When states expanded Medicaid under the Affordable Care Act, millions gained access to healthcare services. But some of the most vulnerable in Republican states are now finding it difficult to physically reach their doctors, after being denied ancillary transportation benefits.
Three states are enacting “a barrier to accessing healthcare, particularly among low-income populations” by stripping new Medicaid enrollees of money for transportation.
The Government Accountability Office detailed in a report published Tuesday that Indiana, Iowa, and Arizona refused non-emergency medical transportation assistance (NEMT) to those who otherwise benefited from the Medicaid Expansion.
Both Indiana and Iowa received waivers from the federal government in order to withhold the benefits. Arizona is currently seeking approval to do the same. All three are among the few red-leaning states that opted to expand Medicaid services on the federal dole under Obamacare.
The government watchdog noted that the remaining twenty-seven states that expanded Medicaid under the ACA included NETM help in the additional coverage.
The GAO has previously described such assistance as “an important safety net” for enrollees in the program, citing a study showing that more than 3.6 million Americans “miss or delay care because they lack appropriate transportation to reach their medical appointments.” Lack of transport was the most common reason cited by Medicaid beneficiaries for missing treatments, particularly among children who depend on the program for dental services.
Officials from each of the states claimed that they wanted the newly-expanded government insurance offerings to resemble private sector plans, which generally don’t offer transportation assistance.
Iowa, which denied NEMT benefits to all ACA-eligible Medicaid enrollees, was required last April to produce data to gauge the effects of the move. GAO stated, however, that the sample size of Iowa’s survey was too small to make conclusions about its decision impacting access to healthcare.
The data did suggest, though, that there was a divide among new enrollees, with the poor being most impacted by the withholding of transportation benefits.
“[T]wenty-five percent of newly eligible enrollees with incomes under 100 percent of the FPL (federal poverty line) reported needing help with transportation,” GAO found, “compared with eleven percent of higher income newly eligible enrollees.”
In another data point, it found that fifteen percent of eligible enrollees earning below 100 percent of the poverty line “reported an unmet need for transportation.” Among slightly higher income earners, the number drops to five percent.
The Department of Health and Human Services reviewed the data, and approved extending Iowa’s waiver through March of this year, despite raising concerns about its impact on the poor.
Indiana is expected to release the results of its statewide study on the matter at the end of February.
The GAO interviewed a number of research and advocacy groups in compiling its report. Nine out of ten officials raised concerns about the negative consequences of denying NETM benefits. One group relayed stories of patients having to “cancel their medical appointments” because they “do not have a car, money to pay for gas, or access to public transportation.”
Groups also stated that lack of Medicaid transportation services could lead to higher medical costs, as individuals “forgo preventive care or health services and end up needing more expensive care, such as ambulance services or emergency room visits.” That includes people receiving regular treatment for substance abuses, who are more likely to miss sessions and relapse without NETM assistance.
