Transportation brokerage services and Medicaid beneficiaries' access to care

This dissertation investigates the effects of transportation brokerage services on Medicaid beneficiaries' access to care. Medicaid pays for non-emergency medical transportation services to help vulnerable patients with transportation needs. The intended effect of transportation brokerage services is to provide reliable transportation at minimum costs. The study period from 1996 to 1999 corresponds to the period of a natural experiment during which Georgia and Kentucky implemented transportation brokerage services. Individual-level data were used to measure changes in use and expenditures of Medicaid services. Three study populations, which are transportation users, children with asthma, and adults with diabetes, were identified to capture possible effects. A difference-in-differences model was used to assess the effect of transportation brokerage services on Medicaid beneficiaries' access to care. The design is strengthened by the staggered implementation dates between states and within each state. Results show that the implementation of transportation brokerage services had significant effects on Medicaid beneficiaries' access to care, measured by Medicaid expenditures and health services use. The effects differed by type of Medicaid services and by medical conditions. Results for ambulatory care sensitive conditions admissions and ER use due to medical conditions suggest that adults with diabetes were better off under transportation brokerage services while the effects for children with asthma were inconclusive. Findings from this analysis could help guide policy modifications that support the reliable provision of non-emergency medical transportation services.