Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation Services

Non-emergency medical transportation (NEMT) can prevent emergency care as a result of delayed or missed medical appointments. Medicaid provides NEMT for low income individuals who have no other means of transportation and this is a critical component of the health care delivery system. This study examined cancelled trips in Medicaid adults age 65+ to explore whether barriers persist for a growing segment of the population who face particular challenges of age-related declines in health and function. Multivariate logistic regression analyses were conducted using transportation brokerage data for Delaware members who intended to travel during 2008-2010, modeling the odds of all cancellations and then these mutually exclusive types: (1) client cancelled; (2) client obtained alternative transportation; and (3) client cancelled due to health. Over half of the cancelled trips were attributed to client reasons. Black race was associated with client canceling (OR=1.4) and canceling due to alternative transportation (OR=1.9). Compared to dialysis, trips for other medical care were more likely to be cancelled for client and health reasons (ORs ranged 1.6-7.9). Higher levels of service increased cancelling for health reasons (OR=2.9 stretcher; OR=1.8 wheelchair). Finally, pre-scheduled or subscription trips were less likely to be cancelled and client factors differed for the cancellation of trips that were not regularly scheduled. The results of this initial study confirm that for this population additional transportation services are often not available and that more support for utilizing NEMT may be needed. Future research should evaluate persistent barriers, service delivery, and long-term outcomes.