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23 with NEMT. These studies test the findings from the literature rapidly growing suburbs. The county manages the transit review and surveys previously conducted. The case studies agency directly and contracts the day-to-day operation of its were selected to reflect a balance of operators in terms of paratransit to a number of private providers. Broward County geographical diversity (as many regions of the country as Transit (BCT) operates throughout Broward County provid- possible and urban, small urban, and rural agencies), demo- ing 36 million fixed-route trips and 1.3 million paratransit graphics, coordination level, and service delivery model. trips annually. Successes as well as coordination efforts that were less than successful were examined. For each case study, the transit Florida has been a leader of the coordination effort since agency and its relationship with the state Medicaid agency, the advent of its Transportation Disadvantaged (TD) pro- as well as the relationship between the state Medicaid agency gram. BCT was selected for this synthesis, not because of its and the state DOT were reviewed. The case studies success, but rather to examine why Broward County decided that coordinating the service in the manner required was not Review relationships between stakeholders, in BCT's best interests. It should be noted that Florida has Describe the state service delivery model, had a number of successful urban transit coordination efforts. Provide a description of the transit agency and approach However, the researchers believe, in this case, that there are to NEMT, and more lessons to be learned from the county's experience than Review the activities that foster or inhibit coordination. from a more successful effort. The five case studies can be summarized as follows: Relationship Between Stakeholders 1. Broward County Transit (Florida)--Florida has long been a model for coordination at the county level as Florida, by legislation, created the Florida Commission for mandated by the state. This case study focused on the TD as part of the Florida DOT (FDOT). The TD Com- Broward County and examines why the county ulti- mission is responsible for the coordination of a wide variety mately ended its relationship with the state Medicaid of human service transportation programs including Medic- agency. aid. To that end, the TD Commission has a contract with the 2. North Georgia Community Action Agency (Jasper, Agency for Health Care Administration (AHCA), which is Georgia)--An early practitioner of the large-scale bro- the state agency charged with the responsibility of the Med- kerage, Georgia has fine-tuned its approach and serves icaid program, to provide oversight and management of the as an excellent case study to examine how this type of NEMT program. This arrangement has reduced costs by 30% brokerage affects coordination. A multicounty rural during the past 10 years. Much of the savings was attributed transit agency that has a good relationship with its to the expanded use of bus passes. broker is profiled. 3. TriMet (Portland, Oregon)--Oregon has designated Although AHCA has ceded day-to-day operating author- regions where local brokers manage all aspects of ity, it continues to look at different ways of managing and NEMT. Each of the brokers are transit agencies. Here controlling the service. The 1915(b) waiver submitted by the the focus is on Portland. agency allows the use of the local county Community Trans- 4. Texoma Area Paratransit System (Texas)--The Texas portation Coordinators (CTC) to control expenditures to the Legislature mandated coordination by placing most NEMT. AHCA is now considering a change in the program. human service transportation operations under the The agency previously tried to eliminate the county brokers control of TxDOT. This review examines their from the NEMT and procure a statewide broker, but the pro- progress 30 months after the legislation was passed. curement was rescinded. The Texoma Area Paratransit System (TAPS), a mul- ticounty system, was examined. Recently, AHCA determined that it needed to reduce fund- 5. Chittenden County Transportation Authority (Ver- ing for NEMT by $11 million in one year and this resulted in mont)--Vermont's Medicaid agency uses the state at least one large transit agency opting out of the program. Oth- transit association to administer the Medicaid trans- ers are considering reducing their role as well. The TD Com- portation program. Contracts are local and typically mission is also considering a termination of the relationship with transit agencies. Burlington's transit agency will with AHCA as the funding continues to be reduced. be reviewed. State Medicaid Service Delivery Model FLORIDA--BROWARD COUNTY TRANSIT As stated previously, AHCA contracts with FDOT's TD Introduction Commission to manage the statewide program. The TD Commission designates a CTC for each county. The CTC Broward County is a large urban/suburban county (population functions in a role as coordinator (or broker) of services; 1.7 million) with sizable cities such as Ft. Lauderdale and actively addressing coordination, monitoring, and reporting.