NEMT as a Social Determinant of Health: Why Transportation Is Central to Health Equity

Social determinants of health account for an estimated 80% of health outcomes — and transportation is one of the most actionable. This guide explains how NEMT addresses SDOH, why CMS and NCQA are elevating transportation in quality frameworks, and how health plans and providers can leverage NEMT to close care gaps, improve HEDIS scores, and advance health equity.

Published: Feb 19, 2025Updated: Feb 19, 202518 min read

What Are Social Determinants of Health?

Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health outcomes, functioning, and quality-of-life risks. These non-medical factors are now recognized by CMS, NCQA, and the broader healthcare industry as the primary drivers of health outcomes — accounting for an estimated 80% of what determines whether a person stays healthy or becomes sick.

The Healthy People 2030 framework, developed by the U.S. Department of Health and Human Services, organizes SDOH into five interconnected domains. Understanding these domains is essential for health plans, MCOs, and providers developing strategies to improve population health and reduce total cost of care.

Economic Stability

Employment status, income level, food security, and housing stability. Economic instability limits a person's ability to afford healthcare, medications, nutritious food, and stable housing — all of which directly affect health outcomes.

Education Access and Quality

Literacy levels, language barriers, educational attainment, and health literacy. Members with lower health literacy are less likely to understand treatment plans, manage chronic conditions, or navigate the healthcare system effectively.

Social and Community Context

Social isolation, discrimination, community engagement, and incarceration history. Members who lack social support networks experience worse health outcomes and are less likely to maintain treatment adherence.

Healthcare Access and Quality

Insurance coverage, provider availability, and transportation to care. Even members with comprehensive insurance cannot benefit from their coverage if they cannot physically reach their provider. Transportation barriers fall directly within this domain.

Neighborhood and Built Environment

Housing quality, walkability, public transit availability, access to healthy foods, and environmental conditions. The built environment determines whether a member has safe, reliable pathways to reach healthcare facilities — making transportation infrastructure a core component of this domain.

Key Insight

Transportation is unique among SDOH factors because it sits at the intersection of two domains — healthcare access and neighborhood/built environment. This dual classification makes it one of the most impactful and measurable social determinants that health plans can address directly through NEMT benefits and partnerships.

Transportation as a Social Determinant

Among all social determinants, transportation is one of the most directly actionable — and one with clear, measurable impact on healthcare utilization and outcomes. When a member cannot get to their appointment, every other investment the health plan has made in that member's care — network adequacy, care management, medication coverage — is rendered ineffective.

Data from the Agency for Healthcare Research and Quality (AHRQ) shows that approximately 3.6 million Americans miss or delay medical care each year due to transportation barriers. Transportation is consistently ranked as the third-largest barrier to healthcare access in the United States, behind only cost and provider availability.

3.6 Million Affected Annually

An estimated 3.6 million Americans miss or delay necessary medical care each year because they lack transportation. This figure represents a massive, preventable gap in healthcare delivery that NEMT is specifically designed to close.

#3 Barrier to Healthcare Access

Transportation ranks as the third-largest barrier to healthcare access nationally. Unlike cost and provider availability — which require systemic policy changes — transportation is an addressable barrier that health plans and providers can solve directly through NEMT.

Disproportionate Impact

Transportation barriers disproportionately affect elderly individuals who can no longer drive, people with disabilities requiring accessible vehicles, rural populations without public transit, low-income households without personal vehicles, and Medicaid and Medicare beneficiaries.

Cascade of Consequences

A missed appointment due to transportation is not just a scheduling inconvenience. It leads to disease progression, delayed diagnoses, unmanaged chronic conditions, preventable emergency department visits, and avoidable hospitalizations — each driving up total cost of care.

For health plans and MCOs, the implication is clear: investing in NEMT is not simply a transportation expense — it is an investment in healthcare access that directly affects quality metrics, member outcomes, and total cost of care. Every dollar spent on getting a member to a preventive screening or chronic disease management appointment avoids multiples of that cost in downstream emergency and inpatient utilization.

Transportation Barriers and Health Disparities

Transportation barriers do not affect all populations equally. The communities most impacted by lack of transportation access are the same communities that already experience the worst health outcomes — creating a compounding cycle of disparity that health plans and providers must address to achieve meaningful equity improvements.

