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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2006. Transit Agency Participation in Medicaid Transportation Programs. Washington, DC: The National Academies Press. doi: 10.17226/13961.
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TRANSPORTATION RESEARCH BOARD WASHINGTON, D.C. 2006 www.TRB.org T R A N S I T C O O P E R A T I V E R E S E A R C H P R O G R A M TCRP SYNTHESIS 65 Research Sponsored by the Federal Transit Administration in Cooperation with the Transit Development Corporation SUBJECT AREAS Public Transit Transit Agency Participation in Medicaid Transportation Programs A Synthesis of Transit Practice CONSULTANTS KENNETH I. HOSEN and ELISABETH FETTING KFH Group, Inc. Bethesda, Maryland

TRANSIT COOPERATIVE RESEARCH PROGRAM The nation’s growth and the need to meet mobility, environ- mental, and energy objectives place demands on public transit systems. Current systems, some of which are old and in need of upgrading, must expand service area, increase service frequency, and improve efficiency to serve these demands. Research is nec- essary to solve operating problems, to adapt appropriate new technologies from other industries, and to introduce innovations into the transit industry. The Transit Cooperative Research Pro- gram (TCRP) serves as one of the principal means by which the transit industry can develop innovative near-term solutions to meet demands placed on it. The need for TCRP was originally identified in TRB Special Report 213—Research for Public Transit: New Directions, pub- lished in 1987 and based on a study sponsored by the Federal Transit Administration (FTA). A report by the American Public Transportation Association (APTA), Transportation 2000, also recognized the need for local, problem-solving research. TCRP, modeled after the longstanding and successful National Coopera- tive Highway Research Program, undertakes research and other technical activities in response to the needs of transit service provid- ers. The scope of TCRP includes a variety of transit research fields including planning, service configuration, equipment, fa- cilities, operations, human resources, maintenance, policy, and ad- ministrative practices. TCRP was established under FTA sponsorship in July 1992. Proposed by the U.S. Department of Transportation, TCRP was authorized as part of the Intermodal Surface Transportation Effi- ciency Act of 1991 (ISTEA). On May 13, 1992, a memorandum agreement outlining TCRP operating procedures was executed by the three cooperating organizations: FTA, the National Academy of Sciences, acting through the Transportation Research Board (TRB); and the Transit Development Corporation, Inc. (TDC), a nonprofit educational and research organization established by APTA. TDC is responsible for forming the independent govern- ing board, designated as the TCRP Oversight and Project Selec- tion (TOPS) Committee. Research problem statements for TCRP are solicited periodi- cally but may be submitted to TRB by anyone at any time. It is the responsibility of the TOPS Committee to formulate the re- search program by identifying the highest priority projects. As part of the evaluation, the TOPS Committee defines funding levels and expected products. Once selected, each project is assigned to an expert panel, ap- pointed by TRB. The panels prepare project statements (requests for proposals), select contractors, and provide technical guidance and counsel throughout the life of the project. The process for developing research problem statements and selecting research agencies has been used by TRB in managing cooperative re- search programs since 1962. As in other TRB activities, TCRP project panels serve voluntarily without compensation. Because research cannot have the desired impact if products fail to reach the intended audience, special emphasis is placed on disseminating TCRP results to the intended end users of the re- search: transit agencies, service providers, and suppliers. TRB provides a series of research reports, syntheses of transit practice, and other supporting material developed by TCRP research. APTA will arrange for workshops, training aids, field visits, and other activities to ensure that results are implemented by urban and rural transit industry practitioners. The TCRP provides a forum where transit agencies can coop- eratively address common operational problems. The TCRP results support and complement other ongoing transit research and train- ing programs. TCRP SYNTHESIS 65 Price $31.00 Project J-7, Topic SB-13 ISSN 1073-4880 ISBN 0-309-09770-3 Library of Congress Control Number 2006905110 © 2006 Transportation Research Board COPYRIGHT PERMISSION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply TRB, AASHTO, FAA, FHWA, FMCSA, FTA, or Transit Development Corporation endorsement of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. NOTICE The project that is the subject of this report was a part of the Transit Coop- erative Research Program conducted by the Transportation Research Board with the approval of the Governing Board of the National Research Coun- cil. Such approval reflects the Governing Board’s judgment that the project concerned is appropriate with respect to both the purposes and resources of the National Research Council. The members of the technical advisory panel selected to monitor this project and to review this report were chosen for recognized scholarly com- petence and with due consideration for the balance of disciplines appropri- ate to the project. The opinions and conclusions expressed or implied are those of the research agency that performed the research, and while they have been accepted as appropriate by the technical panel, they are not nec- essarily those of the Transportation Research Board, the Transit Develop- ment Corporation, the National Research Council, or the Federal Transit Administration of the U.S. Department of Transportation. Each report is reviewed and accepted for publication by the technical panel according to procedures established and monitored by the Transporta- tion Research Board Executive Committee and the Governing Board of the National Research Council. The Transportation Research Board of The National Academies, the Transit Development Corporation, the National Research Council, and the Federal Transit Administration (sponsor of the Transit Cooperative Research Program) do not endorse products or manufacturers. Trade or manufacturers’ names appear herein solely because they are considered essential to the clarity and completeness of the project reporting. Published reports of the TRANSIT COOPERATIVE RESEARCH PROGRAM are available from: Transportation Research Board Business Office 500 Fifth Street, NW Washington, DC 20001 and can be ordered through the Internet at http://www.national-academies.org/trb/bookstore Printed in the United States of America

