Medicare and Medicaid have both experienced significant growth in total annual spending and member enrollment in recent years. According to the US Congressional Budget Office, this trend is expected to continue through 2031 and NEMT brokers should similarly expect to see increases in benefit use. The passing of H.R. 133 in December of 2020 and the codification of transportation as an essential benefit has allowed additional Medicaid members to take advantage of these benefits to access healthcare. Along with the changes in legislation, Medicare Advantage Plans are also adopting transportation benefits and there have been significant increases in Plans offering transportation. As additional members enroll and become eligible to use transportation benefits under either program, we should prepare to see similar growth in NEMT benefit use.

Growth

Since 2015, there have been steady increases in Medicare and Medicaid enrollment. Medicare reported 55.9 million enrollees in 2015 and this number increased to 60.7 million enrollees by 2019. Similarly, Medicaid reported 69.8 million enrollees in 2015 and enrollment increased to 75.1 million by 2019.

In estimated value, the Medicare program total annual spending was last valued at $796.2 billion and has been growing consistently. In 2016, spending was totaled at $678.7 billion and this grew to $796.2 billion by 2019. The Medicaid program was last appraised at $639.4 billion and has been growing alongside Medicare. In 2016, spending was recorded at $577.3 billion and that spending increased in 2019 to $639.4 billion. The following year, 2020 spending was estimated at $672.7 billion in total.

The Transit Cooperative Research Program estimated that NEMT accounts for approximately $3 billion in the annual Medicaid spend. While this is less than 1% of total annual expenditures, it still supports Medicaid members who rely on NEMT services providers to access millions of healthcare appointments each year.

Projections

This pool of members is expected to continue to grow in the coming years. Medicare enrollment and spending are expected to increase through 2031, per the US Congressional Budget Office, and is projected to top $1.78 trillion in spending by that date. Medicaid enrollment is also expected to grow significantly through 2027, with spending following suit. Projections estimate an increase to 82 million enrollees and $1,007.9 billion in spending, growing to 3.3% of GDP.

With both insurance programs experiencing a rise in overall expenditure, the change in legislation to mandate transportation services as an essential benefit to eligible members, and the addition of transportation benefits to Advantage Plans, NEMT providers can also expect to see the amount spent on transportation services each year rise as well. If the NEMT industry captures just 1% of total expenditure by 2027, something it is close to doing today, then we can estimate roughly $10.8 billion in spending on transportation benefits from Medicaid alone. Medicare would add an additional $13.5 billion in 2027.

Should these projections prove correct, millions of additional Medicare and Medicaid members will have access to transportation benefits. At CTS, we have made it our mission to increase the availability of cost-effective and efficient transportation to transportation disadvantaged individuals and communities and we look forward to Connecting even more Members to Care.

For additional reading on Medicare and Medicaid, visit cms.gov!

 

Resources:

CMS. (April 15, 2020a). Distribution of Medicaid enrollment and expenditure in FY 2017, by enrollment group [Graph]. In Statista. Retrieved February 14, 2021, from https://www-statista-com.libdb.fairfield.edu:8443/statistics/255342/medicaid-enrollment-and-expenditure-distribution-by-group/

CMS. (April 15, 2020b). Projected total Medicaid expenditure from 2020 to 2027 (in billion U.S. dollars) [Graph]. In Statista. Retrieved February 14, 2021, from https://www-statista-com.libdb.fairfield.edu:8443/statistics/245451/projected-total-medicaid-expenditure/

CMS. (April 15, 2020c). Projected total Medicaid enrollment from 2020 to 2027 (in millions) [Graph]. In Statista. Retrieved February 14, 2021, from https://www-statista-com.libdb.fairfield.edu:8443/statistics/245449/projected-total-medicaid-enrollment/

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CMS. (November 16, 2020). Distribution of U.S. health care expenditure from 2015 to 2020, by payer [Graph]. In Statista. Retrieved February 14, 2021, from https://www-statista-com.libdb.fairfield.edu:8443/statistics/237043/us-health-care-spending-distribution/

CMS. (April 22, 2020e). Total Medicare spending from 1970 to 2019 (in billion U.S. dollars)* [Graph]. In Statista. Retrieved March 06, 2021, from https://www-statista-com.libdb.fairfield.edu:8443/statistics/248073/distribution-of-medicare-spending-by-service-type/

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CMS. (April 22, 2020g). Enrollment in the Medicare program from 1966 to 2019, by type of beneficiary (in millions) [Graph]. In Statista. Retrieved March 06, 2021, from https://www-statista-com.libdb.fairfield.edu:8443/statistics/237045/us-medicare-enrollment-figures/

Cuellar, H. (2020, December 27). H.R.133 – 116th Congress (2019-2020): Consolidated Appropriations ACT, 2021. Retrieved March 06, 2021, from https://www.congress.gov/bill/116th-congress/house-bill/133

Edrington, S., Cherrington, L., Burkhardt, J., Garrity, R., Raphael, D., Borders, S., . . . Collette, P. W. (2018). Handbook for examining the effects of nemt brokerages on transportation coordination. Transportation Research Board of The National Academies of Sciences, Engineering, and Medicine. doi:10.17226/25184

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