In March 2011, we found that agencies providing transportation services  to transportation-disadvantaged persons often provide similar services to  similar client groups leading to potential duplication and inefficiency. Twenty-one of these programs are  administered or overseen by HHS. In addition, the types of  eligible transportation expenses funded by these programs vary, and may  include capital investments (e.g., purchasing vehicles, such as buses),  reimbursement of transportation costs (e.g., transit fares, gasoline, and  bus passes) or direct provision of transportation service to program  clients (e.g., operating vehicles), travel training, and mobility  management. Total Federal Spending on NEMT Is Unknown

Total federal spending on NEMT in fiscal year 2012 is significant but  unknown because in many cases, federal departments do not separately  track spending for these services. Only one of the six departments (8 of  the 42 programs) for which NEMT is an eligible expense were able to  provide information about NEMT spending. Data not available. NEMT incidental to program mission. Coordination of NEMT Service is Limited and There is Fragmentation, Overlap, and Potential for Duplication

		Coordinating Council

The Coordinating Council has taken some actions to address human  service-transportation program coordination. The absence of key  guidance documents include the lack of a strategic plan and a policy on  cost sharing—that is, the ability to identify and allocate costs among  programs and services. across agencies. Fragmentation, overlap, and duplication can result in service  inefficiencies or increased costs when coordination does not occur. States and Localities Facilitate Coordination in Various Ways but Two Programs in Selected States Largely Do Not Participate in Coordination Efforts

		States Use Variety of Ways to Facilitate Coordination of NEMT

States and localities use a variety of ways to facilitate coordination of  transportation and human service programs, including programs that  provide NEMT. These include state and regional coordinating bodies,  cost and ride sharing, and one call/one-click centers. For example, although the Coordinating Council has not finalized cost- sharing methodologies, we found that cost and ride sharing is occurring in  some locations and this has promoted coordination of NEMT service. These programs are important to NEMT, as they provide services to  potentially over 90 million individuals. Important  factors include ensuring that program integrity is maintained and proper  controls are in place to prevent improper payments and fraud. However,  coordination of NEMT without the Medicaid and VA programs increases  the risk of potential program overlap and duplication. The Coordinating Council is tasked with promoting interagency  cooperation and establishing appropriate ways to minimize duplication  and overlap of federal programs so transportation-disadvantaged persons  have access to more transportation services. Recommendations

To promote and enhance federal, state, and local NEMT coordination  activities, we recommend that the Secretary of Transportation, as the  chair of the Coordinating Council, convene a meeting of the member  agencies of the Coordinating Council and take the following three actions:
Complete and publish a new or updated strategic plan that, among  other things, clearly outlines a strategy for addressing NEMT and how  it can be coordinated across federal agencies that fund NEMT  service. DOT stated that it concurred in part with recommendations to  develop a new strategic plan and to finalize a cost-sharing policy. We believe DOT’s efforts regarding the strategic plan and cost-sharing  policy, in addition to identifying the challenges of coordinating Medicaid  and VA NEMT programs with other federal programs that fund NEMT, are  steps in the right direction toward providing the leadership necessary to  help ensure the benefits of coordination are realized by all federal  programs that fund NEMT services. Going forward, it will be important to  (1) complete a new or updated strategic plan, (2) finalize and issue a  cost-sharing policy, and (3) identify and report to Congress the challenges  with coordinating NEMT, particularly with the Medicaid and VA NEMT  programs. Appendix I: Objectives, Scope, and Methodology

The objectives of this report were to (1) identify the federal programs that  can or may provide funding for nonemergency medical transportation, (2)  describe how federal agencies are coordinating nonemergency medical  transportation services and providing potentially duplicative or  overlapping services, and (3) describe how nonemergency medical  transportation services are coordinated at the state and local levels and  the challenges to coordination in select states and localities. To identify federal programs that provide funding for nonemergency  medical transportation services, we examined prior GAO work that  identified federal programs that provide funding and services for  transportation disadvantaged populations, conducted a search of the  Catalog of Federal Domestic Assistance, and requested program  information from the six federal departments—the Departments of  Agriculture, Education, Housing and Urban Development, Health and  Human Services, Transportation, and Veterans Affairs—for the programs  identified.
Why GAO Did This Study

