Senate panel, Medicaid officials seek fix to NEMT contracting language and funding for driver recruitment

Ashley Berlinger, director of Medicaid policy for the Agency of Human Services, told the Senate Transportation Committee on April 23 that proposed changes in Sections 27 and 29 of the transportation bill would force the state to consider matters outside the scope of Medicaid when contracting for nonemergency medical transportation (NEMT).

Berlinger said federal Medicaid rules — and Centers for Medicare & Medicaid Services (CMS) guidance tied to Vermont's 1115 Global Commitment to Health waiver — prohibit considering other programs or the financial stability of the public transit system when awarding an NEMT contract. "We cannot consider anything beyond the scope of NEMT for Medicaid," she said, and added that federal reviewers are now scrutinizing contracts, manuals and communications more closely than before under a "fraud, waste and abuse" lens.

The testimony prompted committee members, AHS and public-transit providers to agree to redraft the bill language. AHS said it will provide written follow-up with citations and will propose alternative wording intended to avoid any conflict with federal law. The committee aims to circulate revised language by Friday and, if stakeholders agree, amend the T bill before its second reading, which is scheduled for Tuesday.

Why it matters: NEMT provides rides for Medicaid members who need nonemergency medical care. If state contract language requires an agency to analyze impacts beyond NEMT — for example, the financial stability of public transit or effects on an older-adults and persons-with-disability (O & D) program — AHS warns that CMS could view those requirements as inconsistent with federal rules and expose the state to sanction or disallowance.

Key concerns in Sections 27 and 29 - Section 27: Berlinger said the section, as drafted, would require the named state agency to deliver a detailed analysis of a proposed NEMT contract that considers impacts on the older adults and persons with disability program and the public transit system's financial stability. "It doesn't permit us to consider anything related to financial stability of the public transportation system," she said, and urged the committee to remove or rewrite the section. - Preference for incumbent vendor: AHS argued that several subrequirements in Section 27 could effectively enshrine a preference for the incumbent NEMT vendor by imposing extra proof requirements on potential new contractors. - Section 29: The bill's outreach language that would require publicity for a volunteer-driver program raised concerns that state outreach could be construed as pre-bid promotion for an incumbent vendor. AHS offered to work with the committee to find terminology that permits eligibility information to reach potential riders without creating the appearance of advertising for a future bidder.

Stakeholder perspectives and operational concerns - Jim Moulton, executive director of Tri Valley Transit and chair of the Vermont Public Transportation Association (VPTA), described the operational complexity of providing medical rides in rural areas and said transit providers support care in compliance with federal rules while seeking additional resources to make services sustainable. "One of the big elements... is more coordinated transportation, putting more people in any particular vehicle," he said, noting that cost-efficiency goals can conflict with privacy and safety rules. - Kathleen Knox, Blueprint program manager for the Randolph health service area at Gifford Health Care, described on-the-ground scheduling challenges and limits on same-day transport. Knox said her team tries to coordinate multiple appointments for patients when possible but that HIPAA, appointment availability and volunteer-driver shortages constrain options. She noted that her team has five to six staff members whose primary work is coordinating transportation. - Ashley Lincoln of Gifford said the hospital previously provided operating support to Tri Valley Transit and that the most recent gift was about $10,000, though she could not confirm current fiscal-year support.

Funding and timeline discussed by the committee Committee members and appropriations staff described a funding approach under consideration: redirecting a portion of so-called "pilot" funds into the T fund to free approximately $1.1 million in T fund capacity. Under the proposal discussed in committee, about $600,000 of that freed amount would be used for a nonmedical-transport driver recruitment program; the rest would shore up T fund needs. Committee members described that funding as subject to appropriation and implementation details still to be finalized.

Other operational issues raised - Weekends and emergency costs: Witnesses said limited weekend transportation forces some patients to use emergency medical services and ambulance transport, which is substantially more expensive than scheduled NEMT rides. - Service mix: Transit providers and the committee discussed the long-standing model of combining fixed-route, deviated-route and dial-a-ride (including volunteer drivers) services to serve rural areas; speakers urged further study and modeling of fixed routes that serve clusters of senior housing or medical centers. - Eligibility communication: AHS offered to rework outreach language so Medicaid-specific eligibility can be publicly communicated without creating the appearance of vendor promotion.

Next steps AHS said it will deliver written follow-up with legal citations and suggested redrafting to avoid federal compliance risk. Committee staff and stakeholders agreed to share and mark up draft language; the committee's goal is to circulate revised text by Friday and, if agreed, place an amendment on the T bill before its second reading on Tuesday. Appropriations staff and senators also indicated intent to advance an appropriation amendment to fund a driver recruitment effort, with details to be finalized between appropriations and the transportation committee.

Discussion versus decision: The committee did not take any formal votes during this session; the meeting ended with direction to produce and circulate revised bill language and to continue negotiations among AHS, transit providers, hospitals and committee staff.

Ending note: Committee chairs asked stakeholders to confer quickly so that any technical corrections or funding amendments can be ready for the bill's next floor action.