Bill Overview
Title: Access to Critical Non-Emergency Transportation Services Act
Description: This bill requires the Centers for Medicare & Medicaid Services to work with state Medicaid programs to assist individuals who are dually eligible for Medicare and Medicaid with accessing non-emergency transportation benefits under Medicaid. The bill applies to dually eligible individuals who are participating in the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model under Medicare.
Sponsors: Rep. Carter, Earl L. "Buddy" [R-GA-1]
Target Audience
Population: People dually eligible for Medicare and Medicaid using specific transport programs
Estimated Size: 1000000
- The bill targets individuals who are dually eligible for both Medicare and Medicaid.
- These individuals must be participating in a specific program: the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model under Medicare.
- According to CMS data, there are approximately 12 million people in the United States who are dually eligible for Medicare and Medicaid.
- The subset of these individuals participating in the specific ambulance transport model is smaller and would be less than the total dually eligible population.
- This act focuses specifically on improving non-emergency transportation access, which is a critical service for elderly and disabled populations.
Reasoning
- The target population is a subset of dually eligible individuals under Medicare and Medicaid who are part of a specific transport model, which is smaller than the overall eligible population.
- The budget for the policy is quite large, which suggests a significant impact on those within the target group but limited by the total number of eligible individuals.
- The impact assessment across individuals takes into account the likelihood of them continuing their current trajectory regarding well-being without the policy and the expected improvements with the policy.
- People outside the targeted transport program are not directly impacted by this policy, even if they are within the broader dual eligibility set.
- Interviews cover people likely affected by collecting varied demographic and characteristic profiles to reflect a realistic impact spread.
Simulated Interviews
Retired factory worker (Ohio)
Age: 75 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- I struggle to get to my dialysis appointments on my own.
- If transportation were easier, my stress levels would be lower.
- I sometimes have to skip appointments because I cannot find a ride.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 9 | 2 |
Retired teacher (Florida)
Age: 68 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 4/20
Statement of Opinion:
- I've missed past medical appointments due to transportation problems.
- Consistent rides would ease a major burden.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
Retired librarian (California)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- Better transportation access would give me more freedom and reduce reliance on unreliable public transport.
- I worry about missing critical medical appointments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 4 |
| Year 20 | 9 | 3 |
Retired engineer (New York)
Age: 83 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 2/20
Statement of Opinion:
- I heavily rely on facility provided transport, but it's often inconvenient.
- If provided transport improved, it'd greatly help my routine medical needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 7 | 4 |
Retired farmer (Texas)
Age: 90 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- Getting to doctors is tough, sometimes I don't go because it's too much hassle.
- Dependable transport would make things easier.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 2 |
| Year 10 | 7 | 2 |
| Year 20 | 7 | 1 |
Retired logistics operator (Illinois)
Age: 66 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- Dependable transport services would alleviate a lot of stress.
- I've missed treatments because of transportation issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired nurse (Pennsylvania)
Age: 81 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 5/20
Statement of Opinion:
- Transportation isn't my biggest worry, but having reliable transport would benefit my frequent appointments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 5 |
Retired social worker (Georgia)
Age: 69 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 7.0 years
Commonness: 4/20
Statement of Opinion:
- I think the policy would really help streamline the services I need for my health appointments.
- I'm all for improvements if they mean fewer canceled trips.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
Retired construction worker (Michigan)
Age: 78 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 12.0 years
Commonness: 2/20
Statement of Opinion:
- Extra support in securing rides for appointments is necessary because my lung condition.
- Without policy support, issues could result in appointments not happening.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 9 | 2 |
Retired seamstress (South Carolina)
Age: 70 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 4.0 years
Commonness: 3/20
Statement of Opinion:
- I've had to reschedule important therapy sessions due to ride issues.
- Reliable rides could speed up my recovery.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 6 | 3 |
Cost Estimates
Year 1: $150000000 (Low: $120000000, High: $200000000)
Year 2: $155000000 (Low: $125000000, High: $210000000)
Year 3: $160000000 (Low: $130000000, High: $215000000)
Year 5: $170000000 (Low: $135000000, High: $225000000)
Year 10: $190000000 (Low: $150000000, High: $250000000)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Coordination between states and the federal government will be critical for implementation.
- Transportation service availability varies by region, which may impact effectiveness.
- Ensuring eligible populations are aware and can access these services is essential for success.