This is the accessible text file for GAO report number GAO-15-110 
entitled 'Transportation Disadvantaged Populations: Nonemergency 
Medical Transportation Not Well Coordinated, and Additional Federal 
Leadership Needed' which was released on January 9, 2014. 

This text file was formatted by the U.S. Government Accountability 
Office (GAO) to be accessible to users with visual impairments, as 
part of a longer term project to improve GAO products' accessibility. 
Every attempt has been made to maintain the structural and data 
integrity of the original printed product. Accessibility features, 
such as text descriptions of tables, consecutively numbered footnotes 
placed at the end of the file, and the text of agency comment letters, 
are provided but may not exactly duplicate the presentation or format 
of the printed version. The portable document format (PDF) file is an 
exact electronic replica of the printed version. We welcome your 
feedback. Please E-mail your comments regarding the contents or 
accessibility features of this document to Webmaster@gao.gov. 

This is a work of the U.S. government and is not subject to copyright 
protection in the United States. It may be reproduced and distributed 
in its entirety without further permission from GAO. Because this work 
may contain copyrighted images or other material, permission from the 
copyright holder may be necessary if you wish to reproduce this 
material separately. 

United States Government Accountability Office: 
GAO: 

Report to Congressional Committees: 

December 2014: 

Transportation Disadvantaged Populations: 

Nonemergency Medical Transportation Not Well Coordinated, and 
Additional Federal Leadership Needed: 

GAO-15-110: 

GAO Highlights: 

Highlights of GAO-15-110, a report to congressional committees. 

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. 

View [hyperlink, http://www.gao.gov/products/GAO-15-110]. For more 
information, contact Dave Wise at (202) 512-2834 or wised@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

Various Federal Programs Can Fund NEMT Services, but Total Spending Is 
Unknown: 

Coordination of NEMT Service is Limited and There is Fragmentation, 
Overlap, and Potential for Duplication: 

States and Localities Facilitate Coordination in Various Ways but Two 
Programs in Selected States Largely Do Not Participate in Coordination 
Efforts: 

Conclusions: 

Recommendations: 

Agency Comments: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: Inventory of Federal Programs Where Nonemergency Medical 
Transportation Is an Eligible Expense: 

Appendix III: GAO Contact and Staff Acknowledgments: 

Table: 

Table 1: Organizations Contacted for GAO's State and Local Interviews: 

Figures: 

Figure 1: Federal Programs GAO Identified Authorized to Fund 
Nonemergency Medical Transportation in Fiscal Year 2012: 

Figure 2: Example of One-Call/One-Click Information Call Center: 

Abbreviations: 

ACL: Administration for Community Living: 

CHIP: Children's Health Insurance Program: 

CMS: Centers for Medicare and Medicaid Services: 

CTD: Commission for the Transportation Disadvantaged: 

DOT: Department of Transportation: 

FTA: Federal Transit Administration: 

GPRAMA: GPRA Modernization Act of 2010: 

HHS: Department of Health and Human Services: 

HUD: Department of Housing and Urban Development: 

MAP-21: Moving Ahead for Progress in the 21st Century Act: 

NCMM: National Center for Mobility Management: 

NCSL: National Council on State Legislatures: 

NEMT: nonemergency medical transportation: 

SAFETEA-LU: Safe, Accountable, Flexible, Efficient Transportation 
Equity Act: A Legacy for Users: 

SCC: State Coordinating Committee for Human Services Transportation 
(of Maryland): 

VA: Department of Veterans Affairs: 

VTCLI: Veteran's Transportation and Community Living Initiative: 

VTP: Veterans Transportation Program: 

VTS: Veterans Transportation Service: 

[End of section] 

United States Government Accountability Office: 
GAO:
441 G St. N.W. 
Washington, DC 20548: 

December 10, 2014: 

The Honorable Bill Shuster: 
Chairman: 
The Honorable Nick J. Rahall, II: 
Ranking Member: 
Committee on Transportation and Infrastructure: 
House of Representatives: 

The Honorable Thomas Petri: 
Chairman: 
The Honorable Eleanor Holmes Norton: 
Ranking Member: 
Subcommittee on Highways and Transit: 
Committee on Transportation and Infrastructure: 
House of Representatives: 

Access to transportation services is essential for millions of 
Americans to fully participate in society and to access human 
services, including education, job training, and medical care. 
Transportation to medical care, in particular, is becoming more 
important as an increasing number of people develop conditions that 
require access to medical services, the percentage of the population 
that is older continues to grow, and more service members return from 
wars needing medical care. According to the U.S. Census Bureau (Census 
Bureau), people with disabilities often rely on forms of government 
assistance to remain active in the community, including transportation 
to medical appointments and services. The Census Bureau reported there 
were almost 57 million people with disabilities in 2010 with about 38 
million of these people having a severe disability.[Footnote 1] 

We have previously found that there are a number of federal programs 
that are authorized to use federal funds for "transportation-
disadvantaged" individuals in accessing human service programs, 
including nonemergency medical transportation (NEMT).[Footnote 2] 
Federal agencies, including the Departments of Agriculture, Education, 
Health and Human Services (HHS), Housing and Urban Development (HUD), 
Transportation (DOT), and Veterans Affairs (VA), have programs that 
provide funding to state and local agencies that can be used for NEMT 
to help individuals' access medical services.[Footnote 3] In June 
2012, we recommended that the federal Interagency Transportation 
Coordinating Council on Access and Mobility (Coordinating Council)--
the body tasked with developing policies and procedures for 
coordinating federal transportation and human-service programs and 
chaired by the Secretary of DOT--take actions to enhance federal, 
state, and local coordination activities.[Footnote 4] We have reported 
in the past, and most recently in April 2014, that coordination is one 
way to help reduce, eliminate, or better manage duplication, overlap, 
or fragmentation among federal programs and can lead to greater 
efficiency and effectiveness and achieve cost savings.[Footnote 5] 

You asked that we review NEMT programs and coordination at the 
federal, state, and local levels. This report addresses (1) the 
federal programs that are authorized to provide funding for NEMT 
services, (2) how federal agencies are coordinating NEMT services and 
whether there is fragmentation, overlap, or duplication of services, 
and (3) how NEMT services are coordinated at the state and local 
levels and the challenges to coordination in selected states and 
localities.[Footnote 6] 

To identify federal programs that fund NEMT, we reviewed our prior 
work on transportation disadvantaged populations, conducted a search 
of the Catalog of Federal Domestic Assistance,[Footnote 7] and 
requested program information from federal agency officials for the 
programs we identified. We reviewed relevant federal laws governing 
these programs, including the popular title or original source of 
program legislation. We limited our scope to federal agencies that are 
members of the Coordinating Council because these agencies were 
identified by executive order to participate in coordination and 
administered programs that play a key role in funding NEMT. To 
describe how federal agencies are coordinating NEMT services and 
providing potentially duplicative or overlapping services, we 
conducted interviews with program officials from three key agencies--
DOT, HHS, and VA--and reviewed relevant documentation provided by 
agency officials. We deemed DOT, HHS, and VA to be key agencies 
because they provide significant funding for NEMT service and 
administered programs that were authorized to fund NEMT. We also 
interviewed officials of the Coordinating Council as well as state and 
local officials in the locations we visited and reviewed relevant 
Coordinating Council policy documents, its strategic plan, and 2013 
progress report. To describe how NEMT services are coordinated at the 
state and local levels and the challenges to coordination in selected 
states and localities, we reviewed relevant literature and prior GAO 
reports and conducted interviews with state and local officials from 
five states--Florida, Maryland, Oregon, Pennsylvania, and Texas. We 
chose these states based on a variety of considerations, including the 
size of the target populations who use NEMT services, existence of a 
state or regional coordinating body, and geographic diversity. As part 
of our site visits, we spoke with officials from state and local 
transportation and human service agencies, metropolitan planning 
organizations, transportation providers, and transportation 
brokers.[Footnote 8] Information obtained in our site visits cannot be 
generalized to all states. Appendix I contains a more detailed 
discussion of our objectives, scope, and methodology. 

We conducted this performance audit from January 2014 to December 2014 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

Background: 

The transportation-disadvantaged population generally includes those 
individuals who cannot provide their own transportation due to age, 
disability, or income constraints. Although the size of this 
population can vary over time, this population is large. The Census 
Bureau estimated that in 2010 there were about 40 million people age 
65 and over and about 46 million people in poverty.[Footnote 9] In 
addition, the Census Bureau has estimated that, in 2012, 3.6 million 
of about 21-million veterans had a service-connected disability. Some 
or all of these individuals may have need of NEMT to access medical 
services. 

