GOP states embrace Uber, Lyft to take low-income patients to medical appointments

Mississippi is the latest state to partner with ride-hailing companies like Uber and Lyft to transport residents to medical appointments.

It’s an attempt to improve overall health in a state where advocates and medical groups have labeled health care a growing crisis.

The Mississippi Rural Health Association’s executive director, Ryan Kelly, said that while organizations like his have been working to promote more regular annual checkups, transportation barriers have contributed to high rates of missed appointments. According to him, the no-show rate for some providers can reach 75%.

“We’re not airlines and can’t double-book appointments,” he said. “What if your practice’s calendar is full but 75% of people don’t show up?” Many providers have stopped performing many wellness checkups because patients do not show up.”

Uber and Lyft have lobbied states in recent years to use Medicaid funding to transport patients to medical appointments. According to a study conducted by the Texas A&M Transportation Institute for the Arizona Department of Transportation, states spend about $2 billion per year on nonemergency transportation for Medicaid patients, with the federal government spending an additional $3 billion.

Lawmakers have jumped on board, particularly in Republican-led states.

In 2019, Arizona became the first state to change its Medicaid regulations to allow non-emergency medical transportation companies such as Uber and Lyft to operate. Lawmakers paved the way by creating a new provider category that eliminated some safety requirements, such as requiring drivers to undergo drug testing and first aid training. However, the rules limit companies like Uber and Lyft to transporting Medicaid enrollees who do not require assistance.

That same year, lawmakers in Texas and Florida relaxed Medicaid regulations. Medicaid is federal and state-funded health insurance for low-income and disabled people.

Kelly and others in Mississippi are cautiously optimistic, but they are also concerned that diverting patients to private companies such as Uber and Lyft will harm those who currently provide non-emergency transportation. These businesses must adhere to state regulations, such as being wheelchair accessible and maintaining safety certifications.

“There are various policies they have to go by that we haven’t seen Uber and Lyft have to meet,” Kelly said in a statement. If such companies siphon off a portion of riders with less complex needs, existing companies will be left with fewer patients who may be more expensive to transport.

Mississippi’s new contract with Uber Health states that the state will pay the company up to $1 million per year to provide non-emergency transportation to and from local health departments.

“The program’s goal is to make health care accessible and to provide opportunities for all Mississippians to live the healthiest life possible,” said Victor Sutton, chief of community health and clinical services for the Mississippi State Department of Health, in a statement.

Health Consequences

Transportation remains one of the most significant barriers to health care for low-income people. According to a new study from the Urban Institute, a nonprofit think tank focused on social and economic policy, one in every five adults without access to a vehicle or public transportation were more likely to forego needed health care due to transportation difficulties. In a separate study, researchers discovered that nearly 6 million people in the United States missed medical appointments in 2017 due to a lack of transportation.

Lack of transportation leads to missed or rescheduled appointments, delays in getting prescriptions filled, poorer chronic illness management, and, as a result, poorer health outcomes.

Most Medicaid recipients are entitled to free transportation to and from medical appointments. Nonemergency medical transportation is a required Medicaid benefit, which means that states must provide free or low-cost transportation to and from appointments if enrollees lack transportation.

Most states contract with third-party brokers to coordinate enrollment transportation, which is typically public transportation, taxis, or private shuttle services. However, the track record of those brokers is mixed.

“Especially in rural areas, sometimes it’s a very long trip to take [patients] from one place to another,” Kelly said. “You could be picked up at 6 a.m. for a 10 a.m. appointment in a van that travels to various locations, such as a group pickup or a bus route.” It is a service that is available, but it is not always an efficient service.”

Riders in several states have filed lawsuits against companies, alleging safety issues, no-show drivers, and hours-long waits for rides.

Uber and Lyft have entered the market in recent years, positioning themselves as a lower-cost solution for patients who only need a ride and do not require specialized services such as wheelchair lifts. They tout advantages over traditional brokers like on-demand scheduling, an electronic record of rides for transparent monitoring, and customer familiarity with the service.