Rural vs. Urban Access Gaps

Rural communities face a structural transportation deficit. Public transit is limited or nonexistent, rideshare services often do not operate in these areas, and the distance to the nearest healthcare facility may exceed 30 miles. Rural Medicaid members are significantly more likely to report transportation as a barrier to care compared to their urban counterparts.

Elderly Patients Unable to Drive

As individuals age, many lose the ability to drive safely due to vision decline, cognitive changes, or physical limitations. Without family members available to provide rides — an increasingly common reality as family structures and geographic distribution shift — elderly patients face isolation from the healthcare system at the exact point in their lives when they need it most.

Disabled Individuals Without Accessible Transport

People with physical disabilities who use wheelchairs, walkers, or other mobility devices require vehicles with ramps, lifts, or stretcher configurations. Standard rideshare and public transit options frequently cannot accommodate these needs, leaving disabled individuals dependent on specialized NEMT services that may not be readily available in their community.

Low-Income Populations Without Vehicles

Households without personal vehicles — disproportionately concentrated in low-income communities — face compounding barriers: inconsistent public transit schedules, inability to afford rideshare services, and lack of social networks that can provide reliable rides to recurring medical appointments such as dialysis, chemotherapy, or physical therapy.

Medicaid Members and No-Show Rates

Research indicates that Medicaid members facing transportation barriers experience approximately 25% higher no-show rates for medical appointments compared to members without transportation challenges. These missed appointments result in delayed diagnoses, unmanaged chronic conditions, and higher downstream emergency and inpatient utilization — driving up total cost of care for MCOs.

Racial and Ethnic Disparities

Transportation barriers intersect with racial and ethnic health disparities. Communities of color are more likely to live in areas with inadequate public transit, less likely to have access to personal vehicles, and more likely to face geographic distance from quality healthcare providers. Addressing transportation as an SDOH is inseparable from addressing racial health equity.

Key Statistic

Medicaid members with transportation barriers experience approximately 25% higher appointment no-show rates. Each missed appointment represents a lost opportunity for preventive care, chronic disease management, and early intervention — driving avoidable costs and widening health disparities.

CMS and NCQA Focus on Social Determinants of Health

The regulatory and accreditation landscape has shifted decisively toward requiring health plans to identify, document, and address social determinants of health — including transportation. Plans that fail to integrate SDOH into their operations face both compliance risks and competitive disadvantages.

CMS SDOH Screening Requirements

CMS now requires Medicare Advantage plans to report on SDOH screening activities for their member populations. This includes identifying members who face transportation barriers to healthcare access. Plans must demonstrate that they are actively screening for and addressing social determinants as part of their quality improvement and member health strategies.

NCQA Accreditation Standards

NCQA accreditation standards include SDOH assessment requirements that health plans must meet. Plans seeking or maintaining NCQA accreditation must demonstrate processes for identifying members with unmet social needs — including transportation — and connecting them with appropriate resources and interventions.

CMS STAR Ratings and Member Access

CMS Star Ratings factor in member access to care, which is directly influenced by transportation availability. Plans with members who report difficulty accessing care due to transportation barriers will see that reflected in their CAHPS survey results and, by extension, their Star Rating performance.

Medicaid NEMT as a Mandated Benefit

State Medicaid programs are mandated to provide non-emergency medical transportation as a covered benefit under federal requirements. This mandate recognizes transportation as essential infrastructure for healthcare delivery — not an optional convenience. Medicaid MCOs must contract with NEMT providers or transportation management companies to fulfill this obligation.

2024-2025 CMS Rule Changes

Recent CMS rule changes have elevated supplemental benefits — including transportation — as strategic tools for addressing SDOH. Medicare Advantage plans now have expanded flexibility to offer NEMT as a supplemental benefit, and CMS has signaled continued policy movement toward integrating SDOH interventions into quality measurement and reimbursement frameworks.

The regulatory trajectory is clear: SDOH is moving from a voluntary best practice to a compliance requirement. Health plans that build NEMT into their SDOH strategy now are positioning themselves ahead of regulatory expectations while simultaneously improving member outcomes and reducing total cost of care.

Impact on HEDIS and STAR Ratings

For health plans, the connection between transportation and quality performance is measurable and direct. When members miss appointments, the plan's quality scores suffer. When members attend their scheduled care consistently, quality measures improve. NEMT is the intervention that bridges this gap.