While a variety of federal agencies have programs that can provide 
funding for NEMT service, DOT, HHS, and VA play key roles related to 
NEMT. These roles are summarized below. 

* The Federal Transit Administration (FTA), a modal administration 
within DOT, provides funding for public transportation, which can 
include services such as NEMT. Among FTA programs that support NEMT 
are the following: Urbanized Area Formula Program,[Footnote 10] the 
Formula Grants for the Enhanced Mobility of Seniors and Individuals 
with Disabilities program,[Footnote 11] and the Formula Grants for 
Rural Areas program.[Footnote 12] In fiscal year 2014, FTA apportioned 
$4.8 billion, $257.5 million, and $618.4 million, respectively for 
these programs. In general, funding from these programs is provided to 
states and localities for public transportation, including 
transportation services for the elderly and disabled. FTA funds can be 
used, among other things, for capital projects, such as bus purchases, 
and operating expenses, such as fuel and maintenance. FTA also 
provides administrative support and staff for the Coordinating Council 
and, as discussed later in this report, is involved with several 
council initiatives related to coordination of transportation and 
human service programs. 

* Within HHS, Medicaid is a joint federal/state health-financing 
program for certain low-income individuals overseen by the Centers for 
Medicare and Medicaid Services (CMS).[Footnote 13] States administer 
their Medicaid programs, which must operate within broad federal 
guidelines. Under the Medicaid program, states are required to assure 
that Medicaid beneficiaries have access to necessary medical services. 
This includes arranging for transportation to medical appointments and 
other services when beneficiaries cannot transport themselves. In 
fiscal year 2013, the Medicaid program provided health care coverage 
to about 72 million individuals.[Footnote 14] 

* VA operates the largest integrated health-care delivery system in 
America. VA operates 150 medical centers and 820 community-based 
outpatient clinics. Under federal regulations, VA is authorized to pay 
for transportation to medical services for those veterans who meet 
certain eligibility criteria. These criteria include having a service-
connected disability or meeting certain income and other criteria. In 
general, VA provides NEMT through mileage reimbursements, direct 
provision of transportation for special needs patients (such as those 
in wheelchairs or on stretchers), and using veterans' service 
organizations (such as the Disabled American Veterans). 

Federal efforts to coordinate transportation for the transportation 
disadvantaged, including NEMT, began during the 1970s and since 1986, 
responsibility for coordination has rested with the Coordinating 
Council on Access and Mobility, which was created under a memorandum 
of understanding between DOT and HHS. In 2004, Executive Order 13330 
renamed the council the federal Interagency Transportation 
Coordinating Council on Access and Mobility and expanded membership to 
include 11 federal agencies, including VA.[Footnote 15] Among other 
things, the Coordinating Council is tasked with promoting interagency 
cooperation and establishing appropriate mechanisms to minimize 
duplication and overlap of federal programs and services so that 
transportation-disadvantaged persons have access to more 
transportation services, facilitating access to cost-effective 
transportation services, and formulating and implementing policy and 
procedural mechanisms that enhance transportation services at all 
levels. In 2003, the Coordinating Council launched the "United We 
Ride" initiative to act as a forum for interagency communication and 
help states and communities overcome obstacles to coordination. In 
June 2012, we reported the Coordinating Council had taken a number of 
actions through this initiative aimed at improving coordination at the 
federal level and providing assistance for state and local 
coordination.[Footnote 16] This included issuing policy statements and 
progress reports on efforts taken and supporting technical assistance 
efforts. 

Congress has also supported coordination of human service-
transportation programs. As we have previously reported, the Safe, 
Accountable, Flexible, Efficient Transportation Equity Act: A Legacy 
for Users (SAFETEA-LU), which was enacted in 2005, amended several 
human services transportation coordination provisions, sharpening the 
focus on transportation services for persons with disabilities, older 
adults, and individuals with lower incomes.[Footnote 17] SAFETEA-LU 
also required that projects funded by FTA's Formula Grants for Special 
Needs of Elderly Individuals and Individuals with Disabilities program 
come from a locally developed, coordinated public transit-human 
services transportation plan.[Footnote 18] More recently, the Federal 
Public Transportation Act of 2012 (part of the Moving Ahead for 
Progress in the 21st Century Act (MAP-21)), enacted in 2012, continued 
certain requirements of SAFETEA-LU. In particular, it continued the 
requirement that recipients of federal funds under the Formula Grants 
for the Enhanced Mobility of Seniors and Individuals with Disabilities 
program certify that projects selected for funding are included in a 
locally developed, coordinated public transit-human services 
transportation plan.[Footnote 19] The act also required recipients to 
certify that (1) the plan is developed and approved through a process 
that includes participation by seniors, individuals with disabilities, 
and representatives of public, private, and nonprofit-transportation 
and human-services providers, among others, and (2) to the maximum 
extent feasible, the services funded under this program are 
coordinated with transportation services assisted by other federal 
departments and agencies, including those of HHS.[Footnote 20] 
Finally, the Federal Public Transportation Act of 2012 also authorized 
funding for mobility management activities consisting of short-range 
planning and management activities and projects for improving 
coordination among public transportation and other transportation 
providers.[Footnote 21] 

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.[Footnote 22] We have also previously found that many 
federal efforts transcend more than one agency, yet agencies face a 
range of challenges and barriers when they attempt to work 
collaboratively.[Footnote 23] Both Congress and the executive branch 
have recognized this, and in January 2011, the GPRA Modernization Act 
of 2010 (GPRAMA) was enacted, updating the original Government 
Performance and Results Act.[Footnote 24] GPRAMA established a new 
framework aimed at taking a more crosscutting and integrated approach 
to focusing on results and improving government performance. In 
February 2012, we found that effective implementation of this act 
could play an important role in clarifying desired outcomes; in 
addressing program performance spanning multiple organizations; and in 
facilitating future actions to reduce unnecessary duplication, 
overlap, and fragmentation.[Footnote 25] 

Various Federal Programs Can Fund NEMT Services, but Total Spending Is 
Unknown: 

Forty-two Federal Programs May Fund NEMT: 

We identified 42 federal programs in six federal departments that may 
provide funding for NEMT (see fig. 1). Twenty-one of these programs 
are administered or overseen by HHS. The Department of Education 
(Education) administers seven programs; HUD administers six programs 
(three of which are statutory components of the Community Development 
Block Grant program); DOT administers four programs, VA administers 
three programs, and the Department of Agriculture administers one 
program. A full description of the identified programs is included in 
appendix II. 

Figure 1: Federal Programs GAO Identified Authorized to Fund 
Nonemergency Medical Transportation in Fiscal Year 2012: 

[Refer to PDF for image: vertical bar graph] 

Programs (42 total): 

Department of Agriculture (1 program): 
Community Facilities Loans and Grants, 

Department of Veterans Affairs (3 programs): 
Veterans Medical Care Benefits; VA Homeless Providers Grant and Per 
Diem Program; Veterans Transportation Program, 

Department of Transportation (4 programs): 
Urbanized Area Formula Program; Formula Grants for Rural Areas; 
Enhanced Mobility of Seniors and Individuals with Disabilities; New 
Freedom Program, 

Department of Housing and Urban Development (6 programs): 
Congregate Housing Services program; Community Development Block 
Grants/Entitlement Grants; Community Development Block Grants/Special 
Purpose Grants/Insular Areas; Community Development Block 
Grants/State's program and Non-Entitlement Grants in Hawaii; Housing 
Opportunities for Persons with AIDS; Resident Opportunity & Self-
Sufficiency Program, 

Department of Education (7 programs): 
State Vocational Rehabilitation Services Program; Centers for 
Independent Living; Independent Living State Grants; Independent 
Living Services for Older Individuals Who Are Blind; Special Education-
Grants for Infants and Toddlers; Supported Employment Services for 
Individuals with Most Significant Disabilities; Rehabilitation 
Services American Indians with Disabilities, 

Department of Health and Human Services (21 programs): 
Special Programs for the Aging Title III, Part B, Grants for 
Supportive Services and Senior Centers; Special Programs for the 
Aging, Title VI, Part A, Grants to Indian Tribes, Part B, Grants to 
Native Hawaiians; Comprehensive Community Mental Health Services for 
Children with Serious Emotional Disturbances; Coordinated Services and 
Access to Research for Women, Infants, Children and Youth; Urban 
Indian Health Services; Health Center Program; Special Diabetes 
Program for Indians Diabetes Prevention and Treatment Projects; 
Substance Abuse and Mental Health Services-Access to Recovery; 
Transitional Living Program and Maternity Group Homes for Homeless 
Youth; Head Start; Social Services Block Grants; Children's Health 
Insurance Program; Medicaid; Rural Health Care Services Outreach, 
Rural Health Network Development, and Small Health Care Provider 
Quality Improvement Program; HIV Emergency Relief Project Grants; HIV 
Care Formula Grants; HIV Early Intervention Services; Healthy Start 
Initiative; Community Mental Health Services Block Grant; Substance 
Abuse Prevention and Treatment Block Grant; Maternal and Child Health 
Services Block Grant to the States, 

Source: GAO analysis. GAO-15-110. 

