State DOTs Connecting Specialized Transportation Users and Rides Volume 2: Toolkit for State DOTs and Others (2016)

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9 Target Users, Trips, and Modes Many linkage programs are designed to connect specialized transportation user groups (peo- ple with disabilities, seniors, persons with low income, and veterans) and others to transporta- tion providers that can serve a specific trip type. Some transportation services, for example, only serve ADA paratransit trips. Some municipal-based dial-a-ride (DAR) services only serve senior and/or disabled residents of the municipality. Most human service agency transportation options are only available for agency clients and certain trip purposes. Most veterans’ services exclusively focus on transporting veterans to/from VA medical facilities. And even with coordi- nated services, the individual sponsoring organizations set the ground rules of eligible customers and trips. That said, most linkage services seek to connect a wide range of customers, if not the general public, to all available transportation services in a given area. There are many types of target users who use a linkage service. If a linkage service is working correctly, it will connect users to specific trip types and to specific transportation modes that are applicable to their needs. In other words, the linkage program will be able to connect target users and trip types to a target mode (for example: people with disabilities searching for transporta- tion to a medical appointment usually require paratransit service) and screen out other services in the database that are not appropriate for one reason or another. Ideally, the linkage service will connect a target user group to one or more modes that best serve the trips they most often take as well as the trips they most often have trouble taking. Below is a description of the target users, trip types, and modes that are typically included in a linkage program. Target Users Potential target user groups include the following: • Mobility impaired users are individuals who are unable to use one or more of their extremi- ties and/or lack the strength to walk, grasp, or lift objects usually due to a physical, develop- mental, or cognitive disability. These individuals may use a wheelchair, crutches, or a walker to aid in mobility. • Seniors are defined as persons over a specific age—55, 60, or 65 years depending on the pro- gram’s or region’s definition. • Veterans are individuals who have served in the active military, naval, or air service and who were discharged or released from service. • Medicaid recipients are individuals of all ages whose income and resources are insufficient to pay for non-emergency transportation to covered medical appointments. These individuals may be eligible for non-emergency medical transportation paid for by Medicaid programs. S T E P 2

10 State DOTs Connecting Users and Rides for Specialized Transportation: Toolkit • Public transit users are members of the general public who regularly utilize public transit including fixed-route service and paratransit service (defined in the Target Modes section). • General population refers to all other individuals without reference to any specific character- istic mentioned previously. Target Trip Types Potential target trip types include the following: • Non-emergency medical transportation (NEMT) trips refer to medical-related trips that are planned in advance, such as trips to doctor’s appointments, dialysis appointments, cancer treatments, and trips to the medical supply store or pharmacy to purchase equipment or pre- scriptions. Examples include Medicaid, hospital, and insurance NEMT trips. NEMT trips to VA hospitals are often considered a separate trip category. • Dialysis trips are recurring trips for dialysis (a treatment for kidney failure) that typically occur three times per week. Dialysis is a life-support treatment that uses a special machine to filter wastes from blood, performing the duties of a normal kidney. The process can be painful for patients leaving them weak and frail post appointment. • Human service/social services trips include those to adult day centers, senior centers, and other human service facilities that are either government sponsored or a non-profit service provided for the benefit of the community. Many of these services are provided to low-income residents who qualify for subsidies and assistance. These services can also be aimed at specific populations such as seniors, people with disabilities, and/or veterans. • Work/training trips refer to employment-related trips such as those to a daily job, temporary employment, or employment training opportunity. • Shopping/recreation trips are non-medical trips that are essential to quality of life. These trips include grocery shopping, religious services, visits to friends and family, non-medical appointments, and many others. • All trip purposes include all of the previously mentioned trips, plus any other trips that are not defined previously. Target Modes Potential target modes include the following: • Fixed-route transit is a shared passenger transport service available to the general public that operates along an established path at preset times. Modes of fixed-route transit include city buses, trolley buses, trams (or light rail), trains, subway trains, bus rapid transit, intercity bus and rail, and ferries. • ADA complementary paratransit is a specialized transportation service required by the Americans with Disabilities Act. The ADA requires public transit agencies that provide fixed- route service to provide complementary paratransit service to people who cannot use or access the fixed-route bus or rail service because of a disability. The ADA regulations stipulate the population who is eligible for this service and also regulate the minimum service char- acteristics that must be met for this service. In general, ADA paratransit must be provided within 0.75 mile of a bus route or rail station, at the same hours and days, and for no more than twice the regular fixed-route fare. ADA paratransit services that do not provide door-to- door assistance for all trips, and opt instead to provide curb-to-curb service as a default, must accommodate requests for door-to-door assistance. • Dial-a-ride/public paratransit is typically a demand-response, shared-ride passenger transport service available to a specific population group and typically all residents or senior and/or disabled residents of a municipality or transit agency catchment area. For