Diabetes Screening Rates

Comprehensive diabetes care measures — including HbA1c testing, eye exams, and kidney screening — require members to attend specific appointments. Members with transportation barriers are significantly less likely to complete these screenings, pulling down the plan's HEDIS performance on one of the most heavily weighted measure sets.

Breast Cancer Screening

The breast cancer screening HEDIS measure requires eligible members to complete a mammogram within the measurement period. Transportation barriers are a documented reason why eligible members fail to complete screening, particularly among low-income, elderly, and rural populations. Reliable NEMT directly improves screening completion rates.

Follow-Up After Hospitalization

The follow-up after hospitalization (FUH) measure tracks whether members attend a follow-up visit within 7 and 30 days of hospital discharge. This measure is one of the most transportation-sensitive in the HEDIS set — recently discharged patients often cannot drive and may lack family support to get to their follow-up appointments.

Medication Management

Medication management measures assess whether members with chronic conditions maintain their medication regimens. Members who cannot get to medication management appointments are more likely to discontinue medications, take incorrect dosages, or experience adverse drug interactions — all of which worsen the plan's quality scores.

CAHPS Surveys and Member Experience

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey directly asks members about their experience accessing care. Members who face transportation barriers report lower satisfaction with care access, which impacts the plan's CAHPS scores — a significant component of overall Star Ratings. Plans that provide reliable NEMT benefits see measurable improvements in member-reported access to care.

STAR Rating Impact

Plans with reliable NEMT programs see measurable improvements across multiple Star Rating dimensions: higher HEDIS quality measure scores from improved appointment adherence, better CAHPS member experience ratings from improved care access, and lower total cost of care from reduced emergency and inpatient utilization. Each half-star improvement in Star Ratings translates to significant revenue impact through quality bonus payments and member enrollment growth.

Improve Your HEDIS Scores With Reliable NEMT

Partner with Dream Care Rides to close care gaps and improve appointment adherence across your member population. In-house fleet, trip data reporting, and coverage across 80+ cities.

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How NEMT Closes Care Gaps

Care gaps — the difference between recommended care and care actually received — are the central challenge for health plans seeking to improve quality and reduce costs. Transportation barriers are a root cause of many care gaps, and NEMT is the direct intervention that closes them.

Preventive Screenings

NEMT ensures members reach preventive screenings that close HEDIS care gaps: colonoscopies, mammograms, annual wellness visits, diabetic eye exams, and cervical cancer screenings. These appointments are particularly vulnerable to transportation barriers because they are elective — members who face a transportation challenge will often skip or postpone preventive screenings in a way they would not skip an acute care visit.

Chronic Disease Management

Members with chronic conditions require frequent, recurring appointments that cannot be missed: dialysis three times per week, physical therapy two to three times per week, chemotherapy cycles on strict schedules, and ongoing specialist visits for conditions like diabetes, COPD, and heart failure. NEMT with standing order scheduling ensures these members maintain their treatment protocols without gaps.

Post-Discharge Follow-Up

The 7-day and 30-day post-discharge windows are critical periods where follow-up appointments prevent readmissions. Recently discharged patients are often the most transportation-vulnerable — they may have surgical driving restrictions, new mobility limitations, or no family available to drive them. NEMT bridges this gap and directly supports the follow-up after hospitalization (FUH) HEDIS measure.

Behavioral Health Access

Behavioral health appointments face some of the highest no-show rates across all appointment types, and transportation barriers are a primary driver. Members seeking therapy, psychiatric medication management, or substance use treatment often face compounding barriers: stigma, inconsistent motivation, and lack of transportation. Removing the transportation barrier can be the factor that keeps a member engaged in behavioral health treatment.

The Last Mile Problem

Healthcare delivery has invested billions in building provider networks, developing treatment protocols, and expanding insurance coverage. But all of that investment fails at the last mile if the member cannot physically get from their home to the provider's office. NEMT solves the last mile problem in healthcare delivery — connecting members to the care that has already been designed, approved, and funded for them.

NEMT in Health Equity Strategies

Health equity — the principle that every person has a fair opportunity to attain their full health potential — requires addressing the structural barriers that create disparities. For health plans developing equity strategies, NEMT is one of the most concrete, measurable interventions available.

Integrating NEMT Into Population Health Management

Leading health plans are integrating NEMT data into their population health management platforms. Trip utilization patterns, member-level transportation histories, and geographic access analysis provide insights that go beyond traditional claims data — revealing which members face barriers before those barriers result in adverse outcomes.