[End of figure] 

None of the programs we identified has NEMT as a primary mission. For 
example, all funds of the 4 DOT programs we identified are used to 
support public transportation, which may include NEMT. The remaining 
38 programs we identified primarily provide a variety of human 
services such as job training, employment, education, medical care, or 
other services, which incorporate transportation as an eligible 
program expense to ensure participants can access a service. 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. 

Examples of transportation services and capital investments authorized 
for funding under the programs we identified include the following: 

* HHS's Health Center Program provides funding that is used for bus 
tokens, vouchers, transportation coordinators, and drivers to 
medically underserved populations to access health care services. 

* DOT's Enhanced Mobility of Seniors and Individuals with Disabilities 
program can be used by recipient agencies to purchase vehicles such as 
vans to improve access to transportation for any purpose, including 
NEMT. 

* VA's Veterans Transportation Program (VTP) provides funds that can 
be used to purchase vans that transport veterans to VA medical centers. 

* HUD's Congregate Housing Services program provides funds for 
accessible taxis, local transportation programs, and buses for the 
elderly and disabled to access medical appointments, among other 
things. 

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.[Footnote 26] 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.[Footnote 
27] According to agency officials, in fiscal year 2012, Medicaid spent 
at least $1.3 billion and other HHS programs spent over $51 million 
[Footnote 28]--a total of over $1.3 billion.[Footnote 29] The amount 
reported as spent by Medicaid is incomplete; it includes spending by 
those states that have selected to report NEMT as an optional service, 
but does not include spending by states that chose to report NEMT as 
an administrative expense since this information was not available in 
fiscal year 2012.[Footnote 30] No other agencies were able to 
specifically identify NEMT spending. 

According to federal officials, information on NEMT spending may not 
be available for various reasons. 

* Data not available. FTA officials told us the agency does not track 
NEMT expenditures and does not track NEMT trips because its 
transportation funding serves multiple populations and trip types. As 
a result, data are not available on NEMT spending. This is largely the 
result of FTA's programs being used to fund capital expenditures or 
operating expenses that support public transportation systems, not 
NEMT specifically. FTA officials said the Enhanced Mobility of Seniors 
and Individuals with Disabilities program is the one program that most 
likely uses its funds to support NEMT since it is focused on 
transportation services for those who are disabled or seniors. 
However, FTA does not collect specific information about NEMT for this 
program. 

* NEMT incidental to program mission. Several agencies--including the 
Department's of Agriculture, Education, and HUD--have programs for 
which NEMT is incidental to a broader program mission. Each of these 
agencies told us they do not track NEMT spending and could not provide 
specific spending amounts, even though NEMT is an eligible expense for 
each of the programs we identified for those agencies. 

Difficulties in identifying specific expenditures for particular 
program services is similar to what we found in 2012 when we reported 
on services for the transportation disadvantaged population.[Footnote 
31] In that report we found that spending for transportation 
disadvantaged programs was not tracked because (1) some programs allow 
for transportation spending as an optional service and program 
grantees are not asked to provide spending information, and (2) some 
federal programs give states and localities broad flexibility to 
administer program funds and program structures may not lend 
themselves to tracking transportation spending. We also found that 
resources necessary to track this information in some departments may 
outweigh the potential benefits. For example, HUD officials told us 
that for some HUD programs, requiring grantees to report 
transportation expenses would require a new reporting effort and 
resource constraints could limit analysis of any information collected. 

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. In 2012, we found that 
there had been a lack of activity at the leadership level of the 
Coordinating Council and the absence of key guidance documents for 
furthering agency coordination efforts. To better promote and enhance 
federal, state, and local coordination activities, we recommended the 
Coordinating Council complete and publish a strategic plan and report 
on the progress of recommendations made in the Coordinating Council's 
2005 Report to the President.[Footnote 32] The Coordinating Council 
has taken actions to address our recommendations. For example, the 
Coordinating Council developed a strategic plan that covered the 2011 
to 2013 period, and in 2013 it published a progress report providing 
an update on accomplishments and progress that had been made on the 
recommendations made in the 2005 report. Among other things, the 
strategic plan identified the Coordinating Council's priorities and 
objectives over the covered period, identified the council's strategic 
goal, and outlined various strategies for achieving the goal. The goal 
was to continue to improve mobility, employment opportunities, and 
access to community services for persons who are transportation 
disadvantaged. The priorities included demonstrating federal 
leadership on transportation coordination and expanding the 
coordinated human service-transportation infrastructure. Strategies 
for demonstrating federal leadership in coordination included 
developing and approving cost-sharing guidance that facilitated the 
sharing of vehicles and rides. Strategies for expanding the 
coordination of human service-transportation infrastructure included 
strengthening the coordinated planning process, in part by improving 
stakeholder participation. The progress report provided updates on 
five recommendations that were made in the council's 2005 report to 
the President.[Footnote 33] In general, progress had been made in a 
number of areas, including establishing a coordinated transportation-
human service planning process and developing a policy statement about 
vehicle sharing. 

According to the Coordinating Council, other activities to help 
increase coordination among federal transportation and human service 
programs are also underway. These activities include: 

* Enhancing mobility management: Mobility management consists of a 
variety of measures designed to increase accessibility to 
transportation for transportation disadvantaged persons. The National 
Center for Mobility Management (NCMM) is an initiative of the 
Coordinating Council's United We Ride program and is supported through 
a 5-year cooperative agreement with FTA. NCMM was established in 2013 
and its primary activities support FTA grantees, mobility managers, 
and others in developing and adopting mobility management practices, 
including one-call/one-click transportation-information centers. FTA 
also funds technical assistance centers such as the National Center on 
Senior Transportation and NCMM. 

* Establishing one-call/one-click centers: One-call/one-click centers 
are central information sources that individuals can call into or 
access from their computers to obtain information on transportation 
options in a locality (see fig. 2). Coordinating Council officials 
told us the Veteran's Transportation and Community Living Initiative 
(VTCLI) program, led by FTA, in collaboration with VA and HHS, focuses 
on improving access to jobs and services, including medical services, 
for America's military veterans and families. The program makes grants 
available to states and localities to establish, among other things, 
one-call/one-click centers.[Footnote 34] The program only awarded 
grants in fiscal years 2011 and 2012. In that period, VTCLI awarded 
approximately $64 million for 119 grant projects for a wide range of 
activities and technology improvements, including mobility management 
tools, such as one-call or one-click centers. This program was 
identified by the Coordinating Council as the most significant council-
led outcome of the current administration. VTCLI projects were 
underway in four of the five states we visited--Florida, Oregon, 
Pennsylvania, and Texas. In each case one-call/one-click centers were 
being established to provide information about transportation options 
to both disadvantaged populations and veterans. In general, funds were 
being used to develop computer software to collect data on 
transportation services. 

* Creating a more inclusive planning effort: Coordinating Council 
officials identified the Transportation 4 All initiative, which is a 
joint effort by FTA and HHS's Administration for Community Living 
(ACL), to foster creation of an inclusive planning effort in local 
communities.[Footnote 35] According to program documents, the purpose 
of the program is to identify models and approaches that would empower 
people with disabilities and others to be actively involved in 
designing coordinated transportation systems that are responsive to 
the needs of people with disabilities and older adult populations. 

Figure 2: Example of One-Call/One-Click Information Call Center: 

[Refer to PDF for image: photograph] 

Source: TAPS Public Transit. GAO-15-110. 

[End of figure] 

The Coordinating Council also uses interagency working groups to 
accomplish its activities. However, the interagency working group most 
directly related to NEMT is just beginning to address the challenges 
of coordinating transportation and healthcare programs. Of the 
Coordinating Council's two active interagency working groups, the 
Health, Wellness, and Transportation group is most related to NEMT. 
[Footnote 36] This group includes representatives from the Department 
of Labor, HHS, and VA and functions to bring interagency collaboration 
to areas of interest to partner agencies and foster collaboration 
across the federal government. According to Coordinating Council 
officials, working groups assist in developing policy statements and 
initiatives and are activated in response to specific needs that arise 
for collaboration between the Council's member agencies. Coordinating 
Council officials said the Health, Wellness, and Transportation group 
has met monthly since September 2013 and began examining barriers to 
coordinating transportation and healthcare programs over a year ago. 
Various groups, including CMS, have provided presentations on 
healthcare programs, how they operate, and their regulatory 
requirements. One of the issues the working group is trying to analyze 
is the cost of trips and cost sharing, which according to a 
Coordinating Council official, remains a barrier to coordination. 

