There is sufficient evidence that Non-Emergency Medical Transportation (NEMT) can improve social outcomes, providing enhanced abilities for patients to attend scheduled services.
The findings below synthesize the results of the studies on Non-Emergency Medical Transportation (NEMT) interventions across three domains of measurement:
Access to transportation is a key social driver of health[1] that directly affects timely use of medical services[2],[3],[4],[5],[6],[7]. National data show that over 21% of adults without access to a vehicle or public transit reported unmet medical needs due to transportation challenges[8]. These individuals are more likely to miss preventive care, chronic disease management, or behavioral health appointments, increasing their risk of avoidable complications and costly emergency care[9].
Lack of access to reliable, accessible, and safe transportation often intersects with other barriers to care, including geographic isolation, economic wellbeing, self-rated physical and mental health, and caregiving responsibilities[10]. For example, some transportation benefit programs do not allow children or more than one family member or support person to be in the vehicle, limiting individuals with caregiving responsibilities’ ability to attend appointments[11]. National public health goals such as Healthy People 2030[12] aim to reduce unmet medical needs and increase use of evidence-based preventive care, both of which are closely linked to having reliable transportation options.
One key strategy to address these transportation barriers is non-emergency medical transportation (NEMT), a benefit that helps eligible individuals access medical care when they lack reliable means of transport.
Non-Emergency Medical Transportation (NEMT)[13] is transportation to medical appointments. NEMT is a required benefit under Medicaid and is free to Medicaid enrollees[14],[15],[16]. Covered trips include primary and specialty care, dialysis, behavioral health visits, pharmacy trips, and lab testing. States contract with local transportation providers, offering rides via vans, taxis, or public transit to individuals who otherwise experience significant barriers to accessing care.
While NEMT is a mandatory Medicaid benefit[17], service models and eligibility criteria vary by state. Common challenges include complicated scheduling, inconsistent availability, inaccessibility, and restrictive policies around ride companions. These limitations have contributed to low uptake, even among those who qualify. For instance, fewer than 5% of Medicaid beneficiaries accessed the service in 2018[18]. In recent years, rideshare-based NEMT has emerged as an additional NEMT option[19]. Companies like Uber and Lyft have partnered with states and brokers to offer flexible ride options for Medicaid enrollees. Federal law now explicitly permits the use of transportation network companies for NEMT services. This evolution in service delivery may reduce logistical hurdles, increase rider satisfaction, and expand access to care, particularly in areas underserved by traditional NEMT providers.
Medicare Advantage[20] plans increasingly offer NEMT as a supplementary benefit, though coverage varies. For instance, about 36% of all Medicare Advantage plans offer transportation benefits, while among Special Needs Plans, more than 88% provide this benefit[21]. The scope of benefits also differs by plan, ranging from a limited number of rides to unlimited transportation services. Commercial insurance plans[22] typically provide only limited NEMT benefits, often targeted to specific populations or circumstances. Recent evidence suggests that supplemental benefits, which includes transportation, is associated with improvements in healthcare quality metrics[23].
The Teen and Tot clinic, within Boston Medical Center, a tertiary care academic medical center and safety net hospital.
The clinic serves pregnant adolescents up to age 20, and young adult mothers and their children up to when the mother reaches age 23.
Predominantly racial minorities (61% Black, 18% Hispanic, 14% White, and 7% other), and socioeconomically disadvantaged individuals (70% publicly insured, 30% privately insured).
A rideshare intervention involving free transportation to scheduled hospital visits through the UberHealth platform. Halfway into the study, patients were also offered rides home.
Pre-post analysis. A total of 153 rideshare trips were scheduled during the study period, of which 106 were completed.
Healthcare Cost, Utilization & Value: 30% of clinic visits were missed during the study period, compared to 32.7% prior to the study. The study found no significant difference in rates of missed visits or costs for those who participated in the rideshare intervention.
