly Medicaid redeterminations will affect Medicaid NEMT utilization.

In March 2020, Federal legislation included a “continuous coverage” requirement for Medicaid eligibility for the duration of the PHE. This prohibited states from terminating Medicaid coverage for those who enrolled during the PHE, regardless of any change in eligibility status. As a result, Medicaid enrollment sharply increased, providing millions of people with consistent health insurance.

The end of the PHE will result in a complex redetermination process in which Medicaid Agencies will reevaluate enrollees' eligibility. This could result in an estimated 13 percent of current enrollees – primarily those who enrolled as a result of COVID-19 PHE eligibility expansions – losing Medicaid coverage. With the expected decline in Medicaid enrollment, Lyft Healthcare investigated the potential impact of redeterminations on Medicaid NEMT utilization.

At a high level, we do not expect Medicaid NEMT utilization to drop significantly as a result of the COVID-19 PHE unwinding process. Our analysis indicates that any potential NEMT utilization decline will not be proportional to the expected decrease in Medicaid enrollment. There are two main factors that inform our prediction:

Characteristics of New Medicaid Enrollees during the PHE

New Medicaid enrollees during COVID-19 differed from enrollees prior to the pandemic due to the PHE eligibility expansions and continuous coverage requirements. Research shows that new Medicaid enrollees during the PHE were significantly less likely to incur healthcare costs and utilize services such as primary care visits, emergency rooms, and potentially-avoidable hospitalizations than new enrollees prior to the pandemic. This was the case even when accounting for the widespread reductions in healthcare use due to COVID-19.

In addition, experts predict Medicaid beneficiaries who enrolled and maintained eligibility during the PHE are most likely to lose coverage as a result of the redetermination process. Thus, since the group expected to lose coverage utilized Medicaid benefits at lower levels to begin with, we do not anticipate Medicaid enrollment decreases to have significant effects on NEMT utilization.

NEMT Industry Trends

The Centers for Medicare and Medicaid Services’ Medicaid NEMT report to Congress cites that usage of Medicaid NEMT dropped sharply at the start of the COVID-19 PHE but is rebounding to pre-pandemic levels as people continue to re-engage with in-person healthcare services. Additional research demonstrates that in-person ambulatory care service utilization is recovering after the preceding decrease caused by the onset of COVID-19. Therefore, we expect NEMT utilization will continue on its upward path, especially due to similar rebounds of in-person healthcare services to pre-pandemic levels.

The projected continued use of Medicaid NEMT among beneficiaries, as well as the national attention on health equity, presents the perfect opportunity for states to close the transportation divide and assess their NEMT programs.

COVID-19 heightened long-standing health disparities, amplifying the urgency of investing in programs that improve access to healthcare resources. Concurrently, expanded regulations provided new resources to reduce disparities and address transportation insecurity.

As our society attempts to address inequalities in the accessibility of healthcare services, state governments should consider incorporating rideshare into Medicaid NEMT services to strengthen existing provider networks and improve patients’ access to healthcare.

Learn more about Lyft Healthcare’s role in Medicaid NEMT here.

The content provided in this blog post is for informational purposes only, and is not intended to constitute legal or business advice. Lyft Healthcare, Inc. makes no representations as to the accuracy or completeness of the information contained in this blog post. Unless otherwise stated, Lyft Healthcare, Inc. is not affiliated with any of the organizations mentioned in this blog post. Always consult an expert to obtain advice with respect to any particular legal or business matter.