In rural America, access to care often breaks down long before a member ever sees a provider. The problem isn’t coverage — it’s distance, infrastructure, and a transportation system that hasn’t kept up with the times.
For millions of Americans, getting medical care means long drives, missed work, and difficult choices. Across the country, entire communities live hours from hospitals, specialists, or maternity services. These places — known as healthcare deserts — lack the basic infrastructure needed to access care, from pharmacies and primary care clinics to hospitals themselves. Today, healthcare deserts touch nearly 80% of U.S. counties, and one in five counties qualifies as a hospital desert, where the closest facility is more than 30 minutes away. Nearly 400,000 women of childbearing age live in counties without a single maternal care provider. In settings like these, insurance coverage alone cannot close the distance to care.
For Medicaid members in states like New Mexico, those distances are compounded by limited public transit, severe weather, high poverty rates, and low rates of private vehicle ownership. In some rural counties, members routinely travel more than 50 miles or more for basic primary care or behavioral health appointments.
Non-Emergency Medical Transportation, or NEMT, is a required Medicaid benefit intended to close this access gap, but in practice members often experience late rides, long waits, or no shows that cause them to miss care.
A leading Medicaid health plan in New Mexico partnered with Kinetik to fundamentally rethink how NEMT operates across a vast, rural service area. Together, we focused on a clear goal: making it easier and safer for Medicaid members to reach primary care, behavioral health, and specialty appointments on time across hundreds of miles of service area.
Rural transportation challenges are both structural and operational. Members may travel 50 to 100 miles round-trip for care on two-lane roads with limited cell coverage. Transportation providers are typically small, local operators with deep community knowledge but limited technology. Scheduling is manual, visibility is minimal, and when something goes wrong, there’s no real-time data to course-correct. The result is missed appointments, frustrated members, and avoidable downstream costs.
To address these realities, the health plan and Kinetik rebuilt the NEMT program around three core principles: a network designed for rural conditions, technology-enabled dispatch, and data-driven accountability.
The transportation network has been strengthened and diversified by onboarding local providers familiar with rural roads, weather conditions, and community needs. Contracts and onboarding emphasized safety standards, training, and clear communication expectations — ensuring providers understood both member needs and health plan requirements.
Trips are managed end-to-end through the Kinetik platform — from request to completion — with real-time tracking and status updates. Care managers, call center teams, and transportation partners share a single view of upcoming trips, late arrivals, and potential failures. This visibility makes it possible to reroute drivers, contact members, and resolve issues before appointments are missed — across thousands of trips each month in a large, sparsely populated state.
Rather than relying on lagging indicators or member complaints, the program uses data to drive continuous improvement. Standard on-demand reporting provides visibility into on-time performance, cancellations, no-shows, and regional trends. These insights enable targeted member outreach, provider coaching, and operational adjustments — so program administrators can address root causes proactively, instead of applying broad, reactive changes.
Program reporting from the New Mexico partnership indicates that members who received rides through the restructured NEMT program were more likely to complete scheduled visits and less likely to miss follow-up appointments, with the most notable improvements seen in primary care and behavioral health access. Transportation providers reported clearer expectations and fewer surprises, and health plans gained insight into where and why trips were breaking down, enabling proactive fixes rather than after-the-fact remediation.
For the first time, transportation wasn’t a black box. It became something the plan could see, manage, and improve.
The New Mexico experience highlights a broader truth for health plan leaders and Medicaid regulators: NEMT is not a logistics line item. It is a core access benefit that, when modernized, can reliably convert transportation capacity into care delivered. Research consistently links transportation barriers to missed appointments and avoidable emergency department use, particularly among low-income and rural populations.
Several practical lessons emerge:
Position transportation as a foundational component of care access.
Build real-time visibility and accountability into transportation performance.
Invest in technology that enables transportation networks to operate at scale.
Measure success by completed rides, visit adherence, follow-up care, and member experience–not just volume.
As medical deserts expand and hospitals and clinics struggle to remain open, solving transportation barriers is one of the most direct ways to protect access to care. The New Mexico case study shows that with the right design, technology, and accountability, Medicaid NEMT can move from a pain point to a strategic asset — for rural communities and for the plans that serve them.