Medicaid-eligible children and youth under 21 years of age have a legal right to a comprehensive menu of preventive, diagnostic, and ameliorative care under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. A requester contacted the Network seeking guidance on state coverage of ancillary expenses associated with non-emergency medical transportation (NEMT) under EPSDT. The requester wanted to know whether and how states cover meals incidental to NEMT for EPSDT-eligible children.
Access to transportation and nutritious food are essential to positive health outcomes. Without affordable, accessible, and reliable transportation, individuals are unable to obtain medically necessary health and health-related social services. Low-income children are especially vulnerable to transportation barriers. Each year, an estimated 9 percent of children in families with incomes less than $50,000 miss a health care appointment because they have no means of transportation. Similarly, nutritional insufficiencies resulting from food insecurity have significant ramifications for disease management, prevention, and treatment. Low-income children are particularly susceptible to food insecurity: the rate of food insecurity in households with children is 17 percent higher than the national average.
Recognizing the inextricable link between transportation and health, state plans for medical assistance must “specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers[.]” 42 C.F.R. § 431.53. States have significant flexibility in how they will meet this legal mandate for adult beneficiaries. Under Section 1902(a)(70) of the Social Security Act, they may provide NEMT as an administrative expense or an optional service. 42 U.S.C. § 1396a(a). In contrast, states must provide EPSDT-eligible children coverage for all mandatory and optional services listed in Section 1902(a), regardless of whether they are included in the state plan, when medically necessary. 42 U.S.C. § 1396d(r)(5). This includes NEMT.
When an EPSDT-eligible beneficiary qualifies for NEMT, state Medicaid programs must cover certain travel-related expenses necessary to secure examinations and treatment. 42 C.F.R. § 440.170. These ancillary expenses include the cost of beneficiary meals to, from, and while receiving medical care. 42 C.F.R. § 440.170(a)(3). The table below describes state policies implementing these legal requirements.
||Coverage and Limitations
During outpatient treatments requiring an overnight stay outside of a beneficiary’s “home community,” Medicaid will cover up to three beneficiary meals per day.
Meals for children under two years of age are not reimbursed. Instead, meals are reimbursed for the recipient’s companion who must share meals with the recipient.
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The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.