Using Trip Data to Identify At-Risk Members

NEMT trip data is a powerful signal for identifying at-risk members. Members who frequently cancel rides, no-show for scheduled trips, or stop utilizing transportation benefits entirely may be experiencing additional SDOH barriers beyond transportation — housing instability, food insecurity, or worsening health conditions. Plans that monitor trip data can trigger proactive care management outreach before these members fall through the cracks.

Targeting High-Utilization ZIP Codes

Geographic analysis of NEMT utilization reveals concentration patterns that help plans allocate resources more effectively. ZIP codes with high NEMT utilization often correlate with areas of concentrated social need — and plans can use this data to deploy targeted interventions including community health worker programs, mobile health clinics, and enhanced care management.

Community Health Worker Integration

Partnering NEMT with community health worker programs creates a comprehensive SDOH intervention. Community health workers identify barriers and connect members to resources, while NEMT ensures members can physically access the care and services those workers coordinate.

Measuring NEMT ROI

The return on investment for NEMT as an SDOH intervention is measurable: reduced emergency department visits, fewer avoidable hospitalizations, improved chronic disease outcomes, and better quality scores. Plans that track these metrics demonstrate the value of their SDOH investments to CMS, NCQA, and their own leadership.

Value-Based Care Models

Health plans incorporating NEMT into value-based care models recognize that total cost of care cannot be reduced without addressing the social factors that drive utilization. NEMT investment in value-based arrangements pays returns through lower medical loss ratios and improved quality performance.

Health Equity Reporting

CMS and state regulators are increasing requirements around health equity reporting. Plans that can demonstrate how their NEMT programs reduce disparities in care access across demographic groups, geographic areas, and socioeconomic levels position themselves favorably in an evolving regulatory environment.

Dream Care Rides as Your SDOH Partner

Addressing transportation as a social determinant of health requires more than a ride — it requires a partner who provides consistent, equitable access, actionable data, and the operational reliability that health plans need to move quality metrics. Dream Care Rides is built for this role.

In-House Fleet for Consistent Access

Unlike broker-dependent models that rely on fragmented networks of subcontracted drivers, Dream Care Rides operates an in-house fleet. This means consistent vehicle quality, credentialed drivers on every trip, and the reliability that health plans need to ensure equitable member access across their service area.

Coverage Across 80+ Cities in IL & IN

Our coverage spans urban and suburban communities across Illinois and Indiana — including the underserved areas where transportation barriers are most acute. Members in every covered ZIP code receive the same level of service, eliminating the geographic disparities that broker models often create.

All Mobility Levels Served

Ambulatory sedans, wheelchair-accessible vans with hydraulic lifts, stretcher vehicles, and bariatric configurations ensure that no member is excluded from transportation access due to their mobility status. Health equity requires that members with disabilities receive the same access to care as ambulatory members.

Trip Data and Utilization Reporting

We provide trip-level data and utilization reporting that health plans can integrate into their population health management and SDOH reporting workflows. Trip completion rates, member utilization patterns, geographic analysis, and vehicle type distribution — all available for quality reporting and care management.

HIPAA-Compliant and Credentialed

Full HIPAA compliance with encrypted data transmission, secure storage, and staff training. We execute Business Associate Agreements with all health plan partners and maintain credentialing with major MCOs. Every driver is background-checked, drug-tested, CPR-certified, and PASS-trained.

Direct Partnership Eliminates Broker Barriers

Brokered NEMT models create data silos that prevent health plans from accessing the trip-level information they need for SDOH reporting and population health management. Our direct partnership model gives plans unmediated access to transportation data, enabling the analytics that drive SDOH strategy.

Start Your SDOH Transportation Partnership

Contact our health plan team at (866) 507-5724 or visit dreamcarerides.com/mcos
We assess your member population, geographic coverage needs, vehicle requirements, and data reporting priorities
Receive a custom NEMT program design with transparent pricing, service level commitments, and data integration specifications
Launch with full fleet operations, trip tracking, and utilization reporting within your SDOH and population health workflows

Frequently Asked Questions About NEMT and Social Determinants of Health

Social determinants of health (SDOH) are the non-medical conditions in the environments where people are born, live, learn, work, play, worship, and age that affect health outcomes and quality of life. The five domains defined by CMS and Healthy People 2030 are economic stability, education access and quality, social and community context, healthcare access and quality, and neighborhood and built environment. These factors account for an estimated 80% of health outcomes, making them critical targets for health plans and providers seeking to improve population health.