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished schol- ars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. On the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and techni- cal matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Acad- emy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achieve- ments of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, on its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Acad- emy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both the Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. William A. Wulf are chair and vice chair, respectively, of the National Research Council. The Transportation Research Board is a division of the National Research Council, which serves the National Academy of Sciences and the National Academy of Engineering. The Board’s mission is to promote innovation and progress in transportation through research. In an objective and interdisciplinary setting, the Board facilitates the sharing of information on transportation practice and policy by researchers and practitioners; stimulates research and offers research management services that promote technical excellence; provides expert advice on transportation policy and programs; and disseminates research results broadly and encourages their implementation. The Board’s varied activities annually engage more than 5,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. www.TRB.org www.national-academies.org The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished schol- ars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. On the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and techni- cal matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Acad- emy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achieve- ments of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, on its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Acad- emy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both the Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. William A. Wulf are chair and vice chair, respectively, of the National Research Council. The Transportation Research Board is a division of the National Research Council, which serves the National Academy of Sciences and the National Academy of Engineering. The Board’s mission is to promote innovation and progress in transportation through research. In an objective and interdisciplinary setting, the Board facilitates the sharing of information on transportation practice and policy by researchers and practitioners; stimulates research and offers research management services that promote technical excellence; provides expert advice on transportation policy and programs; and disseminates research results broadly and encourages their implementation. The Board’s varied activities annually engage more than 5,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. www.TRB.org www.national-academies.org

TCRP COMMITTEE FOR PROJECT J-7 CHAIR FRANK T. MARTIN PBS&J, Tallahassee, FL MEMBERS DEBRA W. ALEXANDER Capital Area Transportation Authority, Lansing, MI DWIGHT FERRELL The Ferrell Group, Richardson, TX MARK W. FURHMANN Metro Transit, Minneapolis, MN ROBERT H. IRWIN British Columbia Transit, Victoria, BC, Canada PAUL J. LARROUSSE National Transit Institute, New Brunswick, NJ WADE LAWSON South Jersey Transportation Authority, Atlantic City, NJ DAVID A. LEE Connecticut Transit, Hartford, CT DAVID PHELPS Consultant, Moneta, VA HAYWARD M. SEYMORE, III Laidlaw Transit Services, Inc., University Place, WA PAM WARD Ottumwa Transit Authority, Ottumwa, IA JOEL R. WASHINGTON Washington Metropolitan Area Transit Authority, Washington, DC FTA LIAISON KAREN FACEN Federal Highway Administration TRB LIAISON PETER SHAW Transportation Research Board COOPERATIVE RESEARCH PROGRAM STAFF ROBERT J. REILLY, Director, Cooperative Research Programs CHRISTOPHER W. JENKS, Manager, TCRP EILEEN P. DELANEY, Director of Publications TCRP SYNTHESIS STAFF STEPHEN R. GODWIN, Director for Studies and Information Services JON WILLIAMS, Manager, Synthesis Studies DONNA L. VLASAK, Senior Program Officer DON TIPPMAN, Editor CHERYL KEITH, Senior Secretary TOPIC PANEL ANDREA V. BUSADA, Broward County Division of Mass Transit DEBBIE COLLINS, North Carolina State University MAUREEN HENSLEY-QUINN, Community Transportation Association of America REGINALD KNOWLTON, WHEELS, Inc. CAREY ROESSEL, Access Transit Services, Inc. PAM WARD, Ottumwa Transit Authority PARK WOODWORTH, King County Metro Transit DOUG BIRNIE, Federal Highway Administration (Liaison) BRYNA HELFER, Federal Highway Administration (Liaison) NIKKI BRATCHER-BOWMAN, U.S. Department of Health and Human Services (Liaison)