While the Coordinating Council has taken some steps to increase 
coordination, it continues to exercise little leadership in this area, 
including NEMT. This includes the lack of executive leadership and the 
absence of key guidance documents. In 2012, we found that the 
Secretary-level leaders of the 11 Coordinating Council members had not 
met since 2008, and the Executive Council designees had not met since 
2007. This inaction is still the case. We previously found that, 
according to some agency officials, this lack of direction and visible 
activity on coordination from agency leaders contributes to a lack of 
buy-in from federal program officials, which may affect how program 
coordination is undertaken at the state and local levels.[Footnote 37] 
For example, some agency officials told us that direction and formal 
buy-in at the executive level is needed for improvements to 
coordination to occur. 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. 

The strategic plan that the Coordinating Council issued covers the 
2011 to 2013 period but expired in 2013, and has not yet been updated. 
According to a Coordinating Council official, a decision has not been 
made as to whether a new plan will be prepared to continue to 
implement many of the priorities identified in the 2011 to 2013 
strategic plan. Instead, FTA is in the process of developing a 2-year 
strategy. This process will include a decision as to the future role 
of the Coordinating Council and whether there will be a new or updated 
strategic plan. We have previously found that a number of key 
practices enhance and sustain collaboration, including agency plans 
and reports such as a strategic plan. Such a plan can reinforce 
accountability for the collaboration by aligning agency goals and 
strategies with those of the collaborative efforts.[Footnote 38] In 
addition, the goals and priorities outlined in the previous strategic 
plan did not specifically address NEMT. Instead, the goal focused on 
such things as improved mobility and employment opportunities and the 
priorities focused on such things as demonstrating federal leadership 
on transportation coordination and expanding the coordinated human 
service-transportation infrastructure. In the context of NEMT, by not 
updating or issuing a new strategic plan the Coordinating Council may 
be missing an opportunity to identify and align goals and strategies 
for increased NEMT coordination with the benefits of coordination, 
such as increased program efficiency or reduced costs. As discussed 
later, lack of coordination may have resulted in fragmentation, 
overlap, or duplication of NEMT services. 

Coordinating Council officials also told us a draft cost-sharing 
policy had been formulated; however, this policy has not been 
finalized. According to these officials, there are no plans at the 
current time to finalize this policy, and the Coordinating Council 
plans to leave the draft cost-sharing plan as it is until it 
determines where the Coordinating Council's efforts will be focused 
over the next couple of years. Instead, the Coordinating Council is 
promoting a cost-sharing study that was prepared in 2011 under 
sponsorship of FTA by the Transportation Research Board.[Footnote 39] 
This study discusses ways to share costs between transportation and 
human-service programs. In the 2005 Report to the President on Human 
Services Coordination, the Coordinating Council recommended that 
standard cost-allocation principles for transportation be developed 
and endorsed by federal human-service and transportation agencies. A 
2009 National Resource Center for Human Service Transportation 
Coordination report found that ongoing deliberations on a cost-sharing 
policy statement needed to be resolved quickly and in a way that 
promoted successful state and local coordination of public-
transportation and human services. Without developing federal cost 
allocation principles for transportation providers, federal agencies 
may be unable to address cost sharing issues across agencies. A cost 
sharing policy could also help facilitate ride and vehicle sharing. 

Federal Agencies Have Taken Action to Coordinate Transportation 
Planning, but This Action May Not Lead to Coordination of NEMT: 

Similar to the Coordinating Council, federal agencies have also taken 
actions to coordinate transportation planning, including: 

* FTA issued guidance in June 2014 for the public transit-human 
service transportation-planning process under the Enhanced Mobility of 
Seniors and Individuals with Disabilities program. Among other things, 
FTA is required to make sure these plans are prepared and that there 
is participation by a wide range of stakeholders in the coordinated 
planning process.[Footnote 40] The stakeholders are to include local 
transportation and human-service agencies, as well as the general 
public. 

* HHS's ACL, in conjunction with FTA, initiated a program in 2012 that 
seeks to foster inclusive planning efforts in local communities. 
Seventeen projects were initially selected in June 2013 to serve as 
demonstrations in planning, developing, and testing replicable and 
sustainable community models of inclusive planning that include 
participation of people with disabilities and older adults in the 
design and implementation of coordinated transportation systems that 
are responsive to their needs. An initial evaluation of the program 
found that all of the project's activities had actively involved 
organizations and consumers with a focus on ensuring responsiveness to 
the needs of people with disabilities and older adults.[Footnote 41] 

* In 2010, VA established the Veterans Transportation Service (VTS), 
which provides funding to VA medical centers to acquire vehicles, hire 
a mobility manager, and purchase vehicle routing/scheduling software. 
VTS had been established at three of the five VA medical centers we 
visited--Lake City, Florida, Dallas, Texas, and Portland, Oregon. In 
general, VTS funds were being used to provide additional NEMT service. 
Separately, in July 2013, VA also began accepting applications for its 
Transportation of Veterans in Highly Rural Areas grant program. 
[Footnote 42] This program made approximately $3 million available in 
fiscal year 2014 to fund projects that will create innovative ways to 
transport veterans in highly rural areas to VA medical facilities or 
other VA or non-VA facilities in connection with the provision of VA 
medical care.[Footnote 43] 

While the above federal actions may help improve the conditions for 
coordination or the provision of NEMT services, such actions may not 
increase NEMT coordination. Although there is a coordinated 
transportation-planning process for certain FTA programs, full 
stakeholder participation may not take place because human service 
agencies do not have a similar program requirement. For example, 
recipients of funds under FTA's Enhanced Mobility for Seniors and 
Individuals with Disabilities program are required to certify that, to 
the maximum extent feasible, the services funded under the program are 
coordinated with transportation services assisted by other federal 
departments and agencies and come from a locally developed coordinated 
public transit-human service transportation-planning process. However, 
FTA officials told us that non-DOT federal agencies that administer 
programs under which NEMT services may be an eligible expense do not 
have human services-transportation coordination requirements as part 
of laws authorizing these programs. In addition, states and localities 
can invite human service agencies to participate in the transportation-
planning process but it is up to the agencies to actually participate. 
Coordinating Council officials told us that one of the challenges in 
coordinating federal-transportation and human-service programs is the 
inability to reconcile requirements for transportation agencies with 
requirements for human service agencies. We found evidence that not 
all stakeholders participate in the coordinated transportation-
planning process. CMS officials told us they encourage state agencies 
administering the Medicaid program to coordinate their transportation 
services with other non-Medicaid agencies. However, none of the 
Medicaid agencies in the five states we visited participated in the 
coordinated transportation planning process. Similarly, in a March 
2007 letter from VA, the agency's medical centers were encouraged to 
participate in the coordinated transportation planning process but we 
found that none of the five VA medical centers we visited participate 
in this process or make assets, such as vehicles, available to other 
federal agencies. 

Coordination may also be difficult due to internal problems and budget 
constraints within federal agencies. For example, VA officials told us 
that there are management "silos" within VA that make it difficult to 
coordinate NEMT. They said even the simplest of problems like 
connecting VTS to a medical center's budget office, which might 
administer the program, can be complex due to the many groups within 
VA, such as vehicle fleet managers and hospital management that are 
part of the internal coordination process. In addition, budget 
constraints often limit VA's ability to reach the community of 
veterans whom it seeks to serve. These challenges were illustrated at 
one VA medical center we visited where the NEMT fleet manager told us 
he had spent most of the first year in his position trying to 
coordinate NEMT service among the various internal VA components. 
Officials at two VA medical centers also told us NEMT service was 
funded within the medical center's budget and any increases in NEMT 
service meant that there was less money for other medical services 
offered by the center. 

Fragmentation, Overlap, and Potential for Duplication of NEMT Services: 

Our work indicated that as with other transportation services for the 
transportation disadvantaged, fragmentation, overlap and potential 
duplication of NEMT service exist. Fragmentation refers to those 
circumstances where more than one federal agency is involved in the 
same broad area. Overlap occurs when agencies or programs have similar 
goals, engage in similar activities or strategies to achieve them, or 
target similar beneficiaries. Duplication occurs when two or more 
agencies or programs are engaged in the same activities or provide the 
same services to the same beneficiaries. We have previously found that 
the multiple agencies providing transportation services to 
transportation-disadvantaged persons has resulted in fragmented 
services that can be difficult for clients to navigate and that 
narrowly focused programs may result in service gaps.[Footnote 44] We 
have also found those agencies providing transportation services to 
transportation-disadvantaged persons often provide similar services to 
similar client groups, leading to potential duplication and overlap 
and service inefficiencies when coordination does not occur. 
Fragmentation, overlap, and duplication can result in service 
inefficiencies or increased costs when coordination does not occur. 

