There is growing recognition that the health of our nation’s residents is closely tied to the availability of transportation. Transportation is the third most commonly cited barrier to access health services for older adults. Not only is transportation required for patients to be able to get to doctors’ appointments, but also to healthy food, social and recreational opportunities and other services. In this way transportation is considered a social determinant of health. 

The Patient Protection and Affordable Care Act of 2010—better known as ObamaCare—provides a strong incentive for the medical community to support transportation. Under ObamaCare, hospitals are now charged for high readmission rates, totaling millions of dollars a year. Health insurers, also known as managed care organizations, also now have strong incentives and more flexibility to ensure their members can access the care and services they need to avoid costly hospitalization and nursing home care. 

More recent under-the-radar federal policy changes have created new opportunities for transportation and healthcare sector collaboration. 

For one, the U.S. Department of Health and Human Services (HHS) issued a federal “Safe Harbor” ruling for the provision of medical transportation. This ruling, effective January 2017, opened the door for medical providers across the United States to provide or facilitate medical transportation for their established patients. Previously, health care entities could have received penalties stemming from a possible conflict of interest should they include medical transportation as part of their benefit package under the rationale that it would inappropriately induce consumers to choose their plan, hospital, or other service over that of their competitors. Safe harbors protect certain payment practices and business arrangements from sanctions under the anti-kickback statute of the Social Security Act (Section 1128B(b)). 

In 2019, HHS’ Centers for Medicare & Medicaid Services (CMS) expanded the list of benefits private insurance companies may cover as part of a Medicare Advantage Plan to include transportation to doctor’s offices. (The traditional Medicare program (Part A and Part B) still only offers emergency transportation, not health-maintenance transportation.) Furthermore, in 2020 CMS expanded the types of supplemental benefits that health insurance companies may extend to chronically ill enrollees through their Medicare Advantage plans. This includes transportation to obtain non-medical items and services, such as grocery shopping and banking. This has opened up new opportunities to address a critical social determinant of health for financially strapped people ages 65 and older and people with mobility disabilities requiring specialized transportation assistance.   

These new federal rules help align financial incentives for health insurers to provide transportation to those living in a community setting (as opposed to institutional care), including to health care appointments. Transportation can help older adults successfully age in place, providing an important support service they need to remain independent and healthy. As few health insurance companies wish to be in the business of operating transportation services, many look to contract with transportation providers. Hospitals and insurance providers are tapping both private and public transportation providers. For example, Geisinger Health, a not-for-profit healthcare provider and Medicare Advantage and Medicaid managed care organization, worked with a consortium of more than 70 community organizations in south central Pennsylvania to plan and develop a regional coordinated transportation brokerage, housed within the Central Pennsylvania Transportation Authority (known as “rabbit transit’.)

These types of partnerships with healthcare offer public transportation providers the opportunity to fill their seats and serve their communities in new ways. 

Jana Lynott, AICP, MP, is a Senior Strategic Policy Advisor with AARP Public Policy Institute’s Livable Communities team.