Federal, state, and local governments and community-based organizations have created programs to meet the transportation needs of people who require special services. At the federal level there are at least 62 separate programs authorized to fund transportation services for people with disabilities, people with low incomes, and/or older adults. Sixteen of these programs routinely fund such services. Most are human services programs that fund limited transportation so that people can get 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 a direct grant or a block grant. 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. Some reimburse consumers directly. Others reimburse providers. Still others operate their own vehicles with no direct billing required. As a result resource use is inefficient. The public may also find it difficult to identify, understand, and access available services.
Executive Order 13330, issued in 2004, expanded the federal Coordinating Council on Access and Mobility. Under the order, the council must streamline access to transportation services for people with disabilities, people with low incomes, and older adults. The resulting plan, “United We Ride,” coordinates the transportation programs offered by a wide range of federal agencies. Coordination efforts focus on leadership, planning, operations, technology, customer service, policy, programs, and funding.
Consumers may benefit from state, regional, and local coordination among public agencies and private and nonprofit providers. Among the opportunities for doing so 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.
Federal law requires grant recipients of the Enhanced Mobility for Seniors and Persons with Disabilities Program (Section 5310) to certify that the projects they have selected are included in a locally developed, coordinated public transit human services transportation plan. This offers a framework for effective planning from the ground up. The best programs are approached holistically. For example, they typically highlight how local authorities coordinate all federal transportation funding sources and draw connections among transportation, health care, and social services in the community. By law, these plans must include older adults, people with disabilities, transportation providers, and others in the process.
This mandate for coordinated planning represents just a small portion of the total federal expenditure on specialized transportation. The FTA apportioned $262 million for specialized transportation in fiscal year 2016. By comparison, Medicaid spends an estimated $1.5 billion on transportation annually, which itself represents only roughly 40 percent of total federal specialized transportation funds. Medicaid transportation providers are key stakeholders for coordinated planning, but they often choose not to participate in local planning efforts.
The Patient Protection and Affordable Care Act (ACA) also can increase access to medical care. Transportation is key to meeting the law’s objectives. The ACA emphasizes the importance of giving older adults and people with disabilities the choice to live at home in their communities with the supports they need. It also aims to reduce hospital readmission rates among Medicare patients. Inadequate transportation can lead to dependency on institutionalized services. It can also prevent patients from accessing follow-up and preventive medical care, resulting in emergency trips to the hospital.
Transportation can be incorporated into programs related to the ACA. In addition, the coordinated planning process can better incorporate hospital and clinic staff responsible for patient care coordination. In doing so, care coordinators can learn about available transportation services. They can also inform the planning process by helping to identify transportation needs. Some hospitals and clinics provide financial support through service contracts with transportation providers.
Mobility management—mobility management is an approach to managing a coordinated, community-wide transportation network with multiple transit operating partners and local nonprofit groups. It emphasizes the need for transportation providers to coordinate with one another 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 to 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.
The FAST Act established mobility pilot grants for innovative coordinated transportation services projects. In 2016, this resulted to a total of $7 million in grants to 19 agencies.
Coordination of Community Transportation: Policy
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 Patient Protection and 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.
Federal and state governments should ensure that locally developed, coordinated public transit-human services transportation planning efforts involve representatives from the local health care community, in particular those responsible for care coordination.
Congress should ensure coordination of all federally funded transportation programs and services, including specialized transportation programs administered by the Federal Transit Administration 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.
The FTA should continue to provide technical assistance to state and local agencies for coordinating, and carefully monitoring, and evaluating the implementation of state-administered plans for federally funded programs.
The Department of Transportation, with the Administration for Community Living, should continue to help meet nondrivers’ transportation needs by conducting or supporting research, acting as an information clearinghouse, and providing technical assistance on nondriver needs to state and local transportation agencies.