Following Lyft’s entry into non-emergency medical transportation in 2016, Uber launched its health care division, Uber Health, in 2018.

Making contact with patients

Depending on state regulations and how Medicaid benefits are administered, a company like Uber Health can connect with patients in a variety of ways. Third-party brokers, for example, can arrange Uber rides for Medicaid recipients in Georgia. Uber works directly with Medicaid managed care organizations in Arizona. According to the company, over 3,000 health care organizations in the United States use its Uber Health platform to coordinate non-emergency transportation.

Some research supports their low-cost pitch. According to a 2019 study conducted by Stanford University researchers, “modern” alternatives such as Uber and Lyft could save Medicaid programs approximately $268 per expected user and $537 million annually if scaled nationally. This represents a 30%-70% savings over traditional non-emergency transportation services.

In 2017, Texas’ largest Federally Qualified Health Center signed a contract with Uber for a pilot program in coastal Beaumont, Texas, to provide patients with free rides to and from appointments if they lacked transportation.

“A huge issue in Beaumont is transportation and security,” said Lindsay Lanagan, vice president of governmental affairs for Legacy Community Health, which operates 54 health care facilities throughout Southeast Texas.

Almost all of Legacy’s patients are at or near the federal poverty line. The vast majority are either uninsured or children and pregnant women with Medicaid coverage. The majority are Black or Hispanic, and many do not speak English as a first language.

Legacy’s clinics saw a significant decrease in missed appointments after launching the pilot program with Uber, according to Lanagan. Clinic providers backed the 2019 legislation authorizing Uber Health to provide rides to Medicaid recipients through third-party brokers. Uber collaborated directly with Republican Rep. Dade Phelan, a Beaumont native who is now the House Speaker.

“To be honest, that was the easiest bill I’ve ever worked on,” she said. “We had the data to show how critical it is to provide these services.” [Legacy] could always offer them by piecing together grants… but having it available as a state program for everyone is really nice.”

Phelan stated in a tweet that he wrote the bill “to give Medicaid recipients more power to make their medical appointments.” He described the Uber partnership as a cost-effective use of Medicaid funds that would reduce fraud, waste, and abuse.

According to data compiled by OpenSecrets, a nonprofit research and government transparency organization, Uber spent approximately $710,000 on lobbyists in Texas that year. According to its 2022 political engagement report, Uber has a lobbying presence at the state and local levels in 46 states and the District of Columbia, and spent approximately $6.6 million on state lobbyists that year.

According to William Lyons, senior manager for social determinants of health programs at Legacy Community Health, Legacy Health continues to use grant funding to provide approximately 300 rides per month via companies such as Uber and Lyft that it schedules using third-party software.

A small number of rides are still booked using specialized medical transport vehicles. These are typically reserved for patients who live in rural areas with a scarcity of Uber and Lyft drivers, or who require specialized services such as a wheelchair lift.

Before Uber and Lyft, patients who lived further away from their nearest clinic might have had to ride a bus for two hours or more to get to an appointment, according to Lyons.

“That could mean a whole day of traveling for a medical appointment that may last 30 minutes,” he went on to say. “Many people don’t have paid leave to go to medical visits and they’re missing out on work to go to the appointment.”

Lyons explained that, like any other program, it is only as good as its coverage area. There are still gaps, especially in rural areas where Uber and Lyft do not operate.

But in the end, he said, “this is definitely a more cost-effective way to make sure that patients can not only participate in their medical care, but also maintain a job and have their children still in school.”

According to Sutton, the agency’s community health and clinical services chief, Mississippi is likely the first state to offer rides specifically to appointments at county health departments rather than private providers. The state has one of the nation’s worst physician shortages, and county health departments are the only option for primary care in many areas.

When Uber rides become available, Mississippi’s program will provide them. To address concerns about whether there are enough Uber drivers in rural areas, Sutton said the company will collaborate with the state health department to develop a marketing strategy to recruit more drivers. Because the health department is in charge of scheduling rides, people without smartphones should be able to use the service.

Transportation is important in a rural state like Mississippi because it provides “access to care, social services, and educational opportunities,” according to Sutton.