Racial and Ethnic Disparities in Access to the Medicaid Transportation Benefit and Implications for Patient Outcomes

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PROJECT SUMMARY Racial/ethnic minority populations in the United States face pervasive disparities in health care access, utilization, and outcomes. Access to transportation is an important environmental factor that has the potential to affect access to care. Past work has found that low-income and minority populations in the United States encounter disproportionate barriers accessing transportation, and that improved transportation has significant impacts on both health care utilization and outcomes. Little is known, however, about the extent to which the Medicaid non-emergency medical transportation (NEMT) benefit is associated with racial/ethnic disparities in health care access and outcomes. The long-term goal of the proposed research is to determine how transportation services and related policy are related to health care disparities in the United States and can be used to improve health equity. The overall objective of this project is to provide evidence for state and federal policymakers on who uses the NEMT benefit, how use and disparities in use correlate with state-level NEMT program design, how eligibility and use correlate with patient outcomes, and barriers to use for populations most likely to have meaningful transportation needs to access care. The central hypothesis is that use of the NEMT benefit, and the association between use and health care access and outcomes, vary substantially by race/ethnicity and across beneficiary populations, as a function of discrete features of states’ NEMT policies and administrative requirements. These hypotheses will be tested by pursuing three specific aims: (1) examine racial/ethnic disparities in beneficiary-level NEMT utilization across states and assess the correlation between observed disparities and state-level NEMT policies; (2) estimate the association between use of and eligibility for the NEMT benefit and health care access and outcomes, as well as heterogeneity in this association by race/ethnicity; and (3) investigate the process of NEMT benefit administration and use of NEMT to identify barriers to effective NEMT use and potential ways to improve the program. Methodologically, the project will employ rigorous quasi-experimental approaches, including difference-in-differences analyses, as well as semi- structured interviews with Medicaid beneficiaries, health care providers, and transportation providers. The proposed research is innovative, in the applicants’ opinion, because it fills critical gaps on the potential for the NEMT benefit to reduce health care disparities in the United States using quantitative findings from a large, multi- state data source paired with in-depth, qualitative research on barriers to NEMT use. It also relies on a multi- stakeholder advisory board composed of Medicaid beneficiaries, policymakers, clinicians, and transportation providers to inform the research design and maximize translation to policy. The project is significant because it will provide actionable guidance for state and federal policymakers on how to optimize the design of the NEMT benefit to ensure equitable access to medical care in the United States.