Transit administrators, engineers, and researchers often face problems for which in- formation already exists, either in documented form or as undocumented experience and practice. This information may be fragmented, scattered, and unevaluated. As a conse- quence, full knowledge of what has been learned about a problem may not be brought to bear on its solution. Costly research findings may go unused, valuable experience may be overlooked, and due consideration may not be given to recommended practices for solv- ing or alleviating the problem. There is information on nearly every subject of concern to the transit industry. Much of it derives from research or from the work of practitioners faced with problems in their day-to-day work. To provide a systematic means for assembling and evaluating such use- ful information and to make it available to the entire transit community, the Transit Co- operative Research Program Oversight and Project Selection (TOPS) Committee author- ized the Transportation Research Board to undertake a continuing study. This study, TCRP Project J-7, “Synthesis of Information Related to Transit Problems,” searches out and synthesizes useful knowledge from all available sources and prepares concise, documented reports on specific topics. Reports from this endeavor constitute a TCRP re- port series, Synthesis of Transit Practice. This synthesis series reports on current knowledge and practice, in a compact format, without the detailed directions usually found in handbooks or design manuals. Each re- port in the series provides a compendium of the best knowledge available on those meas- ures found to be the most successful in resolving specific problems. FOREWORD By Staff Transportation Research Board This synthesis documents and summarizes the tasks necessary for a public transit– Non-Emergency Medical Transportation (NEMT) partnership to be successful. The purpose is to report on the real and perceived barriers to NEMT and public transit coordination and to describe case studies of Medicaid transportation program participation by transit agen- cies. This topic is of interest to transit agency staff at the local level. They might use this report to learn from and compare their experiences with the experiences of other agencies. Opportunities exist for public transit agencies to participate in the NEMT program as providers of service or as brokers. Findings in this report are based on a literature review; surveys of selected transit agen- cies, corresponding state department of transportation transit divisions, and state Medicaid agencies; analysis of documentation submitted; interviews; and site visits. Case study descriptions were prepared to reflect geographical diversity; urban, small urban, and rural agencies; and different service delivery models. The case studies are: Broward County, Florida; North Georgia Community Action Agency, Georgia; TriMet, Portland, Oregon; Texoma Area Paratransit System, Texas; and Chittenden County Transportation Authority, Vermont. Kenneth I. Hosen, KFH Group, Inc., Bethesda, Maryland, collected and synthesized the information and wrote the paper, under the guidance of a panel of experts in the subject area. The members of the Topic Panel are acknowledged on the preceding page. This syn- thesis is an immediately useful document that records the practices that were acceptable within the limitations of the knowledge available at the time of its preparation. As progress in research and practice continues, new knowledge will be added to that now at hand. PREFACE

CONTENTS 1 SUMMARY 3 CHAPTER ONE INTRODUCTION Background, 3 Non-Emergency Medical Transportation, 3 Public Transportation and Americans with Disabilities Act, 3 Purpose of Synthesis, 4 Synthesis Organization and Methodology, 4 Glossary, 4 6 CHAPTER TWO LITERATURE REVIEW Introduction, 6 Selected Publications, 6 Key Issues, 8 10 CHAPTER THREE SURVEY OF STATE MEDICAID AGENCIES, DEPARTMENTS OF TRANSPORTATION, AND TRANSIT AGENCIES Survey Methodology, 10 Survey Results, 10 Barriers and Challenges, 13 22 CHAPTER FOUR CASE STUDIES OF MEDICAID AND PUBLIC TRANSIT COORDINATION Emerging Coordination Themes, 22 Background, 22 Florida—Broward County Transit, 23 Georgia—North Georgia Community Action Agency, Jasper, 24 Oregon—TriMet, Portland, 25 Texas—Texoma Area Paratransit System, Sherman and Dennison, 26 Vermont—Chittenden County Transportation Authority, Burlington, 28 Summary—Case Studies, 29 31 CHAPTER FIVE CONCLUSIONS Success Factors, 31 Helpful Factors, 31 Challenges, 32 Suggestions for Further Research, 32 33 REFERENCES 34 BIBLIOGRAPHY

35 APPENDIX A SURVEYS 48 APPENDIX B STATE DEPARTMENTS OF TRANSPORTATION, MEDICAID AGENCIES, AND TRANSIT SYSTEMS RESPONDING TO THE SURVEYS

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TRB's Transit Cooperative Research Program (TCRP) Synthesis 65: Transit Agency Participation in Medicaid Transportation Programs explores the tasks that may help develop successful public transit-non-emergency medical transportation (NEMT) partnerships. The report examines real and perceived barriers to NEMT and public transit coordination and includes case studies of Medicaid transportation program participation by transit agencies.

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