By NextBestFitCover ambulance and non-emergency transport
Cover ambulances (ending surprise bills for ground ambulances) and rides to care for everyone, not only Medicaid.
Draft decision:ChosenPhase 2: Wave 1: seniors, near-seniors, and childrenConfidence: high · not yet reviewed
Covers ambulances and rides.
Review ledgerHow this path connects
This path
Cover ambulance and non-emergency transport
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Cover ground ambulance and non-emergency rides for everyone
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Getting to care: transportation and ambulances
Covering rides and ambulances for everyone reduces missed appointments and ends surprise ground ambulance bills.
- Surprise billing and a runaway arbitration system
Covering ground ambulances ends surprise bills for these trips.
What it creates or worsens
- Fraud and improper payments
Universal ride coverage creates a risk of fraudulent claims for fake rides.
- Raises spending or loosens control over it
Covering rides and ambulances for everyone adds costs.
- Medical errors and poor care coordination
Covered rides depend on brokers whose reliability records are poor.
7 paths soften this
Mandatory error reporting and learning systemMedical errors and poor care coordinationChosenEvery person registered with a primary care homeMedical errors and poor care coordinationChosenStandby payments to keep labor units openMaternity care desertsChosenMinimum nurse staffing ratiosNursing and direct-care shortages and burnoutChosenEvidence-based coverage decisionsLow-value care and overtreatmentChosenShift to small homes and home careNursing home understaffing and qualityChosenNational health record and patient IDRecords don't follow patientsChosen
Who's affected
Who gains
- Older adults
- Getting to care: transportation and ambulances: Lack of transportation causes missed appointments.
- People with ongoing or specialist care needs
- Getting to care: transportation and ambulances: Lack of transportation causes missed appointments.
- Surprise billing and a runaway arbitration system: Ambulance rides and out-of-network specialists send bills patients didn't choose.
- Rural residents
- Getting to care: transportation and ambulances: Closing rural emergency transport services reduce access to care.
- People with employer coverage
- Surprise billing and a runaway arbitration system: Premiums fund the higher arbitration awards.
- Fraudulent operators and cybercriminals
- Fraud and improper payments: Fraudulent providers receive improper health payments.
- Hospitals, clinics, and care organizations
- Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
Who loses
- Private ambulance operators
- Getting to care: transportation and ambulances: Out-of-network ground ambulance bills lack surprise-billing protections.
- Hospitals and specialist groups with high private prices
- Surprise billing and a runaway arbitration system: Private-equity-backed emergency, anesthesia, and radiology groups win high awards.
- Taxpayers and public budgets
- Fraud and improper payments: Fraud and improper payments consume public funds and premiums.
- Raises spending or loosens control over it: Public budgets pay the added spending.
- People with employer coverage
- Fraud and improper payments: Fraud and improper payments consume public funds and premiums.
- People with ongoing or specialist care needs
- Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
Where it has been tried
- Medicaid NEMT: Medicaid covers rides to appointments.
- United States: A 2016 KFF brief cited estimated annual Medicaid non-emergency transport spending of $3 billion, less than 1% of total Medicaid expenditures.Sources: KFF (2016)