149716 Devolution's policy impact on non-emergency medical transportation (NEMT)

Tuesday, November 6, 2007: 2:50 PM

Stephen Borders, PhD , School of Nonprofit and Public Administration, Grand Valley State University, Grand Rapids, MI
Craig H. Blakely, PhD , Department of Health Policy and Management, School of Rural Public Health, College Station, TX
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.

Learning Objectives:
1. Recognize how and why transportation creates barriers to health care services for the poor and near-poor. 2. Recognize and discuss the weaknesses devolution creates as it relates to a national strategy to ensure access to care. 3. Identify and discuss the challenges and strategies of improving access to health care services.

Keywords: Access to Care, Children's Health

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.