Iowa Medicaid non-emergency medical transportation system review and options for improvements

Inadequate transportation has long been identified as a major issue in rural Iowa, and it is particularly acute for people of all ages with disabilities and their families, including Medicaid members. In 2005 the Iowa Department of Human Services (DHS) received a federal Real Choices Systems Transportation Grant to address a number of barriers to community living faced by this population, including transportation. Iowa Medicaid Enterprise (IME), charged with administration of the grant, was interested in the ways in which a statewide, Medicaid-funded transportation brokerage could improve services for Medicaid members. Currently, Medicaid members are reimbursed for transporting themselves, or providers are reimbursed for transporting individuals, which places the bulk of the responsibility on consumers, DHS Income Maintenance workers and case managers. Under a brokerage, IME would contract with an entity to (1) establish a network of transportation providers; (2) maintain a call center; (3) ensure compliance with Medicaid regulations related to eligibility of the individual and trip; (4) arrange and pay for the trips; and (5) monitor services and transportation providers for compliance and quality. States that have established brokerages have, in general, experienced an increase in the number of trips and a reduction in the cost per trip. In some instances, significant problems with fraud have been addressed. The brokerage concept has been actively supported at the federal level for both Medicaid and the general population.