Medicaid Transportation and Urban Public Transit: Strategies and Opportunities for Increasing Transit Ridership

This paper describes how coordination of human service and public transportation has been a valuable tool for transit operators for almost 30 years. Prior to the creation of rural public transit subsidies in the 1980’s, many rural transportation programs embraced coordination of multiple human service programs realizing that the only way they could survive was to diversify. The General Accounting Office (GAO) recognized this in the first of their studies on the coordination of human service transportation (GAO, 1977). This report concluded that the most significant hindrance to coordination was confusion and misperception regarding restrictions to coordination. In the 31 years since that initial study, coordination has been and continues to be essential to the survival of many rural transit systems. Urban transit systems however have generally eschewed coordination of Non- Emergency Medical Transportation (NEMT) or Medicaid transportation services as an unnecessary complication to the ADA service that is already very difficult to operate (a view expressed by many of the transit managers interviewed as part of this effort). Fixed-route transit however is a service that some state and local Medicaid programs have used to dramatically reduce their per trip costs. Using fixed-route service is a cost effective tool to coordinate NEMT and urban public transit. Recent trends indicate that more urban public transit operators are turning to brokerage of services as well. This paper, adapted from the TCRP Synthesis No. 65: Transit Agency Participation in Medicaid Transportation Program focuses on the current status of coordination with urban public transit and how transit can take advantage of coordination opportunities.