The Pennsylvania Public Transportation Association (PPTA) commissioned ESI and the Texas A&M Transportation Institute (TTI) to produce a report on the potential impacts of a Full-Risk Brokerage Model for the delivery of Pennsylvania’s Medical Assistance Transportation Program (MATP). The study was designed to follow the guidelines of June 2019 legislation that required DHS to study the potential impacts of implementing this approach, in parallel to a December 2019 study for DHS by Mercer Health & Benefits LLC in response to the legislation. The central task of the study was to assess the fiscal, transportation system, and consumer impacts of implementing a full-risk brokerage model compared to maintaining the current coordinated human services transportation framework.
As of spring 2026, ESI is in the process of updating the study with more recent data.
ESI and TTI applied a comprehensive cost-benefit analytical framework to evaluate the full-risk brokerage model relative to Pennsylvania’s existing coordinated human services transportation system. The analysis addressed state and local government financial impacts, effects on public transit agencies, service quality implications for riders, and broader economic and public health consequences.
The team first conducted a detailed review of federal and state laws governing Medicaid non-emergency medical transportation (NEMT), including the Deficit Reduction Act and Medicaid State Plan requirements. A 50-state scan of NEMT delivery models was performed to compare in-house management, managed care, statewide broker, and regional broker systems, with particular attention to states that had recently transitioned to brokerage models.
To quantify potential impacts, ESI analyzed shared ride operational data from Ecolane (covering 65 counties), MATP utilization records, Federal Transit Administration (FTA) funding formulas, and Medicaid expenditure patterns.
The analysis found that while the brokerage model could generate approximately $15 million annually in additional federal Medicaid matching funds, these savings would likely be exceeded by broader system costs. These include the loss of cross-program efficiencies resulting from disaggregation of MATP from other human service transportation programs; reductions in FTA formula funding due to decreased passenger miles and vehicle miles; and downstream public health and productivity effects associated with missed medical trips.
The study concluded that the net fiscal loss impact to the Commonwealth and its transit agencies was approximately $38 million annually despite the gain in revenue from enhanced federal reimbursement.
