Project Details

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  • Impacts of Medicaid Transformation on North Carolina Public Transit Systems: Lessons Learned and Best Practices

    NCDOT Research Project Number: 2023-08

 Executive Summary

  • The shift from Fee-for-Service to Managed Care Organizations changed the landscape and possibilities for coordinated human service transportation in NC. Previously, Non-Emergency Medical Transportation (NEMT) trips were serviced extensively by community transit systems (CTS), alongside both other human services transportation purposes and service to the public. These trips were part of a coordinated transportation model, in which revenue from Medicaid NEMT was coupled with other funding sources to maximize funding efficiency by serving multiple rider types on the same trip. The shift to Managed Care places decisions about how to provide NEMT trips—and the money that pays for these trips—in the control of transportation brokers. This shift promises to open new transportation options for Medicaid beneficiaries, potentially bringing benefits like reduced wait or trip times. Nevertheless, the transformation decreases the opportunity for CTSs to pool funding and trip purposes—effectively limiting the ability of these organizations to coordinate human services transportation. This study explored the impacts of Medicaid Transformation on community transit systems and the Medicaid beneficiaries who had historically depended on them for NEMT. Key findings include: 1) In aggregate, the number of Medicaid trips served by CTSs has exhibited moderate recovery since Transformation and the onset of the pandemic but has not reached pre-pandemic levels, 2) Impacts of the Transformation varied across geographies, 3) CTS administrators expressed concerns about lost rides, reduced revenue, and inefficient use of resources, 4) CTS administrators reported communication and collaboration difficulties with NEMT brokers, 5) Informal connections and communications between riders and NEMT personnel were eroded, and 6) CTS personnel shared concerns about the experiences of their former riders on new services. The main recommendations that stem from these findings focus on ways for CTSs to maintain financial viability post-transformation and the collection and use of data to monitor and improve the experiences of NEMT users across all providers post-transformation.​
Principal Investigator
  
Noreen McDonald
Researchers
  
Noreen McDonald; Abigail Cochran
Committee Chairman
  
Ryan Brumfield
Project Manager
  
Curtis T. Bradley
Lead Research Org
  
UNC Chapel Hill
Partner Research Org
  

 Related Documents
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 Additional Information on:

 Report Period
  • July 13, 2022 - December 31, 2023

 Status
  • Complete

 Category
  • Planning, Policy, Programming and Multi-modal

 Sub Category
  • Public & Rural Transportation

 Related Links
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