Federal, state, and local governments and community-based organizations have created programs to meet the transportation needs of people who require specialized services. This includes people with disabilities, people with low incomes, and older adults. At the federal level, there are over 60 programs to fund transportation services for these populations. Most of these programs fund limited transportation programs to get people to job training, health care, senior centers, or rehabilitation programs.
Program requirements differ widely. Most federal transportation funds are provided to states, local governments, and nonprofits through direct grants or block grants. Each federal funding program may require different reporting data and operate under a different funding cycle. Coordinating funding across local agencies is further complicated because the organizations themselves often use different billing systems. The public may also find it difficult to identify, understand, and use available services.
The best programs include coordination between public agencies and private and nonprofit providers at the state, regional, and local levels. This leads to better outcomes because the agencies can transport more people more efficiently. And riders can find rides more easily and conveniently. Coordinated programs are less likely to have vehicles sitting idle part of the day and are more likely to fill up all available seats. Among the opportunities for coordinating are joint vehicle purchase and use, vehicle maintenance, driver training, insurance, and dispatch program use. These programs can reduce long-term costs but sometimes require higher up-front costs.
Mobility management—mobility management is the coordination of a community-wide transportation network. Multiple transit operating partners and local nonprofit groups work together so that passengers can use multiple systems seamlessly. Passengers can enter through a single point of entry and use multiple travel modes run by different agencies. This improves convenience and saves passengers and transit agencies money.
Mobility management is especially useful for improving specialized transportation for older adults, people with disabilities, and people with low incomes. For example, the Transit Authority of River City in Louisville, Kentucky, implemented a mobility management plan that increased access and convenience for people with disabilities and lowered the cost of providing these services. To do so, it partnered with local taxi agencies to supplement paratransit services. It also secured a federal grant to make every bus wheelchair-accessible. As a result, people with disabilities are not limited to using paratransit services, which require advanced scheduling.
Nonemergency medical transportation (NEMT)—NEMT connects people without access to transportation with their nonemergency, yet medically necessary, appointments. These could be such things as kidney dialysis and chemotherapy sessions. NEMT ensures that people not only have access to care but that they can receive that care. It can help ensure that people with no way to travel to and from medical appointments do so before a medical problem intensifies—and, as such, NEMT providers maintain that such services save money in the long run and improve health outcomes.
The limited availability of nonemergency medical transportation and its high cost are significant concerns for many older adults. Although Medicaid reimburses for NEMT, Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… does only in some circumstances. Some nonprofit and human services agencies provide such transportation. But there is no targeted NEMT funding or program to meet the needs of older adults of all income and ability levels.
States may contract with brokers to manage NEMT services to expand access, improve quality, and contain the costs of such services. Brokers manage trip scheduling, provider oversight, and claims processing. They are selected through a competitive bidding process and must be cost-effective. Use of brokers can help states control costs and improve service quality.
Section 5310—the Federal Transit Administration (FTA) Section 5310 funding program provides capital-assistance grants to buy buses and vans used to transport older adults and people with disabilities to places such as senior centers and congregate meal sites.
Coordinated funding—in order to fully fund programs, effective state agencies coordinate financing from among federal programs. For example, many states use part of the funding from the Older Americans Act (OAA) to provide transportation services, often by transit operators under contract with the local area’s agency on aging. Typically, area agencies on aging use Section 5310 funding from the FTA to purchase vehicles. They then operate the vehicles in part with OAA funding, along with other federal, state, and local sources, including Medicaid and Head Start. The coordination of funding sources at all levels of government promotes the most efficient and effective use of transportation funds (see also this chapter’s section Coordination of Community Transportation).
COMMUNITY TRANSPORTATION OPTIONS FOR UNDERSERVED POPULATIONS: Policy
Ensuring access to community transportation
Policymakers and the private sector should establish coordinated public transit-human services transportation programs to meet the needs of underserved populations. These populations include older adults, people of limited mobility, and people with disabilities. They should also support the creation and maintenance of mobility management programs that help connect individuals to the most appropriate community transportation services (see also the Mobility on Demand—Universal Mobility as a Service policy in this chapter.)
Policymakers and the private sector should ensure a common transactional data format to enable efficient coordination of human services transportation.
In establishing and coordinating these programs, policymakers should consult with representatives from the local health care community, in particular, those responsible for care coordination.
Local governments should provide publicly owned or publicly operated passenger vehicles for the transportation of older adults when such vehicles are not otherwise in use.
State and local governments should ensure coordination of all transportation programs and services that receive public funding.
All levels of government should foster coordination of transportation assets, eliminate duplicative services and other inefficiencies, and simplify consumers’ access to human services providers.
As part of implementing the Affordable Care Act, federal and state governments should explicitly designate transportation as an essential service for providing access to health care and for enabling older adults and people with disabilities to remain in their homes and communities.
Congress should ensure coordination of all federally funded transportation programs and services, including specialized transportation programs administered by the Federal Transit Administration (FTA) and those programs administered by the Department of Health and Human Services.
The federal government and states should encourage public-sector, nonprofit, and private-sector initiatives in joint vehicle purchase and use, shared vehicle maintenance, driver training, packaged insurance arrangements, and the development and support of dispatching programs that use geographic information systems; to do so, they should fund the initial start-up costs of these and other coordination efforts.
Technical assistance: The FTA should continue to provide technical support to state and local agencies for coordinating, carefully monitoring, and evaluating the implementation of state-administered plans for federally funded programs.
The U.S. Department of Transportation, with the Administration for Community Living, should continue to help meet the transportation needs of those who do not drive by conducting or supporting research, acting as an information clearinghouse, and providing technical assistance to state and local transportation agencies.
Medicaid nonemergency medical transportation (NEMT)
Policymakers at all levels should expand access to NEMT for people of varying income and ability levels. This should include exploring whether transportation brokerages can help expand access, reduce costs, and increase quality.
Funding: Policymakers should coordinate funding and provide sufficient budget to ensure adequate community transportation options to meet the needs of older adults and people with disabilities.
Section 5310: Congress should require the Federal Transit Administration to evaluate how well the Section 5310 program meets the needs of riders. Congress should fund the Section 5310 program at a level sufficient for providers to purchase replacement vehicles and expand services.