As healthcare costs rise and barriers to access multiply, non-emergency medical transportation (NEMT) is proving to be a crucial intervention. Yet experts argue that far more investment is needed to meet the scale of the problem.
The Perfect Storm: Why America Faces a Healthcare Access Crisis
The U.S. healthcare system is under intense strain. A Gallup and West Health poll conducted in 2023 found that roughly 11% of American adults could not afford necessary medical care or prescription drugs, the highest figure recorded in recent years (Gallup & West Health, 2023). Only about half of the respondents reported confidence in their ability to afford both quality healthcare and needed prescriptions.
Cost isn’t the only obstacle. Every year, an estimated 3.6 million Americans skip medical care due to transportation difficulties, often leading to worsening conditions and expensive emergency interventions (National Academies of Sciences, Engineering, and Medicine, 2021). Missed appointments are linked to delayed treatments, poorer health outcomes, and preventable hospital visits.
Several forces have converged to make care harder to access. Inflation grew by more than 12% between 2021 and 2023, while Medicare reimbursement rates for inpatient hospital care rose by just over 5% during the same period (KFF, 2023). This imbalance squeezes providers and leaves patients with higher out-of-pocket costs.
The disparities are stark. Between 2021 and 2023, the share of Hispanic adults reporting an inability to pay for care rose eight points to 18%, while the rate among Black adults grew to 14%. For households earning less than $24,000 annually, one in four reported being unable to cover medical costs (Gallup & West Health, 2023). Meanwhile, CDC data show that over 7% of adults avoided medical care due to cost pressures (CDC, 2022).
Demographics add another layer. The U.S. Census Bureau projects that by 2034, older adults will outnumber children for the first time in U.S. history, with the over-65 population surpassing 77 million. By 2030, all baby boomers will be retirement age, intensifying demand for healthcare.
Transportation is one of the most visible bottlenecks. About one in five adults lacking access to either a car or reliable transit missed needed medical appointments in the past year (Urban Institute, 2022). Patients with chronic conditions such as liver disease are especially vulnerable to these disruptions.
The $20 Billion Solution: Non-Emergency Medical Transportation
Amid these challenges, NEMT stands out as a cost-effective way to bridge the gap between patients and providers. Unlike ambulances, NEMT services are designed for scheduled, non-emergency trips, such as dialysis appointments, physical therapy, or follow-up care. Vehicles are often equipped to accommodate wheelchair users, stretchers, and mobility devices, and drivers are trained to assist patients safely.
NEMT has been part of Medicaid since its creation in 1965, grounded in the principle that insurance coverage means little if patients cannot physically reach a provider (CMS, 2021). What began as a simple transportation benefit has grown into a national network of dedicated providers and technology platforms.
Market estimates vary, but analysts place the value of NEMT and related services at nearly $20 billion today, with continued growth expected (Value Market Research, 2023). Evidence suggests strong returns: Florida’s Medicaid program found that each dollar invested in NEMT yielded more than $11 in avoided healthcare costs (Florida Medicaid ROI Study, 2018). Other studies confirm that integrating transportation into chronic disease care management saves hundreds of millions annually (Medical Transportation Access Coalition, 2018).
Transportation’s link to hospital readmissions is well-documented. Surveys of Medicare beneficiaries show that nearly one-third miss appointments or run out of medications due to a lack of transport (Kaiser Family Foundation, 2019). Patients without reliable transportation are more than twice as likely to visit emergency departments multiple times per year (Health Affairs, 2017).
Missed routine visits accelerate disease progression and raise the likelihood of costly emergency interventions. Improved transportation access, by contrast, has been shown to enhance treatment adherence, reduce overall spending, and improve patient quality of life (MTAC, 2018).
Why $20 Billion May Not Be Enough
Despite NEMT’s proven value, experts say the current investment scale falls far short. Each year, nearly 6 million Americans miss non-emergency appointments due to transportation barriers (Transportation Research Board, 2021). With the over-65 population projected to rise almost 50% by 2050, the demand will only intensify.
Rural areas highlight the gaps. Limited or nonexistent public transportation in sparsely populated regions forces seniors and people with disabilities to rely on family, neighbors, or costly alternatives. This leaves many unable to attend critical appointments or even access pharmacies.
Physical and cognitive limitations also make travel difficult for older adults. Conditions such as arthritis, sensory impairments, and cognitive decline often limit mobility and driving ability. Many older adults require specialized equipment, such as walkers or wheelchairs, and vehicles with accessibility modifications, while limited retirement incomes make car ownership and upkeep unaffordable.
Health disparities remain another pressing concern. Adults with disabilities report three times higher rates of missed care due to transportation compared to the general population (CDC, 2022). Communities of color and low-income households also face disproportionate access challenges.
A Critical Path Forward: Maximizing NEMT’s Potential
The evidence is clear: NEMT represents one of the most cost-effective interventions in healthcare, delivering more than $11 in savings for every dollar invested. Yet with nearly 6 million Americans missing medical care annually due to transportation barriers to healthcare access, the current $20 billion market represents just the beginning of what’s needed.
Healthcare policy experts suggest several strategies to maximize impact: integrating technology, such as GPS tracking and electronic scheduling software like RouteGenie, can strengthen program integrity and improve on-time performance. Expanded coverage with streamlined authorization processes can reduce wait times, while closer coordination among providers can ensure faster response times.
As America grapples with rising healthcare costs and access barriers, scaling NEMT investment could provide a pathway to a more equitable and efficient healthcare system. The question isn’t whether America can afford to invest more in NEMT—it’s whether the nation can afford not to. With hospital readmissions costing billions annually and transportation barriers contributing to widening health disparities, expanding NEMT services from a $20 billion solution to a comprehensive national infrastructure could be the key to unlocking a healthier, more equitable America.
Dorothy I. Johnson is the heart and soul of Flash Flyer Blog’s writing team. Dorothy loves storytelling and finds the extraordinary in everyday life. She has a unique voice for sharing travel stories, tech trends, wellness tips, and food finds. Her relatable style makes complex ideas easy to grasp. She also turns simple moments into captivating stories. Dorothy’s background and curiosity inspire her to make content that connects with readers. They can find either practical tips or new viewpoints in her work. When she’s not writing, she likes to explore new places. She experiments in the kitchen or dives into a new personal growth book.
