Project Background

The Federal government has long recognized and promoted the benefits of coordinating human services transportation. The Coordinating Council on Access and Mobility (CCAM), an interagency group comprised of senior leadership from multiple Federal departments and agencies, has been formed to coordinate Federal efforts. The CCAM defines “human service transportation” as any means used to meet the basic, day-to-day mobility needs of transportation-disadvantaged populations, especially individuals with low-incomes, people with disabilities, and older Americans.¹

The General Accountability Office hasidentified 80 federal programs that fund a variety of transportation services for transportation-disadvantaged populations.² While many different federal programs support transportation, Medicaid has become, after the U.S. Department of Transportation, the largest funding source of medical and health-related transit services.³

Established in 1965, Medicaid is an entitlement program administered by the Centers for Medicare and Medicaid (CMS) and is jointly funded by individual states and the Federal government. Medicaid benefits are guaranteed by law to pregnant women, children, disabled people, and the elderly based on income qualifications. States have the option of extending coverage to other additional populations, based on criteria established in a state Medicaid plan. It is estimated that 71.4 million persons were enrolled in Medicaid and a related children’s health program.⁴

Efforts to coordinate transportation for the transportation disadvantaged, including non-emergency medical transportation (NEMT), began during the 1970s, primarily through state and local initiatives. These entities recognized that a myriad of Federally-sponsored programs either directly funded client transportation as a direct service or as a supplemental service necessary to ensure access to the primary program services. Federal interest regarding the coordination — or lack thereof — was first documented by the U.S. Senate Committee on Public Works. In public hearings held in 1975, concerns were raised about the lack of coordination of Federally-funded programs supporting transportation in rural areas. This hearing led directly to a landmark General Accounting Office (later renamed as the Government Accountability Office (GAO)) report issued in 1977 that identified a number of hindrances to transportation coordination efforts, including “accountability, paperwork, and bookkeeping problems.”⁵

In October 1986, the U.S. Department of Transportation (USDOT) and the U.S. Department of Health and Human Services (USDHHS) executed the “Agreement on the Coordination of Transportation Services,” declaring:

…it is the policy of the Department of Health and Human Services and the Department of Transportation to coordinate related programs at the Federal level wherever possible and to promote maximum feasible coordination at the State and local level.⁶

Since 1986, responsibility for coordination has rested with the Coordinating Council on Access and Mobility (CCAM), which was created under a memorandum of understanding between the USDOT and USDHHS. In 2004, Executive Order 13330 renamed the council the Federal Interagency Transportation Coordinating Council on Access and Mobility.

GAO continued its investigations and studies regarding the coordination of transportation, periodically focusing on specific recommendations. In one 2003 study, GAO recommended executive action on the part of the Federal government to:

Develop and distribute additional guidance to states and other grantees that encourages