In Arizona, Medicaid beneficiaries can now use an Uber or Lyft to get to the doctor's office. Arizona has become the first state to change Medicaid rules to make it easier for ride-sharing companies to provide non-emergency transportation. The idea is that better availability of rides will make it easier for beneficiaries to keep medical appointments.
 
The changes have opened up thousands of potential new rides in a state where approximately 24% of the 7 million residents are on Medicaid, says a recent article in Kaiser Health News (KHN).
 
The new rules relax some safety requirements, such as driver drug testing and first aid training. However, Uber and Lyft generally serve healthier beneficiaries who are less likely to need specialized assistance. The extra capacity frees up space in specialized vehicles for people who are in wheelchairs or need more intensive help. Ride-sharing vehicles also can come quickly and take solo passengers, while specialized vehicles often require reservations days in advance and are shared rides.
 
The changes address a key problem highlighted in the National Health Interview Survey: that in 2017, more than 2 million Medicaid enrollees under age 65—more than 4% of Medicaid members—delayed care because they did not have transportation.
 
At this point, the effectiveness of ride-sharing programs is not clear. While about 15% of Arizona’s beneficiaries used Uber and Lyft this summer, so far there is no estimate of cost savings. A recent University of Pennsylvania study found no improvements in missed appointments among Medicaid beneficiaries in West Philadelphia who had access to ride-sharing services, which points to other possible causes. Perhaps Medicaid beneficiaries miss appointments because they are more limited by lack of time off work or need for child care, study co-author Krisda Chaiyachati told KHN.
 
The trend toward adding ride-sharing programs to the transportation mix is continuing. Florida and Texas have relaxed state regulations to make it easier for Uber and Lyft to transport Medicaid beneficiaries, starting in early 2020. In about a dozen cities, Uber is training drivers to serve passengers who use fold-up wheelchairs, walkers, and scooters.
 
“I think what we are seeing is the beginning of a domino effect,” Megan Callahan, vice president of health care at Lyft, told KHN. “Our overall driver availability and speed are the big advantages that will have an impact on Medicaid members’ satisfaction.”