NEMT services are fragmented because there is more than one federal 
agency involved in the same broad area. As discussed earlier in this 
report, six federal agencies administer 42 different programs for 
which NEMT is an eligible expense. Overlap exists because programs 
that provide NEMT have similar goals and target potentially similar 
beneficiaries. Both Medicaid and VA have similar goals of helping 
their respective beneficiaries access medical services (some 
individuals could be eligible for both Medicaid and VA), serve 
potentially similar beneficiaries--those individuals with 
disabilities, who are low income or who are elderly--and engage in 
similar activities, such as providing NEMT transportation directly or 
indirectly. The potential for duplication in NEMT programs exists 
because two or more programs provide the same services to the same 
beneficiaries. 

The Coordinating Council has not directly addressed duplication, 
overlap, or fragmentation issues. The strategic plan did not 
specifically address these issues or establish a goal to help minimize 
or reduce them. In addition, the Coordinating Council has no on-going 
activities regarding these issues. Coordinating Council officials told 
us the council's purpose is to promote coordination efforts at the 
federal level, and that in general, there are no specific activities 
related to identifying and reducing duplication, overlap, or 
fragmentation. We have also previously found that the Coordinating 
Council could play a more active role in helping to reduce duplication 
and overlap by developing the means for collecting and sharing program 
information by establishing agency roles and responsibilities and 
developing a strategy to reinforce cooperation.[Footnote 45] In regard 
to NEMT, as discussed earlier, some agencies have disseminated 
guidance and policies regarding coordination of programs but few 
agencies have collected information on NEMT expenditures. In at least 
one case, an agency did not think it was cost effective to collect 
transportation expenditures. For example, in our 2012 report on 
transportation programs for disadvantaged persons, HUD officials told 
us that reporting transportation expenses would require a new 
reporting effort and the resulting information may not be analyzed due 
to resource constraints.[Footnote 46] 

State and local officials told us there is duplication, overlap, or 
fragmentation among NEMT programs, particularly for the Medicaid 
program. Officials in all five states we visited told us duplication 
and overlap existed among NEMT programs. Officials we spoke with at a 
private, not-for-profit agency in Florida that provides NEMT service 
in St. Augustine and St. John's counties told us there is overlap and 
fragmentation because Medicaid and non-Medicaid NEMT services are not 
coordinated. They said many of the Medicaid rides are single passenger 
trips instead of multi-passenger trips because providers handling the 
Medicaid trips are not coordinating trips for passengers going to the 
same place. Similarly, officials at the Texas Department of 
Transportation told us there is duplication, overlap, and 
fragmentation and NEMT can be a part of the service that public 
transit agencies can provide. However, they said Medicaid is a 
challenge since it has little leeway in coordinating its service with 
other programs. For example, the Medicaid service provider is given a 
passenger manifest each day, provides the transportation service, and 
then moves on to the next day. The officials said there is no room to 
coordinate schedules or to trip plan which could facilitate sharing of 
services and costs with public transit agencies or others. CMS 
officials said the use of Medicaid funds are for specific purposes, 
and this specification may limit how much states or brokers can 
coordinate with non-Medicaid programs. However, they said states are 
not prohibited from participating in the transportation planning and 
coordination process. 

We were unable to quantify the extent of duplication, overlap, and 
fragmentation of NEMT programs. In general, this is because there are 
no data on the extent of duplication or overlap. In addition, other 
factors that make it difficult to quantify duplication, overlap, or 
fragmentation include: 

* Presence or lack of transportation options: Some programs may 
provide services that are duplicative in some locations because, for 
example, there is already public or other transportation present, but 
not duplicative in other locations where there is no other available 
service. For example, urban locations tend to have more transportation 
options, whereas rural locations tend to have fewer options. 

* Nature of population served: A service may be duplicative for some 
portion of the population using NEMT service but not for other 
portions. For example, ambulatory individuals (those who can walk or 
otherwise move themselves) may be able to avail themselves of a number 
of transportation options. Those portions of the population who are 
not ambulatory (e.g., in a wheelchair) may have fewer, if any, options. 

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. In March 2013, 
the National Council on State Legislatures (NCSL) reported that at 
least 28 states had established state-level coordinating councils and 
29 states had established regional coordinating organizations. 
According to NCSL, these organizations--which can be established by 
state legislation, executive order, or are voluntary associations of 
various groups that come together to facilitate planning efforts--
facilitate cooperation among government agencies and stakeholder 
groups. Two of the states we visited, Florida and Maryland, had 
established state-level bodies to lead coordination efforts for 
transportation and human service programs, including NEMT. Two other 
states, Oregon and Texas, had regional bodies that facilitated 
coordination, while the fifth state, Pennsylvania, primarily relied on 
local metropolitan planning organizations to facilitate coordination. 

In the states we visited, the activities of state and local 
coordinating bodies vary. For example, Florida's Commission for the 
Transportation Disadvantaged (CTD) coordinates transportation 
statewide in Florida for persons with disabilities, older adults, low-
income persons, and those who do not have access to healthcare, 
education, or other life sustaining activities. CTD coordinates 
transportation by contracting with Community Transportation 
Coordinators in Florida counties. According to CTD officials, Florida 
has a highly coordinated transportation system, particularly since the 
local Community Transportation Coordinators are responsible for 
knowing the transportation system in their area and preparing the 
public transit-human service transportation coordinated plan. One 
Community Transportation Coordinator we spoke with told us the 
coordinated transportation planning process included NEMT. In 
contrast, officials with the Maryland State Coordinating Committee for 
Human Service Transportation (SCC) told us that although they are 
responsible for coordinating transportation and human service programs 
in the state, the committee had not been active in recent years and 
state agencies mainly leave coordination of programs to local agencies 
and transportation providers. This includes Medicaid; state Medicaid 
agency officials told us they leave coordination of transportation 
services like NEMT to local health departments. Officials at two local 
health departments that we spoke to, one in Baltimore, Maryland, and 
one in a rural Maryland county, told us they do not participate in the 
coordinated transportation-planning process and do not coordinate 
their NEMT with non-Medicaid NEMT programs. 

Cost and ride sharing and one-call/one-click information centers, 
among other efforts, are also used in some states to coordinate NEMT 
programs. 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. Two Oregon transit agencies we spoke 
with said they have coordinated Medicaid NEMT and non-Medicaid NEMT 
using cost and ride sharing. One agency developed software that it 
uses to schedule transportation, record customer eligibility for 
transportation programs, including Medicaid NEMT, and coordinate 
Medicaid and non-Medicaid NEMT by implementing ridesharing, when 
feasible. We also found transit agencies in Texas that were using cost 
and ride sharing to coordinate NEMT service. On the other hand, one-
call/one-click information centers do not always promote coordination 
of NEMT. Projects were under way in all five states we visited, in 
some instances funded by VTCLI grants, to establish one-call/one-click 
information centers. Officials with the VA medical center in Lake 
City, Florida, told us they were aware of the one-call/one-click 
center being established and were interested in participating in this 
center and thought it might be a way to coordinate NEMT. However, 
Medicaid and VA officials in Texas and Maryland told us they do not 
participate in one-call/one-click centers but rather have established 
their own call centers to handle eligible NEMT program beneficiaries. 
An official with a Medicaid agency in Baltimore thought one-call/one-
click centers might be more efficient but wait times for NEMT could be 
longer than if calls were handled directly by Medicaid. 

Medicaid and VA NEMT Programs in Selected States Largely Do Not 
Participate in the Coordination Process: 

As discussed earlier, one of the priorities identified in the 
Coordinating Council's 2011-2013 strategic plan was expanding the 
coordinated human service-transportation infrastructure. In part, this 
was to be accomplished by developing and promoting strategies for 
improving stakeholder participation in the coordinated planning 
process required by law.[Footnote 47] In its 2013 progress report, the 
Coordinating Council stated that more efforts were needed to ensure 
all federally-assisted programs funding transportation participated in 
the process since participation varied from community to community. 
The coordinated transportation planning process is based on a locally 
developed coordinated public transit-human service transportation plan 
and is intended to be an inclusive process that involves participation 
by a wide variety of stakeholders. This includes individuals with 
disabilities and representatives of public, private, and non-profit 
transportation and human services agencies. The coordinated public 
transit-human service transportation plans produced by this process 
are required to assess available transportation resources, including 
federal, state, and local transportation programs (which would include 
NEMT programs), gaps in service for individuals with disabilities, 
seniors, and others, and identify strategies and projects to 
coordinate transportation resources and programs to best address the 
service gaps. 