Members of a Medicare accountable care organization (ACO) with a large academic health system, the UNC Health Alliance ACO. ACO members were Medicare beneficiaries not currently participating in Medicare Advantage.
NEMT benefit.
A mixed-methods evaluation observational study with a comparison group, and a qualitative study.
The observational evaluation involved propensity score weighting of 173 users of the transportation program compared to 11,660 in the comparison group, and semi-structured interviews with 21 program users.
Healthcare Cost, Utilization & Value: Participation in the transportation program was associated with a greater number of outpatient visits (9.2) and higher outpatient spending ($4,420) than in the comparison group. However, there was no difference in inpatient admissions or emergency department visits, and the program was not cost saving.
Social: Qualitative analyses revealed that participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health.
Medicaid patients in Philadelphia, PA.
As part of their routine care, patients assigned to both study groups received automated appointment phone call reminders. Additionally, patients assigned to both groups received up to three additional appointment reminder phone calls from research staff two days before their scheduled appointment. During these calls, patients in the intervention group were offered a complimentary ridesharing service. Research staff prescheduled rides for those interested in the service. After their appointment, patients phoned research staff to initiate a return trip home.
Randomized clinical trial. A total of 786 individuals were enrolled (n = 394 rideshare intervention group; n = 392 to the usual care control group).
Healthcare Cost, Utilization & Value: In the intervention group, 144 of 394 (36.5%) had missed appointments compared to 144 of 392 (36.7%) for the usual care group. From this study, authors concluded that “the uptake of ridesharing was low and did not decrease missed primary care appointments.”
Patients with Medicaid in West Philadelphia.
Rideshare-based medical transportation.
Observational study with a comparison group.
Healthcare Cost, Utilization & Value: At the control practice, the show rate declined from 60% (146/245) to 51% (34/67). At the rideshare practice, the show rate improved from 54% (72/134) to 68% (41/60). In the adjusted model, controlling for patient demographics and provider type, the odds of showing up for an appointment before and after the intervention increased 2.57 (1.10-6.00) times more in the rideshare practice than in the control practice.
Radiation therapy patients at a single institution from 2017-2022. Rideshare utilizers had a lower median age (60 vs. 66, p = .02) and were more likely to identify as Black or African American (60 vs. 22%, p<.0001) compared to non-rideshare utilizers. Rideshare utilizers also had higher Area Deprivation Index scores (median 9 vs. 5, p<.0001), indicating higher socioeconomic disadvantage, and travelled shorter distances for treatment (median 5 vs. 14.7 miles, p<.0001).
A free hospital-provided rideshare service.
Observational study with a comparison group. 58 out of 2,906 patients utilized the rideshare service.
Healthcare Cost, Utilization & Value: Even after adjusting for socioeconomic, clinical, and treatment characteristics, utilization of free hospital-provided rideshare service was associated with improved radiation therapy completion rates.
Medicaid beneficiaries.
A partnership between Amerigroup Tennessee, its transportation vendor Tennessee Carriers, and Lyft to enhance access to NEMT.
Pre-post analysis. The Lyft program provided more than 3,000 rides to beneficiaries enrolled in the Amerigroup Tennessee health plan from August 2019 through March 2020.
Healthcare Cost, Utilization & Value: Among beneficiaries who used the Lyft program, the number of claims per beneficiary per month for primary care provider (PCP) visits increased by 13% during the first three full months (September–November 2019) of the program compared to the three months prior to implementation (May–July 2019). Compared to the first quarter of 2019, claims per beneficiary per month for PCP services were 63% higher in the first quarter of 2020 among individuals who used the Lyft program. Beneficiaries receiving NEMT through the Lyft program experienced improvements in measures of healthcare utilization, such as PCP visits and quality of care. Additionally, among those who used the Lyft program, the number of beneficiaries who visited a physician for preventive or outpatient services increased by 73% between January and March 2020.
