Medicaid covers rides for eligible individuals to and from the doctor’s office, the hospital, or another medical office for Medicaid-approved care. This coverage is called “non-emergency medical transportation” or NEMT, because it does not involve a medical emergency. Medicaid consumers who need a ride to a medical appointment, and it is not an emergency, require prior approval.
Medicaid also covers the cost of emergency medical transportation for eligible individuals. Examples include having a heart attack or being seriously injured in a car accident. In cases like these, consumers can be transported to the emergency department by ground (ambulance) or air (medical flight) without pre-approval.
Pennsylvania’s NEMT program is called the Medical Assistance Transportation Program (MATP) and it is available at no cost for Pennsylvanians enrolled in MA who lack other available transportation. The Department of Human Services (DHS) oversees the entire MATP and provides funding for MATP in all 67 counties. Pennsylvania allows counties to decide how to transport residents. A county can operate MATP in a variety of ways. Currently:
54 counties operate MATP at least partially through an in-house or county model; some counties provide transportation directly, some through hired vendors, and some through a mix of the two systems;
Philadelphia County uses a broker model, which was introduced in in 2005; and
12 counties elected to allow DHS to manage NEMT services and DHS has direct agreements with transit agencies to provide NEMT.
In December 2019, the state announced they would continue to run MATP through the counties. This is a departure from Act 40 of 2018, which amended the Human Service Code and required DHS to end the county system and issue a solicitation for either statewide or regional brokers where the broker is at full or partial‑risk to provide MATP services.
However, this summer, state lawmakers passed Act 19 of 2019, which directed the Departments of Aging, Human Services, and Transportation to halt the procurement, study MATP, and issue a report before the end of calendar year 2019. The report, delivered to state legislators in late December 2019, found both approaches—i.e., county and regional models—have advantages and disadvantages. In 2020, DHS officials have expressed a commitment to working with entities involved in MATP to improve the administration and delivery of MATP services. To read the full report, click here.