In the states we visited, we found that two programs --Medicaid and 
collectively VA's NEMT programs--largely do not participate in the 
coordinated transportation-planning process. Both Medicaid and the VA 
NEMT programs are locally administered. States administer the Medicaid 
program and local medical centers administer VA's NEMT program. These 
programs are important to NEMT, as they provide services to 
potentially over 90 million individuals. As of fiscal year 2013, about 
72 million individuals were enrolled in Medicaid (which includes some 
enrollees in the CHIP) and, as of fiscal year 2012, VA served a 
population of over 20-million veterans--about 9 million of whom were 
enrolled in VA health care in fiscal year 2013. In general, these 
programs provide their own NEMT service that is focused on serving 
eligible beneficiaries. In part, this is driven by federal 
requirements. Specifically, for Medicaid, states are required to 
assure that necessary transportation will be provided to eligible 
beneficiaries to and from medical providers. Medicaid regulations also 
require that transportation be furnished by a provider to which state 
agencies can make a direct vendor payment and that payment for 
transportation service be used only to benefit eligible Medicaid 
beneficiaries. These requirements make clear that federal Medicaid 
funding for NEMT services must be applied to the individuals who 
qualify for the program and not to the broader public that would use 
public transportation. 

While program requirements drive the structure of the Medicaid NEMT 
program, they also present a challenge to coordinating Medicaid NEMT 
with other programs. CMS officials told us that using strategies such 
as cost or ride sharing could increase the risk of Medicaid funds 
being spent for individuals who do not qualify for Medicaid benefits. 
The officials added that, without proper controls, cost or ride 
sharing with other non-Medicaid programs could allow for improper 
payments for individuals who do not qualify for Medicaid. Past GAO 
studies have identified concerns about Medicaid's improper payments, 
citing concerns about the appropriateness of states' claims for 
transportation and other services, such as those provided in schools 
that merge Medicaid funds with other programs.[Footnote 48] Federal 
and state Medicaid officials largely confirmed that these program 
requirements and integrity issues limit their ability to participate 
in the coordinated transportation-planning process or engage in cost 
or ride sharing with other non-Medicaid programs. For example, 
Medicaid officials in all five states we visited said program 
requirements limit their ability to participate in the coordinated 
transportation-planning process or share rides or costs with non-
Medicaid programs. 

Another challenge to coordination of Medicaid NEMT with other NEMT 
programs is state use of brokers to arrange NEMT service. By law, 
states may, at their option, use brokers to arrange NEMT service. 
Brokers can be either public or private entities. CMS officials told 
us they do not keep track of which states use brokers; however, states 
are required to amend their state Medicaid plan to show the use of 
brokers to provide transportation service. Officials in all five 
states we visited said they contracted with brokers to arrange NEMT 
services for Medicaid beneficiaries. In four of the five states we 
visited, private entities were being used as brokers.[Footnote 49] By 
contrast, in Oregon, public transit agencies were the brokers in the 
two areas we visited. However, Oregon could use private brokers in 
these areas in the future depending on decisions on how NEMT would be 
provided by the Coordinated Care Organizations being established to 
administer the Medicaid program. In general, brokers may have less 
incentive to participate in the coordinated transportation-planning 
process than public transit agencies. First, private brokers are not 
required to participate in the coordinated-planning process and may 
choose not to do so. Second, Medicaid regulations require 
transportation be provided to beneficiaries to access Medicaid 
providers, and this is the service that brokers are contracted to 
provide, not coordinate rides with non-Medicaid programs. Public 
transit agencies, on the other hand, are required to participate in 
the coordinated planning process if they receive funds from FTA's 
Formula Grants for Enhanced Mobility of Seniors and Individuals with 
Disabilities. We spoke with two private Medicaid NEMT brokers 
operating in different states and neither participated in the 
coordinated transportation-planning process. Both said the 
coordination process deals with policy decisions that are left to the 
agency they contract with. One of the companies was being paid on a 
fee-for-service basis (e.g., paid for each trip provided), while the 
other was being paid on a flat capitation basis based on the number of 
eligible Medicaid beneficiaries in the area it served. 

Finally, recent Medicaid reform efforts in some states may also 
present a challenge to coordination of NEMT with non-Medicaid 
programs. Three of the five states we visited--Florida, Texas, and 
Oregon--are in the midst of making significant changes to their 
Medicaid programs. In general, these reforms are aimed at moving to 
managed-care organizations making decisions about medical services. In 
some states, decision making will include how NEMT is provided. For 
example, Oregon officials told us that Coordinated Care Organizations 
were being created to better coordinate and integrate medical benefits 
provided to Medicaid recipients. According to officials with the state 
Medicaid agency in Oregon, these organizations must provide access to 
all Medicaid state plan services included in their contracts, and are 
accountable for administering benefits to beneficiaries in whatever 
manner will achieve the best outcome with cost effectiveness, 
including NEMT. Local transit authorities and private brokerages may 
be used by the Coordinated Care Organizations, and the activity 
related to coordinating the NEMT benefit with the delivery of other 
Medicaid services may be performed by the Coordinated Care 
Organization, or subcontracted to the brokerage, according to the 
terms of their agreements. In Texas, regional transportation 
management areas are being created and competitively selected 
transportation managers will provide NEMT for each area. 
Transportation managers could be either public or private entities. 

In each of the three states, the Medicaid reforms will likely affect 
the way NEMT is provided, primarily by increasing the role of brokers 
in arranging service. For example, prior to May 2014, the Florida CTD 
provided Medicaid NEMT through contracts with Community Transportation 
Coordinators and subcontracted transportation providers in each of 
Florida's 67 counties. Community Transportation Coordinators also 
provided much of the non-Medicaid NEMT services in their respective 
counties and were able to coordinate Medicaid NEMT and non-Medicaid 
transportation services using ride and cost sharing. After February 
2015, CTD will no longer provide Medicaid NEMT under Florida's new 
Medicaid system. Instead, managed-care organizations will provide 
Medicaid NEMT in each of Florida's 11 Medicaid regions, using private 
transportation brokers. Similarly, transportation and local transit 
officials in Texas anticipated that the state's transition to a 
brokerage system for providing Medicaid NEMT will decrease 
coordination between Medicaid and non-Medicaid NEMT services. The 
officials said that, unlike transit agencies that also provide non-
Medicaid NEMT services using their own vehicles and participate in the 
coordinated transportation-planning process, transportation brokers 
might not coordinate Medicaid and non-Medicaid NEMT through ride and 
cost sharing and may choose not to participate in the coordinated-
planning process because they are not required to do so. 

VA's NEMT programs also largely operate outside of the coordinated 
transportation-planning process. Similar to Medicaid, VA NEMT programs 
are standalone and designed to serve only eligible VA clients. In 
addition, like Medicaid, VA's NEMT programs are client based and 
provide NEMT only for qualified persons who need NEMT services for VA 
medical appointments. Federal statute authorizes the Secretary of 
Veterans Affairs to pay the transportation costs of eligible persons 
to or from VA facilities or other places for the purpose of receiving 
medical services.[Footnote 50] However, this transportation is limited 
to eligible participants. In general, eligible veterans must have a 
service-related disability, receive a VA pension, or not exceed 
specified annual income thresholds.[Footnote 51] 

VA officials in the states we visited told us these funding and 
mission requirements pose a challenge to coordinating NEMT services 
with other federal programs. For example, VA medical center officials 
in Maryland and Oregon stated that they do not provide VA subsidized 
bus passes because those passes could be used for non-medical 
purposes--which are non-authorized uses under program rules. 
Accordingly, they said VA provides transportation to veterans for NEMT 
only, even if the VA's costs for providing NEMT is higher than the 
cost for a public transit bus pass. VA officials in Pennsylvania told 
us that even if they wanted to they cannot use other transportation 
programs, such as community-based programs, to transport veterans who 
are eligible for VA NEMT services to medical appointments. This is 
because the cost of the services cannot be determined and they cannot 
handle bills from agencies providing community-based services. VA 
officials in Texas stated that the various NEMT programs have 
different rules for eligibility and that the differing rules make it 
difficult for them to institute ride-sharing arrangements with other 
non-VA NEMT programs. At the five medical centers we visited, none of 
the officials told us that they shared resources with non-VA NEMT 
programs and officials at two of the centers stated that using 
community-based resources to provide NEMT for veterans could raise 
legal questions about how federal funds are being spent since VA 
program rules limit NEMT to eligible veterans. 

