Medicaid NEMT brief: brokers, regions and rising costs; committee asks for PMPM detail

The House Study Committee received a technical briefing on Medicaid nonemergency medical transportation (NEMT) and the broker model used in Georgia.

"NEMT is the program that provides medically necessary transportation for eligible Medicaid members who have no other means of transportation available," James Peoples, Director of Provider Services at the Department of Community Health, told the committee. DCH divides the state into five NEMT regions and contracts with brokers (Motive Care and Verata) that, in turn, build local provider networks to deliver trips.

Peoples described modes of service (ambulatory curb‑to‑curb, wheelchair door‑to‑door, stretcher bed‑to‑bed), mileage guidelines (30 miles urban/50 miles rural for medical appointments; 15/30 for pharmacy/adult day health) and exceptions when medical necessity requires travel beyond those limits. He said brokers are paid a PMPM (per member per month) rate that covers call centers, technology and operational costs as well as trip payments to providers; the broker PMPM, and the brokers’ total annual payments, were included in materials provided to the committee.

DCH also summarized volunteer‑driver rules (adults with a valid license and insurance may be reimbursed for gas), the state’s early adoption of rideshare (Uber/Lyft) for eligible members, and ongoing work groups with skilled‑nursing, dialysis and other high‑trip facilities to reduce complaints. Representatives noted regional coverage maps appear to aggregate large rural swaths; DCH said regional boundaries were based primarily on Medicaid population per region to sustain a broker’s operations.

Lawmakers asked DCH to provide district‑level counts of Medicaid members, PMPM rates, and the brokers’ regional trip volumes and payments for further scrutiny. No vote was taken; DCH committed to following up with the committee on volunteer‑driver fluctuations and the broker reports.