For some families, getting a child to behavioral therapy starts with a ride.
Van With a Plan, a Colorado non-emergency medical transportation provider, specializes in transporting children to and from applied behavior analysis, or ABA, treatment.
Eric Ostendorf, the company's transportation coordinator, says some families rely on the service because they do not have reliable transportation of their own.
"Some of these families don't even have a reliable car that they can get their child to center," Ostendorf said.
Some children also require additional behavioral support during transportation, he said.
"Some of them have such high magnitude behaviors that they can't get to and from the center safely," Ostendorf said. "The parent can't transport them safely."
A sharp drop in Medicaid reimbursement
The company is paid through Colorado's Medicaid non-emergency medical transportation program.
On July 1, 2026, reimbursement rates for certain NEMT services changed.
The per-trip reimbursement for ambulatory and taxi services dropped from $36.40 to $12.15.
The per-mile reimbursement for ambulatory and wheelchair services also dropped from $3 to $2.74.
The Colorado Department of Health Care Policy and Financing, or HCPF, said the changes were approved by the Colorado Legislature's Joint Budget Committee.
HCPF said the reductions were implemented as part of broader efforts to reduce Medicaid expenditures.
For Van With a Plan, Ostendorf says the reduction has changed how the company operates.
"I had to let about 15 people go," he said.
Ostendorf said the company has also stopped taking some farther-out trips because it no longer has the staff and resources to provide them.
Fewer families served
Before the rate change, Ostendorf said Van With a Plan was serving approximately 110 to 115 clients.
He said the company ultimately had to stop transporting roughly 25 families outside of its partnership with Colorado Behavioral and Learning Group.
The company's client count is now around 80, according to Ostendorf.
The decision has been difficult, he said, particularly when families ask whether their transportation can resume.
"I wish I could. I really, really wish I could," Ostendorf said.
He said the company's remaining resources have to cover expenses including employee wages, training, insurance, fuel and vehicle maintenance.
"I'm basically driving around with cars with 200,000 miles on them that have maintenance regularly week to week because they just keep breaking down and I can't afford to fix them," he said.
What HCPF says
HCPF said it has received feedback from NEMT providers about the new reimbursement rates and is monitoring the program for their impact.
The department also said it evaluated whether the current rates are sufficient to cover the costs of taxi and ambulatory NEMT services.
HCPF said the Medicaid Provider Rate Review Committee also evaluated the rates.
According to HCPF, a preliminary report found the rates were between 101% and 181% of benchmark comparisons among other state Medicaid agencies.
HCPF is also investigating allegations involving improper billing by some NEMT providers. The department said those investigations remain ongoing and that it cannot provide specific figures or findings at this time.
A statewide transportation broker is also coming
The reimbursement changes come as Colorado transitions to a statewide NEMT broker.
HCPF said the statewide broker will help Medicaid members who do not have another means of transportation access medically necessary services.
The department said the broker will use the least costly appropriate transportation option and connect members with providers able to serve them.
Full statewide implementation is expected by January 2027.
New legislation will also allow transportation network companies such as Uber and Lyft to serve as NEMT providers as a "provider of last resort" when traditional NEMT providers are unavailable, according to HCPF.
That option is also expected to begin January 1, 2027.
For Ostendorf, the concern is whether a broader transportation system can account for clients who need more specialized support.
"We aren't your normal NEMT," he said.
"We specialize in that, so I think that would be important to know."
"What we specialize in matters."
As Colorado moves toward the statewide system, HCPF says it will continue monitoring transportation access and identifying providers that can serve Medicaid members.
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