| When no ride = no show
Peer-reviewed research in the American Journal of Managed Care found Medicaid patients have 66% greater odds of missing a medical appointment than privately insured patients, despite having coverage and transportation benefits. Meanwhile, in a 2021 report on NEMT beneficiary experiences, advocates told researchers that brokers sometimes treat a complaint about an hours-late pickup as “resolved” once the member is eventually picked up. The dysfunction stays hidden. That gap isn’t a data anomaly. It’s a structural failure. Members who never get their ride often don’t file complaints. They don’t know how. That’s what they have come to expect. In rural communities where distrust of institutions runs deep, a no-show ride doesn’t just mean a missed appointment — it confirms what many already believe: that the system wasn’t built for them. Broken by design
The current NEMT model is built on fragmentation. Brokers sit between health plans and transportation providers, operating proprietary systems that don’t talk to care management platforms, EHRs or state Medicaid infrastructure. Trip data, when it exists, is often incomplete, unverifiable and audit-vulnerable. No-shows get logged as completed rides. Patterns of failure go undetected for years. Some of this is due to bad actors. Most of it is the system designed to make bad behavior easy and accountability optional. When transportation operates as a siloed service rather than a connected component of care delivery, the entire data chain breaks. When the data chain breaks, outcomes can’t be measured, which means outcomes can’t be improved. More than a support service
Reframing transportation as infrastructure, not a support service, means holding it to the same standard as any other component of care delivery. The data exists. The technology exists. The evidence that effective NEMT reduces costs and improves outcomes is not in dispute. What’s missing is the commitment to hold transportation to the same standard the industry holds every other component of care delivery. Health plans, state Medicaid agencies and the vendors they contract have collectively accepted a level of opacity in transportation management that wouldn’t be tolerated in pharmacy, behavioral health or primary care. — By MedCity Influencer Sufian Chowdhury |
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