Devolution's Policy Impact on Non-emergency Medical Transportation in State Children's Health Insurance Programs

• Published in: Social work in public health Vol. 26; no. 2; pp. 137 - 157
• Main Authors: Borders, Stephen, Blakely, Craig, Ponder, Linda, Raphael, David
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis Group 01.03.2011; Taylor & Francis Ltd
• Subjects: Access; Adolescent; Adult; Child; Child Care Services; Child Welfare - statistics & numerical data; Child, Preschool; Children; Children & youth; Childrens health insurance programs; Constraints; Decentralization; Delivery Systems; devolution; Diffusion of Innovation; disparities; Female; Health administration; Health care access; Health care policy; Health Care Surveys; Health Insurance; Health Policy - trends; Health Services Accessibility; Health Services Needs and Demand - statistics & numerical data; Health Status Disparities; Humans; Infant; Infant, Newborn; insurance coverage; Insurance Coverage - statistics & numerical data; Male; Medicaid; Medicaid - statistics & numerical data; medical transportation; Medicine; Patient Transfer - economics; Patient Transfer - statistics & numerical data; Power; SCHIP; Surveys and Questionnaires; Transportation; United States; Young Adult; United States
• ISSN: 1937-1918; 1937-190X
• DOI: 10.1080/19371911003776704

Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This article provides one of the first empirical evaluations of this assumption as it relates to non-emergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care. Yet states have great latitude in making such services available. The authors utilize data from 32 states to provide a preliminary assessment of devolution's consequences and policy impact on transportation-related access to care. Their findings provide mixed evidence on devolution's impact on policy outcomes. Proponents of devolution can find solace in the fact that several states have gone beyond federally mandated minimum requirements to offer innovative programs to remove transportation barriers to care. Detractors of devolution will find continued pause on several key issues, as a number of states do not offer NEMT to their SCHIP populations while cutting services and leaving over $7 billion in federal matching funding unspent.