Target Users, Trips, and Modes 11 example, a public paratransit program may determine that persons over the age of 60 are eligible for the service. Service can be offered curb-to-curb or door-to-door. It is not uncommon for such services to be consolidated with ADA paratransit services to form a “coordinated” service. Most such services are by advance request, although a number of DAR services are now providing same-day if not immediate service. More and more transit agencies are using these demand-responsive services, as a key component to its family of services, to provide first mile/last mile (FMLM) connections to its fixed-route services and to provide such services in communities and/or at times for which fixed-route service is not appropriate (due to low-demand, grade issues, etc.). • Human services transportation (HST) is a specialized transportation service funded by human service organizations and agencies to transport customers to and from organiza- tion facilities and for programmatic events and field trips. Depending on the organization or agency, human service transportation may also transport customers for other purposes, such as to the grocery store, medical appointments, or recreational events. By far, the largest program that falls under this category is Medicaid NEMT trips. The organization of Medicaid trips varies by state. Lead entities responsible for Medicaid NEMT can include (1) the state or county Medicaid office; (2) statewide or regional Medicaid NEMT brokers; (3) managed care organizations (or their transportation brokers or providers); or (4) statewide, regional, or county-based coordinated transportation systems, often led by a transit agency or broker. • Senior transportation is a specialized transportation service offered by municipal or county- sponsored senior programs to transport seniors to and from senior centers and program- ming. Similar to HST, depending on the organization, some programs will offer additional trips to customers outside of those related to the program; most common are trips to medical appointments and shopping trips. • Veterans transportation is specialized transportation targeted to serve veterans and funded by the VA. This type of transportation is typically operated by VA staff, or a contractor or con- tractors, and often is operated with accessible vehicles in the locale of the VA medical center or facility. Some of these services are fixed-route shuttles, while others provide demand-response door-to-door service, or both. Another veterans service is operated by volunteer drivers (often veterans themselves) with non-accessible vans obtained and maintained through Disabled American Veterans (DAV) and typically provides long-distance trips. • Taxicab and livery services are private, for-hire services typically operated with a car, sport utility vehicle, or minivan licensed to transport passengers in return for payment of a fare that is usually based on distance traveled. Taxicab programs are usually regulated by a municipal- ity or county. Some cities have programs that require or encourage taxicab companies to purchase wheelchair-accessible vehicles; however, the typical taxicab vehicle and the typical livery vehicle are not wheelchair accessible. The primary difference between taxis and livery services are that taxis have meters and can be hailed. Livery vehicles do not have meters and are requested in advance. • Chair car services are livery services operating wheelchair-accessible vehicles. While most of the services provide services for Medicaid NEMT and other human service agencies, many have private for-hire rates to non-sponsored individuals; unfortunately such rates are often prohibitively expensive for many individuals who require accessible vehicles (also see vouchers and subsidies below). • Transportation network companies are private companies that use an online-enabled plat- form to connect passengers with drivers using their personal, non-commercial vehicles. Popu- lar examples include Lyft, UberX, and Sidecar. Most of the current TNCs use vehicles that are not wheelchair accessible, although some cities are creating programs to increase the number of wheelchair-accessible vehicles available. For example, TNCs are beginning to pilot specific services for customers who require accessible vehicles and/or who require special assistance. TNCs are also beginning to partner with transit agencies to provide an alternative approach

12 State DOTs Connecting Users and Rides for Specialized Transportation: Toolkit to addressing FMLM needs, suburban mobility needs, and guaranteed-ride-home programs. Some TNCs in certain venues are also piloting “micro-transit” and “smart transit services” where they provide fixed- or flex-route services in areas—or at times—when public bus ser- vice is not provided. • Carpooling is when two or more people make an arrangement to make a regular journey in a single vehicle, sharing the cost of the ride and taking turns to drive the others. A vanpool is similar to a carpool, but typically involves four or more commuters who travel together to work in a van, the cost of which is usually subsidized by a government or non-profit program. • Voucher/subsidy programs work as a way of lowering the cost of the trip, so that riders are able to receive existing transportation services at a reduced cost. Many voucher programs are used to pay for taxicab service, but multiple-mode vouchers (commonly termed “flex” vouchers or “travel” vouchers) can also be used for other types of transportation providers such as pri- vate companies, volunteer drivers, and friends and family members. Many programs providing user-side subsidies are now experimenting with paperless subsidy programs. • Volunteer driver programs typically provide mileage reimbursement to individuals that oper- ate their own vehicles and transport individuals to medical appointments or other services, thereby negating the need for additional labor and capital costs. These programs can also utilize agency vehicles with volunteer drivers. Volunteer driver programs are a key strategy used by human service programs to provide much-needed trips in a cost-effective manner and aid in filling transportation gaps in the community, often providing services where no others exist. Many volunteer driver programs are oriented for seniors and/or human service agency clients. Probably the next most common volunteer programs are provided by faith- based organizations.