Transportation qualifies as an SDOH under two domains: healthcare access and quality, and neighborhood and built environment. When individuals lack reliable transportation, they cannot reach medical appointments, pharmacies, preventive screenings, or ongoing treatments. This barrier directly impacts their ability to access the healthcare system, regardless of whether they have insurance coverage. The built environment dimension recognizes that where a person lives — including the availability of public transit, road infrastructure, and proximity to healthcare facilities — fundamentally shapes their health outcomes.

According to data from the Agency for Healthcare Research and Quality (AHRQ), approximately 3.6 million Americans miss or delay medical care each year due to transportation barriers. This figure disproportionately affects elderly individuals, people with disabilities, rural populations, and low-income communities. Transportation is consistently ranked as the third-largest barrier to healthcare access in the United States, behind only cost and availability of providers.

Yes. CMS has progressively increased requirements around SDOH screening and reporting. Medicare Advantage plans are now required to report on SDOH screening activities, and CMS rule changes in 2024 and 2025 have elevated supplemental benefits — including transportation — as tools for addressing social determinants. NCQA accreditation standards also include SDOH assessment requirements. State Medicaid programs have long mandated NEMT as a covered benefit, recognizing transportation as essential infrastructure for healthcare delivery.

NEMT directly impacts HEDIS quality measures by improving appointment adherence rates. When members consistently attend their scheduled care, plans see improvements in measures such as comprehensive diabetes care screening, breast cancer screening, follow-up after hospitalization, follow-up after emergency department visits, and medication management. These individual measure improvements contribute to overall HEDIS performance, which in turn affects CMS Star Ratings, plan reimbursement rates, and quality bonus payments.

Yes. NEMT trip data provides valuable population health insights that help plans identify at-risk members. Trip patterns can reveal members who frequently cancel or no-show for rides, indicating potential barriers beyond transportation. Utilization data by ZIP code highlights geographic areas with concentrated access challenges. Trip completion rates for specific appointment types — dialysis, chemotherapy, behavioral health — can flag members at risk for treatment non-adherence. Plans that integrate NEMT data into their care management platforms gain an additional signal for proactive member outreach.

The populations most affected by transportation barriers include elderly individuals who can no longer drive safely, people with physical disabilities who require accessible vehicles, rural residents with limited or no public transit options, low-income individuals and families without personal vehicles, Medicaid and dual-eligible members, and racial and ethnic minority communities in underserved areas. These populations experience higher no-show rates, delayed preventive care, worse chronic disease management, and more frequent emergency department utilization as a direct result of transportation barriers.

NEMT supports health equity by ensuring that access to medical care is not determined by a person's ability to drive, afford a vehicle, or live near public transit. By providing reliable, accessible transportation to all members regardless of income level, mobility status, or geographic location, NEMT eliminates one of the most significant structural barriers to equitable healthcare access. Health plans that invest in NEMT as part of their equity strategies demonstrate measurable improvements in care access and outcomes among their most vulnerable member populations.

Health plans can leverage several categories of NEMT data for SDOH reporting: trip completion rates and member utilization patterns, geographic analysis of transportation barriers by ZIP code and service area, member-level trip history correlated with appointment adherence, vehicle type utilization indicating mobility needs across the member population, cancellation and no-show patterns that may signal additional SDOH barriers, and cost-per-trip data demonstrating the value of transportation investments relative to avoided emergency and inpatient utilization. Direct NEMT partnerships — as opposed to brokered models — provide richer, more timely data for these reporting purposes.

Dream Care Rides supports health plan SDOH strategies through a direct partnership model that provides both reliable transportation and actionable data. Our in-house fleet covers 80+ cities across Illinois and Indiana with vehicles for every mobility level — ambulatory, wheelchair, stretcher, and bariatric. We provide trip-level data and utilization reporting that integrates into population health management workflows. Our HIPAA-compliant operations, credentialed driver team, and direct partnership model eliminate the data barriers that broker-based NEMT creates. Contact our health plan team at (866) 507-5724 to discuss how we support your SDOH initiatives.

Address SDOH With Dream Care Rides

Partner with a credentialed NEMT provider to close care gaps, improve health equity, and generate the trip data your SDOH strategy requires. In-house fleet, 80+ cities, every mobility level.