In any given year, 3.6 million individuals miss or delay medical appointments due to a lack of available and affordable transportation.[i] For individuals with chronic health care needs, such as cancer or kidney failure, not having access to transportation to go to the doctor or clinic can result in re-hospitalization, nursing home placement…even death. Furthermore, there is growing awareness that missed medical appointments have economic consequences for the health care industry. A recent study by Health Outreach Partners identified the annual costs of missed appointments ranging from $3 million in clinical settings to $564 million in the VA system.[ii]
Accessible and affordable transportation is not a one-size-fits-all proposition. There is wide variation in the availability of transportation services across the U.S., with rural areas more likely to offer limited public transportation or none at all. Rural residents without access to a car also are challenged by needing to travel long distances, sometimes across county (or even state) lines to get to the nearest medical center. However, even in communities with robust transportation systems, an individual with chronic care needs may not be able to find a ride when and where they need to go, or may not know of the transportation services available. Furthermore, older adults and people with disabilities often have complex transportation needs, requiring more than just a ride. For example, an individual receiving kidney dialysis or chemotherapy may be able to use public transit to travel to an appointment, but feel unable to walk to the nearest bus stop, require physical assistance to get into a vehicle or even need someone to travel with them or help them walk from the vehicle to their door.
Medicaid is a primary provider of non-emergency medical transportation (“NEMT”) for Medicaid-eligible individuals. A 2016 Kaiser report noted that approximately $3 billion is spent on NEMT by the Medicaid Program per year, providing rides primarily to behavioral health services, dialysis, preventive services (including doctor visits), specialists, physical therapy/rehabilitation and adult day health services. Traditional Medicare does not provide NEMT, even though many Medicare recipients and professionals mistakenly assume it is provided; however, Medicare Advantage Plans sometimes offer NEMT, most often in plans targeted to lower-income beneficiaries. [iii]
Public transit typically forms the backbone of community transportation, especially in metropolitan areas. Paratransit services, whereby individuals with mobility limitations who need a ride can be picked up at home and transported to their destination, are offered as an adjunct to public transit. However, paratransit services are expensive, and costs are on the rise. Passengers must schedule rides in advance and sometimes experience unanticipated wait times that can cause anxiety and physical exhaustion for individuals with chronic conditions. It is hoped that new partnerships between public transportation and Uber or Lyft that are currently being developed in a number of metropolitan areas will both save money and alleviate passenger concerns.
Communities across the country have also developed alternative transportation options designed with older adults and people with disabilities in mind, including volunteer transportation programs, partnerships with taxi companies, voucher programs and shared-ride programs. Often, such programs prioritize or may only provide medical transportation. Unfortunately, gaps remain due to lack of sufficient funding, lack of coordination between transportation providers, or a limited number of volunteer drivers, among other reasons. Nevertheless, communities are finding creative ways to maximize limited transportation funding, coordinate existing services and provide older adults and people with disabilities with readily accessible information and assistance to choose the right transportation option to fit their needs. Rides to Wellness grants funded by the Federal Transit Administration are developing cost-effective solutions to better connect patients to health care.[iv] In addition, the National Aging and Disability Transportation Center (NADTC) funded six communities this year to develop innovative approaches for providing accessible transportation to address the needs of older adults and people with disabilities. One project, located in rural southwest Virginia, is operated by Mountain Empire Older Citizens (MEOC), which serves as both the Area Agency on Aging and the Public Transit Agency. Individuals with chronic care conditions can book a ride through a designated “one-call center” staffed by a community care coordinator who may also connect callers to other needed services. Volunteer Transportation Aides educate riders on using available transportation services and provide assistance as needed, such as helping passengers on and off the bus, walking with them to their door or accompanying them at their destination.[v]
Transportation has intrinsic value as an important community service. Today, transportation is increasingly recognized as both a necessary adjunct to the health care system and critical support to enable older adults and people with disabilities to live and thrive in their homes and communities.
[i] Richard Wallace, Paul Hughes-Cromwick, et al., “Access to Health Care and Nonemergency Medical Transportation: Two Missing Links,” Journal of the Transportation Research Board, Vol. 1924 (2005).
[ii] Health Outreach Partners, Rides to Wellness Community Scan Project, Spring 2017.
[iii] The Kaiser Commission on Medicaid and the Uninsured, Medicaid Non-Emergency Medical Transportation: Overview and Key Issues in Medicaid Expansion Waivers, February 2016.
[iv] Federal Transit Administration, Coordinating Council on Access and Mobility: https://www.transit.dot.gov/ccam/about/rides-wellness.
[v] National Aging and Disability Transportation Center: http://www.nadtc.org/grants-funding/nadtc-grant-opportunities/nadtc-awarded-grants/.