At the VA medical centers we visited, VA coordination with non-VA NEMT 
programs was mainly limited to consultation with local transit 
agencies about using VTCLI grants to establish one-call/one-click 
information centers to benefit transportation disadvantaged 
populations, including veterans. For example, officials at the VA 
medical centers in Dallas, Texas, and Portland, Oregon, have consulted 
with local transit agency officials who are using VTCLI grant funds to 
establish one-call/one-click centers that will serve their 
metropolitan areas. These centers will arrange NEMT and other 
transportation services for veterans and other transportation-
disadvantaged populations. The officials told us that they worked with 
the transit agencies to identify veterans' transportation needs, as 
well as how to make veterans aware of the mobility management centers 
and the transportation options they offer. 

It is clear there are a number of challenges in increasing Medicaid 
and VA participation in the coordinated transportation-planning 
process. 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. In addition, given the significance of these programs to 
the provision of NEMT service, coordination that does not include 
these programs makes it more difficult for the Coordinating Council to 
achieve its goal of promoting interagency cooperation to enhance the 
access of transportation-disadvantaged persons to both more and cost 
effective transportation services. 

States and Localities Cited Additional Challenges to NEMT Coordination: 

State and local officials in the five states we visited identified 
additional challenges to NEMT coordination. These challenges include: 

* Lack of leadership or guidance at the federal level. State and local 
transportation officials in four of the five states we visited told us 
that federal leadership on NEMT coordination issues and coordination 
guidance are inadequate or lacking. For example, Maryland SCC 
officials told us neither FTA nor the Coordinating Council had 
provided clear policies or guidance to Maryland on how to coordinate 
programs that fund NEMT service. In addition, Oregon Department of 
Transportation officials told us that among the changes needed at the 
federal level are making more transportation-coordination policy 
information available, including policies regarding coordination with 
human services programs. 

* State and local officials' perceptions of agency rules and effects 
of improved NEMT coordination. Transportation and human services 
agency officials in three of the five states we visited told us that 
many state and local officials for human-services agencies and 
transportation are reluctant to coordinate NEMT services with other 
agencies because they interpret their agencies' policies as 
prohibiting coordination activities such as cost and resource sharing. 
In addition, the officials told us that some local transportation and 
human-service agency officials believe increased NEMT coordination 
could result in loss of NEMT funding for their jurisdictions. 

Conclusions: 

NEMT is an important and growing part of America's transportation 
service as millions of Americans who are elderly, have disabilities, 
or are low income depend on government-funded transportation to get to 
medical appointments and other medical services. However, NEMT 
services are not well coordinated, and little is being done at the 
federal level to help ensure that those who provide NEMT services can 
achieve the benefits of coordination, such as reduced trip costs and 
more efficient use of vehicles. The Coordinating Council, the 
organization tasked with promoting interagency coordination of federal-
transportation and human-service programs, has exercised little 
leadership and provided little guidance. The executive council, which 
provides top management direction, has not met since 2007, the 
strategic plan that outlines the goals and strategies for coordination 
did not specifically address NEMT and expired in 2013, and the 
Coordinating Council's interagency working group on transportation and 
healthcare, which develops guidance for agencies, is just now starting 
to look at the challenges associated with coordinating transportation 
and healthcare programs. The Coordinating Council has also not 
provided the tools for coordinating NEMT programs. In particular, it 
has not finalized a cost-sharing methodology that could facilitate 
ride and vehicle sharing. As a result, the federal government is 
missing opportunities to save costs, use funds more efficiently, and 
provide more services to those who depend on federally funded programs 
for NEMT. 

Efforts to coordinate NEMT will also need to address those programs 
not currently fully participating in the coordinated transportation-
human services planning process, notably the Medicaid and VA programs. 
These programs are major funders of NEMT yet generally operate their 
own NEMT service and do not coordinate their service with other 
programs. 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. 
Since both Medicaid and VA are major players in providing NEMT, it is 
incumbent on the Coordinating Council and its member agencies to both 
identify the challenges some programs have in participating in the 
coordination process and developing approaches to address these 
challenges so all programs can share in the benefits of program 
coordination, yet do so in ways that maintain program integrity and 
prevent fraud. 

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. 

* Finalize and issue a cost-sharing policy and clearly identify how it 
can be applied to programs under the purview of member agencies of the 
Coordinating Council that provide funding for NEMT. 

* Using the on-going work of the Health, Wellness, and Transportation 
working group and other appropriate resources, (1) identify the 
challenges associated with coordinating Medicaid and VA NEMT programs 
with other federal programs that fund NEMT, (2) develop 
recommendations for how these challenges can be addressed while still 
maintaining program integrity and fraud prevention, and (3) report 
these recommendations to appropriate committees of Congress. To the 
extent feasible, the Coordinating Council should implement those 
recommendations that are within its legal authority. 

Agency Comments: 

We requested comments on a draft of this report from the Departments 
of Agriculture, Education, HHS, HUD, Transportation, and VA. DOT 
provided its comments in an e-mail from their Deputy Director for 
Audit Relations. DOT stated that it concurred in part with 
recommendations to develop a new strategic plan and to finalize a cost-
sharing policy. It concurred with the recommendation to identify and 
report to Congress challenges with NEMT coordination and said it 
agreed that more work is needed to increase coordination activities 
with all HHS agencies, especially CMS. DOT also said FTA is asking its 
technical assistance centers to assist in developing responses to NEMT 
challenges. Regarding development of a strategic plan, DOT said 
efforts were underway at FTA to develop a new 2-year Coordinating 
Council implementation strategy. As part of developing this strategy, 
FTA would determine what governing framework is most effective and 
what, if any, updates were needed to the strategic plan. Regarding the 
cost-sharing policy, DOT said, expanding upon past efforts and 
building on the 2011 Transportation Research Board's cost-sharing 
study discussed earlier in this report, FTA plans to further refine a 
cost-sharing model with the Coordinating Council. However, DOT said 
final acceptance of the policy by non-DOT council members would be 
dependent on their receptiveness to adopting a cost-sharing strategy. 
The Departments of Agriculture and Education had no comments on the 
report. HHS, HUD, and VA made technical comments, which were 
incorporated as appropriate. 

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. 

As agreed with your offices, unless you publicly announce the contents 
of this report earlier, we plan no further distribution of this report 
until 30 days from the report date. At that time, we will send copies 
of this report to interested congressional committees and the 
Secretaries of Agriculture, Education, Health and Human Services, 
Housing and Urban Development, Transportation, and Veterans Affairs. 
We will also make copies available to others upon request. In 
addition, this report will be available at no charge on GAO's website 
at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report, please 
contact David Wise at 202-512-2834 or wised@gao.gov. Contact points 
for our Office of Congressional Relations and Public Affairs may be 
found on the last page of this report. GAO staff who made major 
contributions to this report are listed in appendix III. 

Signed by: 

David J. Wise: 
Director, 

Physical Infrastructure Team: 

[End of section] 

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,[Footnote 52] 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. We included only programs that provide nonemergency, 
nonmilitary, surface transportation services of any kind for the 
purposes of receiving medical care; this includes programs that fund 
infrastructure-related costs for NEMT as well as those that fund the 
actual transport in a private vehicle, van, or public transportation, 
such as a bus, to medical appointments or services. We limited our 
scope to federal agencies that are members of the federal Interagency 
Transportation Coordinating Council on Access and Mobility 
(Coordinating Council)[Footnote 53] because these agencies were 
identified by executive order to participate in coordination[Footnote 
54] and administered programs that play a key role in funding 
nonemergency medical transportation. Other federal agencies may also 
have programs that provide funding for NEMT. However, we did not 
systematically identify every program governmentwide that could 
provide such funding as part of this review. We subsequently asked 
program administrators to review and verify the programs identified 
and the program information collected, including the general target 
population, allowable uses of program funds, types of transportation 
services and trips typically provided, and program spending on 
nonemergency medical transportation services in fiscal year 2012. We 
chose fiscal year 2012 since it was the most recent year for which 
full year data were available about the Medicaid program. Agency 
officials provided requested spending data when available, but we did 
not independently verify the data provided. We supplemented and 
modified the inventory based on this information. In addition, we 
reviewed the relevant federal laws governing these programs including 
their popular title or original source of program legislation and the 
U.S. Code or other provisions cited as authorizing nonemergency 
medical transportation. 

