Devolution's policy impact on non-emergency medical transportation (NEMT)

Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This research provides one of the first empirical evaluations of this assumption as it relates to Non-emergency Medical Transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care. Yet states have great latitude in making such services available. We completed in-depth interviews with SCHIP officials from 32 states to provide a preliminary assessment of devolution's consequences and policy impact on transportation-related access to care. These findings provide mixed evidence on devolution's impact on policy outcomes. Proponents of devolution can find solace in the fact that several states have gone beyond federally mandated minimum requirements to offer innovative programs to remove transportation barriers to care. Detractors of devolution will find continued pause on several key issues as a number of states do not offer NEMT to their SCHIP populations. State budget pressures have curtailed or even eliminated outreach programs, reduced reimbursements to providers, created waiting lists and reduced eligibility, generally reducing access to care. This has occurred in the face of states having collectively left over $7 billion in federal matching funding unspent as debates on the reauthorization of SCHIP begin in Congress.