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

    NCDOT Research Project Number: 2023-08

 Executive Summary

  • On July 1, 2021, North Carolina began the transition of Medicaid health care delivery from fee-for-service to managed care. Prior to the transition, in 2019, community transit systems in North Carolina provided 1.3 million rides through the Medicaid Non-Emergency Medical Transport (NEMT) benefit amounting to 23% of all trips and 21% of revenues. The NEMT rides were blended into the coordinated transportation system, meaning at any time, a public transit vehicle could be carrying trips sponsored by NEMT, senior centers, employment programs, and/or other programs. Under managed care, private transport brokers make NEMT decisions which may bypass public sector transport providers completely or include service standards that make it difficult to coordinate NEMT with other transportation needs. The scale of this change in health care delivery will alter community transportation systems' finances and operations and transit riders' level of service for all trip purposes.

    With this project, we will document how Medicaid Transformation is impacting community transportation's ability to provide North Carolinians with access to critical destinations. We will consider operational and financial impacts on transit systems and travel impacts on riders. We anticipate significant variation across the state with some systems able to maintain or increase service delivery while others reduce service. We will exploit these differences to identify the factors such as service area characteristics, population characteristics, NEMT agreements with private transport brokers, and service policies that allow systems to provide access to health care, employment, and other destinations while maintaining operational efficiency and financial health.

    This issue is of critical importance to NCDOT because the organization provides tens of millions of dollars in state and federal funding for community transportation systems and any impact to the service delivery model will change the levels of mobility and access that these funds support. This issue is also important to rural areas in North Carolina and other transportation disadvantaged communities because community transportation provides essential mobility options that allow people to age in place, supporting individual freedoms and rural economies. Identifying and sharing lessons learned and best practices for managing Medicaid Transformation with community transportation systems and NCDOT will maintain essential mobility for North Carolinians, assist agencies negotiating with private transport brokers and improve access to health care and other opportunities. Our investigation will also provide NCDOT with information needed to work effectively with NCDHHS to coordinate community transportation for medical access.

Noreen McDonald
Noreen McDonald; Abigail Cochran
Ryan Brumfield
Curtis T. Bradley
UNC Chapel Hill

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 Report Period

  • July 13, 2022 - December 31, 2023


  • In Progress


  • Planning, Policy, Programming and Multi-modal

 Sub Category

  • Public & Rural Transportation

 Related Links

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