North Carolina Medicaid spent $206.6 million on Non-Emergency Medical Transportation (NEMT) in 2023 – a 59% increase in four years. Members still miss appointments.
This isn’t a budget problem. It’s an infrastructure problem. And for health plans managing Medicaid in North Carolina, the status quo is no longer tenable. A large North Carolina claims analysis spanning 2019–2023 shows:
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2.8 million to 3.3 million increase in total NEMT claims
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$60.90 average cost per trip (up from $45.12)
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70.6 percent of NEMT claims in 2023 were for rural members
That last number is the unlock. The majority of NEMT trips, and therefore costs, are concentrated in rural areas where coordination is most difficult and current broker models offer the least visibility and the thinnest provider networks. Costs are rising because the operational infrastructure that supports the benefit is failing. The consequence isn't just budget pressure. It's members who can't get to dialysis, chemotherapy, or behavioral health appointments — and whose conditions deteriorate as a result. That downstream health impact ultimately comes back to the plans.
3 breaking points in the current system
1. Members navigate a maze, not a system.
Today, how a member requests an NEMT ride in North Carolina depends on which Medicaid program they are enrolled in, which introduces friction with:
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Different contact numbers and intake processes by plan/county
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Variation in approval rules, ride types, and reimbursement models
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Limited real-time visibility for members, care teams, and plans
For members with complex medical needs, this isn’t an inconvenience. It’s a barrier. Missed appointments aren't just a member experience failure. They're a clinical risk that compounds over time.
2. Rural transportation providers operate without transparency.
Rural NEMT is not just “urban NEMT with longer distances.” It operates under different constraints, and those constraints are magnified by today’s program management structure.
Under current program structures, transportation providers operate with partial information: incomplete trip details, late eligibility changes, or unclear authorization status. This leads to denials, rework, and administrative burden. Over time, that friction affects willingness to participate, further constraining rural supply and reinforcing a cycle of higher costs and lower reliability.
The claims analysis covering 2019–2023 found that rural managed care NEMT consistently showed higher average costs than Medicaid Direct in multiple years, suggesting that coordination inefficiencies, not just distance, are driving spend.
3. Disconnected data creates a lack of transparency
North Carolina's managed care NEMT policy requires plans to track trips "from intake through disposition." In practice, that data lives in:
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Member call centers
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Broker scheduling platforms
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Provider dispatch systems
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Paper driver trip logs
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Separate billing and claims databases
Without a closed-loop record of each trip, every stakeholder operates on partial information. Health plans and county agencies can't identify waste. Transportation providers can't predict cash flow. Members can't track their rides. And the State can't answer the most basic question: Is this system working?
What modernization needs to solve
North Carolina has already articulated what NEMT should be: coordinated, timely, safe, clean, reliable, and medically necessary. The remaining work is operational, and health plans are in the best position to drive it. That means investing in systems that can:
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Coordinate rural supply with real-time awareness of provider capacity
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Reduce fragmentation across plans and brokers
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Support providers with clearer, earlier, and more reliable trip information
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Give plans and the state a single source of truth across the full lifecycle of each ride
What modernization can look like (and why it matters now)
The infrastructure gaps described above are solvable. Modern NEMT platforms connect health plans, members, and transportation providers into a single digitally integrated workflow, with full visibility into each trip from request through payment. That connectivity enables plans to move from reactive problem management to proactive coordination: identifying gaps in rural provider supply before they affect access, reducing manual touchpoints that drive administrative spend, and closing the data loops that currently leave members without reliable rides and plans without reliable answers.
Plans that implement interoperable closed-loop NEMT infrastructure now will be better positioned to protect member access as rural provider supply continues to tighten, and to demonstrate the accountability the State is increasingly expecting.
The call to action for Medicaid leaders in North Carolina
North Carolina has already done the hard policy work to define what NEMT should be. Now it's time for health plans to do the hard operational work:
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Make member experience the primary KPI, not an afterthought
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Treat NEMT cost as a workflow problem to solve with data insights
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Establish end-to-end transparency so every stakeholder operates from a single source of truth
If you’re a health plan leader in North Carolina working to strengthen NEMT, Kinetik is ready to modernize the infrastructure.
Authored by: Ari Weber