Access to transportation services is essential for millions of Americans to fully participate in society and access human services, including medical care. NEMT is nonemergency, nonmilitary, surface transportation service of any kind provided to beneficiaries or clients for the purpose of receiving medical care. GAO was asked to review the coordination of NEMT services. This report addresses (1) the federal programs that provide funding for NEMT services, (2) how federal agencies are coordinating NEMT services, and (3) how NEMT services are coordinated at the state and local levels and the challenges to coordination.
GAO analyzed a compendium of federal programs that provide assistance to the public; reviewed program information from the six departments that fund NEMT; interviewed officials of DOT, HHS, and VA; and interviewed state and local officials in five states, chosen based on a variety of considerations, including geographic diversity and existence of a coordinating body.

What GAO Found

Forty-two programs across six federal departments—Agriculture, Education, Health and Human Services (HHS), Housing and Urban Development, Transportation (DOT), and Veterans Affairs (VA)—can provide funding for nonemergency medical transportation (NEMT) service, although NEMT is not their primary mission. Twenty-one of these programs, including Medicaid, are administered or overseen by HHS. The type of funding provided by these programs varies, but includes capital investments (such as bus purchases) and reimbursements of transportation costs (e.g., bus passes). Total federal spending on NEMT is unknown because federal departments do not separately track spending for these services. In some cases data were not available or NEMT was incidental to a program's mission. However, one of the six departments (HHS) was able to provide estimates indicating that its spending totaled at least $1.3 billion in fiscal year 2012—most of this attributable to Medicaid.
Coordination of NEMT programs at the federal level is limited, and there is fragmentation, overlap, and potential for duplication across NEMT programs. The federal Interagency Transportation Coordinating Council on Access and Mobility (Coordinating Council)—chaired by the Secretary of DOT and tasked with promoting interagency cooperation and establishing mechanisms to minimize duplication and overlap of programs for the transportation disadvantaged—has taken some actions to improve coordination, such as developing a strategic plan. The strategic plan identified the council's goal, priorities, and objectives for 2011 to 2013. However, the council has provided limited leadership and has not issued key guidance documents that could promote coordination. For example, the council has not met since 2008 and has not finalized a cost-sharing policy that would allow agencies to identify and allocate costs among programs. GAO has previously found that agencies providing similar transportation services to similar client groups may lead to duplication and overlap when coordination does not occur. This review found instances of fragmentation, overlap, and the potential for duplication, although the extent could not be quantified.
State and local officials in the selected states GAO visited identified a variety of ways they facilitate coordination of NEMT. These include state coordinating bodies (two states GAO visited), regional coordinating bodies (two states GAO visited), local metropolitan planning organizations, and local transit agencies. Cost and ride sharing and one-call/one-click information centers were also used to coordinate NEMT services. However, GAO found two programs—Medicaid and VA NEMT programs—largely do not participate in coordination activities. Requirements to serve only eligible individuals and ensuring proper controls are in place to prevent improper payments and fraud are among the challenges to coordination for these programs. These important NEMT programs provide services to potentially over 90 million individuals and coordination without the Medicaid and VA programs increases the risk for potential overlap and duplication of services.

What GAO Recommends

GAO recommends that the Secretary of Transportation, as chair of the Coordinating Council, should publish a new strategic plan, issue a cost-sharing policy, and address the challenges associated with coordinating Medicaid and VA NEMT programs with other federal NEMT programs. DOT concurred in part with developing a new strategic plan and issuing a cost-sharing policy, and it concurred with identifying challenges of coordinating NEMT, particularly with HHS agencies.