Health: The health plan also observed positive changes in other Healthcare Effectiveness Data and Information Set metrics for recommended services and clinical goals, such as cervical cancer screening (13%) and management of blood glucose levels in individuals with diabetes (21%).
Patients receiving sedation for colonoscopy at a safety-net healthcare system in Seattle, Washington.
Rideshare NEMT. The average rideshare cost was $24.66 (range, $9.99–$54.49), which is on par with published costs of rideshare NEMT for other health indications (range, $14.00–$67.00).
Non-randomized mixed trial. 31 rides were completed between February 2022 and August 2023.
Social: 100% of patients who used the intervention arrived at their intended post-procedure destination without incident.
In post-intervention interviews, patient participants uniformly shared that they could not have completed their colonoscopies without the rideshare NEMT, they would use the intervention again if offered, and would recommend it to others.
Patients with chronic diseases at safety net clinics in Multnomah County, Portland, Oregon.
Rideshare based transportation to reduce barriers to participating in a seasonal, clinic-based food security project that connects community supported agriculture (CSA) farms with safety-net clinics during the harvest season. $8,000 in rideshare credits provided by the Uber Northwest Community Impact Initiative were shared among four of five CSA Partnerships for Health pickup sites.
Descriptive study. Mixed methods were used, involving patient surveys, focus groups, and rideshare usage data. N = 155.
Social: Over 80% of rideshare users rated their experience as good or excellent, and clinic and program staff reported that the service allowed patients a greater sense of control over their time and health.
Pediatric and adolescent patients with HIV between 0 and 24 years old receiving care at Children’s National Hospital in Washington, DC. Their median age was 17.9 years, 89.3% were Black, 48.9% male patients, and 78.7% perinatally infected.
Rideshare services and telemedicine-based support for clinic and laboratory visits.
Observational study with a comparison group. N = 178 pediatric and adolescent patients with HIV.
Healthcare Cost, Utilization & Value: Patients used rideshare services for 13.3% of all completed visits (including rideshare for in-person visits and laboratory testing for telemedicine visits). Rideshare usage to complete visits and/or laboratory testing (12.4% vs. 26.5%, P = 0.0068) was lower in telemedicine versus non-telemedicine patients. Providing telemedicine with ridesharing helped to address access to care, transportation barriers, and infection control requirements associated with the pandemic.
Pregnant Medicaid recipients in Franklin County, Ohio, a county with high rates of infant mortality.
Individuals were randomly assigned to usual NEMT services or enhanced smart transportation services (i.e. on-demand transportation with access to a mobile application and trips to the grocery store, food bank, or pharmacy).
Randomized controlled pilot trial. N = 143.
Healthcare Cost, Utilization & Value: There were no meaningful differences in adequacy of prenatal care or preterm delivery between groups.
Social: The rideshare group reported increased satisfaction with NEMT compared to usual transportation.
Diverse county hospital surgical patients. Patients using rideshare services resided in zip codes with lower household incomes. Rideshare group patients were more likely to be older, male, Black/African American, less healthy per physical status classification ratings, and residing in neighborhoods with lower income.
Rideshare service. Overall, $18,733 in funds were used to fully subsidize 1,562 Lyft rides for patients traveling to and from the hospital.
Observational study with a comparison group.
N = 376 in the rideshare group, compared to 3,774 in the non-rideshare group.
Healthcare Cost, Utilization & Value: The patients participating in the rideshare program had non-significant increases in the proportion of operating room (OR) cases delayed (48.2% and 44.1%, respectively) and average time delayed in OR case start times (18.7 and 14.6 min, respectively) compared to the non-rideshare group.
Residents of rural eastern North Carolina. Over half (58%) of Project TRIP (Transporting Residents with Innovative Practices) users were female with a mean age of 54. Most riders were Black (69%), either received Medicaid (32%) or Medicare (17%) or were uninsured (22%).
Project TRIP offered free nonemergency privately operated individualized transportation for low-income residents in rural eastern North Carolina.
