A good number of NEMT brokers are beginning to test private taxis and rideshare services as an alternative to make available transportation for Medicaid enrollees. Via this approach, NEMT services are provided by drivers using their personal vehicles, similar to rideshare companies like Uber and Lyft.
Note that this can be combined with traditional NEMT to also provide rides via prearranged vans or taxis. In the United States, this sort of transport is becoming appealing since it provides more flexibility for passengers; and it is more suited for last-minute rides, like hospital discharges; and may reduce wait times and cost.
They can also help out with NEMT broker companies since they can better track rides and collect data, potentially addressing quality, fraud, waste, and abuse. However, some experts in the industry complain about lower pay for drivers, lack of access in rural areas, inadequate driver screening, and safety issues for drivers and riders.
Presently, the capabilities of private taxis are well suited for individuals with medical conditions. The use of private taxis by brokers is also most appropriate for inpatient and outpatient discharges, on-demand rides, requests for rides in which the scheduled mode failed to meet up, and rides requiring minimal assistance or monitoring.
As the world of private taxi and rideshare services grow in popularity—and as the populations accessing NEMT through Medicaid and Medicare Advantage heightens —it becomes more necessary to look into gaps and failures in current NEMT service paradigms, the role private taxis can impeccably play, and the numerous advantages of private taxis playing that role in the healthcare ecosystem. Rideshare is a new technology in the NEMT space, and its role is still evolving.
Service Lines Offered By Private Taxis to Help Out With NEMT Broker Companies
Individuals who require the services offered by NEMT providers more or less lack certain necessary physical and cognitive abilities.
Have it in mind that using private taxis or rideshare services to make available NEMT services is very appropriate for a subset of people. However, before considering who makes up this subset, it is imperative to define the service lines offered by private taxis that help out brokers in the NEMT market.
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Hand-to-Hand (H2H)
Note that these services are most often necessary either because of the level of assistance needed by the individual or the necessity of a chain of custody.
In terms of the level of assistance required, this may include individuals who need standby assistance or are unable to travel independently for any distance within their home or outside without constant support from a companion, assistant, and/or potentially the NEMT driver.
Have it in mind that an individual could need such assistance owing to cognitive, sensory, or physical impairment. In terms of the chain of custody, children most often fall into this category of need since they would not be allowed to travel alone.
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Door-to-Door (D2D)
D2D services are more suited to individuals who can move at least semi-independently and will only require light assistance from the driver to move from their front door to (and into) the vehicle and vice versa. Note that within the scope of this D2D service, the driver offers light assistance getting from the point of origin to and then into the vehicle and, at the end of the trip, out of the vehicle and then to the location.
Have it in mind that this level of service may be ideal since the intended individuals will need assistance opening vehicle doors, getting into the vehicle, fastening seatbelts, moving and stowing any goods or mobility devices they have with them.
In addition, assistance may include physically helping and interacting with the passenger, managing doors and buckles, or offering auditory or task-based guidance.
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Curb-to-Curb (C2C)
According to experts, this service is ideal for individuals who can get to the curb independently and enter a vehicle with little or no assistance. In the NEMT industry, It is argued that D2D service features lower dwell time (time between arrival and departure from the curb) than C2C, although this is debated and yet to be convincingly proven.
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Area-to-Area (A2A)
These services are more tailored for individuals who are quite ambulatory, able to walk distances (e.g., a half-mile to a bus stop) independently and without strain, and can easily enter a vehicle without assistance. Have it in mind that individuals in this group can walk to a nearby medical service or to a public transit.
This service line is very different from C2C since people who use C2C can only move a short distance from a building exit to a curb but not farther, however, A2A individuals can walk farther to, for instance, a group pickup location or bus or train stop.
Conclusion
In the United States, NEMT can involve any mode of transportation. Note that the modes vary massively —from a bus or a subway to a neighbor’s or family member’s vehicle, to a taxi-passenger vehicle, paratransit, or other options up to an airplane.
Most often, the decision about the sort of NEMT to assign an individual is usually based on the individual rider/beneficiary needs, available transportation options, environmental conditions, what the ride involves, and system constraints.