Pre-post analysis. N = 101 Project TRIP users.
Healthcare Cost, Utilization & Value: The number of hospital admissions decreased (statistically significant at 1% level) for TRIP users. Other key measures also improved for TRIP users, but not at statistically significant levels. The estimated net savings of Project TRIP in hospital and emergency room visits alone after deducting operating costs in the past five years was $720,544.
Health: The average A1C level decreased by 0.52 post TRIP utilization (statistically significant at 10% level).
Residents of the United States.
Modern (transportation networks such as Lyft or Uber) NEMT that utilizes digital transportation networks compared with traditional (taxi vouchers, direct provision of transportation, and contracts with local transportation providers) NEMT in the U.S.
Cost-effectiveness analysis involving a literature review, commercial information, and structured expert interviews.
Healthcare Cost, Utilization & Value: Total annual net savings for traditional NEMT in Medicaid was approximately $4 billion. For modern NEMT, estimated savings on ride costs varied from 30% to 70%. In comparison with the traditional, modern NEMT was estimated to save $268 per expected user and $537 million annually when scaled nationally.
Patients receiving gynecologic cancer treatment at five University of Pennsylvania practices. Patients who received transportation assistance were more likely to be older, self-identify as a race other than white, have Medicare or Medicaid insurance, and have a higher ECOG score than the overall patient population.
Donor-funded rideshare service. The mean cost of a one-way trip was $25.75 (range $13.83–129.91).
Descriptive study. 48 patients received rides.
Healthcare Cost, Utilization & Value: Patients who received rides had a higher baseline no-show rate (7%) before receiving transportation assistance compared to the overall clinic population (3%).
Social: The mean time via ridesharing was 19.5 minutes shorter than public transportation, which may contribute to more equitable access to cancer care.
Women with gynecologic visits reporting transportation difficulties at an urban refugee women’s health clinic in Boston Medical Center, Boston, Massachusetts
A healthcare-directed rideshare application for overcoming transportation barriers. The intervention cost $2,033 and generated $30,337 in charges.
Observational study with a comparison group. Of 102 eligible visits, 31 reported transportation insecurity and received rides.
Healthcare Cost, Utilization & Value: Women offered rides had a 6% no-show rate, compared to 30% among women who reported no transportation barriers and 50% among women who could not be reached.
Patients requiring access to transportation.
Interventions aimed to reduce barriers to NEMT and non-medical transportation. Study interventions included van rides, bus or taxi vouchers, ride-sharing services, and others.
Systematic review and meta-analysis. 12 studies were included.
Healthcare Cost, Utilization & Value: Non-emergency transportation interventions reduced missed appointments, but there was no clear association with differences in costs, utilization, or health outcomes.
Patients requiring access to transportation.
NEMT interventions including taxi vouchers, ridesharing services, van services, bus tickets, and parking vouchers.
Systematic review. Eight studies were included for analysis.
Healthcare Cost, Utilization & Value: Results were mixed. More rigorous studies showed low patient uptake of transportation services and inconsistent impacts on health and utilization outcomes. The authors concluded that despite considerable interest in subsidizing transportation services to improve health for patients facing transportation barriers, rigorously conducted research has not demonstrated the impact of transportation services on health or health care utilization.
Patients with chronic diseases.
Transportation interventions for chronic disease management including one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1).
Systematic review. 10 studies met the inclusion criteria.
Healthcare Cost, Utilization & Value: This systematic review found evidence to support the provision of bus passes, taxi vouchers, and reimbursement for transportation to improve healthcare utilization, chronic disease management, and follow-up care among diverse socioeconomically disadvantaged populations, particularly older adults.
Health: This systematic review found evidence to support the provision of bus passes, taxi vouchers, and reimbursement for transportation to improve chronic disease health outcomes among diverse socioeconomically disadvantaged populations, particularly older adults and women.
Social: This systematic review found evidence for improvements in maternal empathy.
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