To describe how federal agencies are coordinating nonemergency medical-
transportation services and providing potentially duplicative or 
overlapping services, we conducted interviews with program officials 
from DOT, HHS, and VA and reviewed relevant documentation provided by 
agency officials. We chose these agencies because they administered 
programs that are authorized to provide funding for nonemergency 
medical-transportation services in fiscal year 2012 and provide 
significant funding for such services. We also interviewed officials 
from the Coordinating Council[Footnote 55] and reviewed relevant 
Coordinating Council policy documents, its strategic plan, and the 
council's 2013 progress report. We also interviewed state and local 
officials in the locations we visited, and interviewed representatives 
from relevant industry and advocacy groups, including the following: 

* Center for Urban Transportation Research at the University of South 
Florida: 

* Community Transportation Association of America: 

* Easter Seals Project ACTION: 

* National Center for Mobility Management: 

* National Conference of State Legislatures: 

To describe how nonemergency medical transportation services are 
coordinated at the state and local levels and the challenges to 
coordination in selected states and localities, we reviewed relevant 
literature and prior GAO and Congressional Research Service reports 
and conducted interviews with state and local officials from five 
states--Florida, Maryland, Oregon, Pennsylvania, and Texas. We based 
our selection of these states on a variety of considerations, 
including size of target populations per state, geographic diversity, 
existence of state and regional coordinating bodies, and states deemed 
notable for their transportation coordination efforts. As part of our 
state and local interviews, we spoke with officials from state and 
local human services and transportation agencies, VA medical centers, 
state and regional coordinating bodies, metropolitan planning 
organizations, transportation providers, transportation brokers, 
interest and advocacy groups, and others and reviewed relevant 
documentation. Since we only visited selected states, our findings 
cannot be generalized to all states and cannot be used to make 
inferences about states we did not select. Table 1 provides more 
detailed information about the state and local entities we interviewed. 

Table 1: Organizations Contacted for GAO's State and Local Interviews: 

State: Florida; 

Organization: Capital Region Transportation Planning Agency; 
Description: Regional Metropolitan Planning Organization. 

Organization: Florida Commission for the Transportation Disadvantaged; 
Description: State transportation coordinating body. 

Organization: Eldersource; 
Description: Area agency on aging. 

Organization: Florida Agency for Health Care Administration; 
Description: State health agency. 

Organization: Florida Department of Elder Affairs; 
Description: State agency on aging. 

Organization: Florida Department of Transportation; 
Description: State transportation agency. 

Organization: Jacksonville Transportation Authority; 
Description: Local transportation provider. 

Organization: Lake City Veterans Affairs Medical Center; 
Description: Veterans Affairs Medical Center. 

Organization: North Florida Transportation Planning Organization; 
Description: Regional Metropolitan Planning Organization. 

Organization: Ride Solution; 
Description: Local transportation provider. 

Organization: St. Johns Council on Aging; 
Description: Area agency on aging and local transportation provider. 

State: Maryland; 

Organization: Allegany County Department of Health; 
Description: Local health department. 

Organization: Baltimore City Health Department; 
Description: Local health department. 

Organization: Baltimore Regional Transportation Board; 
Description: Regional Metropolitan Planning Organization. 

Organization: Baltimore Veterans Affairs Medical Center; 
Description: Veterans Affairs Medical Center. 

Organization: Maryland Department of Health and Mental Hygiene; 
Description: State health agency. 

Organization: Maryland State Coordinating Committee for Human Services 
Transportation; 
Description: State transportation coordinating body. 

Organization: Maryland Transit Administration; 
Description: State transportation agency. 

Organization: Veolia Transportation; 
Description: Local transportation provider. 

State: Oregon; 

Organization: Clackamas County Social Services; 
Description: Area Agency on Aging. 

Organization: Health Share Oregon; 
Description: Oregon Medicaid Coordinated Care Organization. 

Organization: Lane Transit District; 
Description: Local transportation provider. 

Organization: Oregon Department of Human Services, Aging, and People 
with Disabilities; 
Description: State agency on aging. 

Organization: Oregon Health Authority; 
Description: State health agency. 

Organization: Oregon Department of Transportation; 
Description: State transportation agency. 

Organization: Oregon Metro; 
Description: Regional Metropolitan Planning Organization and local 
transportation provider. 

Organization: Portland Veterans Affairs Medical Center; 
Description: Veterans Affairs Medical Center. 

Organization: Ride Connection; 
Description: Local transportation provider. 

Organization: Tri-County Metropolitan Transportation District; 
Description: Local transportation provider. 

State: Pennsylvania; 

Organization: Access Transportation; 
Description: Local transportation provider. 

Organization: Allegheny County Area Agency on Aging; 
Description: Local agency on aging. 

Organization: Allegheny County Department of Human Services; 
Description: Local health agency. 

Organization: Pittsburgh Veterans Affairs Medical Center; 
Description: Veterans Affairs Medical Center. 

Organization: Port Authority of Allegheny County; 
Description: Local transportation provider. 

Organization: Southwestern Pennsylvania Area Agency on Aging; 
Description: Local agency on aging. 

Organization: Southwestern Pennsylvania Commission; 
Description: Regional Metropolitan Planning Organization. 

State: Texas; 

Organization: Dallas Area Agency on Aging; 
Description: Local agency on aging. 

Organization: Dallas Area Rapid Transit; 
Description: Local transportation provider. 

Organization: Dallas Veterans Affairs Medical Center; 
Description: Veterans Affairs Medical Center. 

Organization: Logisticare; 
Description: Local transportation provider. 

Organization: North Central Texas Council of Governments; 
Description: Regional Metropolitan Planning Organization. 

Organization: STAR Transit; 
Description: Local transportation provider. 

Organization: TAPS Public Transit; 
Description: Local transportation provider. 

Organization: Texas Department of Aging and Disability Services; 
Description: State agency on aging. 

Organization: Texas Department of Transportation; 
Description: State transportation agency. 

Organization: Texas Health and Human Services Commission; 
Description: State health agency. 

Source: GAO. GAO-15-110. 

[End of table] 

We conducted this performance audit from January 2014 to December 2014 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

[End of section] 

Appendix II: Inventory of Federal Programs Where Nonemergency Medical 
Transportation Is an Eligible Expense: 

The following is an inventory of federal programs identified by GAO 
where NEMT is an eligible program expense. 

Department of Agriculture: 

Catalog of Federal Domestic Assistance Number: 10.766; 
Program name: Community Facilities Loans and Grants; 
Popular title or original source of program legislation: Consolidated 
Farm and Rural Development Act of 1972; 
U.S. Code or other provision cited as authorizing transportation: 7 
U.S.C. § 1926; 
Typical use of transportation funds as reported to GAO by program 
officials: Purchase of vehicles; 
Purpose of trips as reported to GAO by program officials: Routine 
medical appointments, shopping, entertainment, etc.; 
Target population reported to GAO as defined by program officials: 
People who are disabled, senior citizens, and low-income persons; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Program 
funds are available for health care projects (assisted living, nursing 
homes, etc.) and may be used to purchase vehicles to transport 
patients/residents for medical appointments and shopping. 

Department of Education: 

Catalog of Federal Domestic Assistance Number: 84.126; 
Program name: State Vocational Rehabilitation Services Program; 
Popular title or original source of program legislation: 
Rehabilitation Act of 1973; 
U.S. Code or other provision cited as authorizing transportation: 29 
U.S.C. § 723(a)(8); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit subsidies for public and private transportation, 
training in the use of public transportation; 
Purpose of trips as reported to GAO by program officials: To access 
vocational rehabilitation services. This may include medical services 
such as corrective surgery or therapeutic treatment; 
Target population reported to GAO as defined by program officials: 
People with disabilities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
for services to medical appointments. 

Catalog of Federal Domestic Assistance Number: 84.132[B]; 
Program name: Centers for Independent Living; 
Popular title or original source of program legislation: 
Rehabilitation Act of 1973; 
U.S. Code or other provision cited as authorizing transportation: 29 
U.S.C. §§ 796f-4(b)(2) and 705(18)(xi); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit subsidies for public and private transportation, 
training in the use of public transportation; 
Purpose of trips as reported to GAO by program officials: To access 
independent living services. This may include medical services such as 
physical rehabilitation or therapeutic treatment; 
Target population reported to GAO as defined by program officials: 
Individuals with significant disabilities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
for services to medical appointments. 

Catalog of Federal Domestic Assistance Number: 84.169[C]; 
Program name: Independent Living State Grants; 
Popular title or original source of program legislation: 
Rehabilitation Act of 1973; 
U.S. Code or other provision cited as authorizing transportation: 29 
U.S.C. §§ 796e-2(1) and 705(18)(xi); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit subsidies for public and private transportation, 
training in the use of public transportation; 
Purpose of trips as reported to GAO by program officials: To access 
independent living services. This may include medical services such as 
physical rehabilitation and therapeutic treatment; 
Target population reported to GAO as defined by program officials: 
Individuals with significant disabilities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
for services to medical appointments. 

Catalog of Federal Domestic Assistance Number: 84.177; 
Program name: Independent Living Services for Older Individuals Who 
Are Blind; 
Popular title or original source of program legislation: 
Rehabilitation Act of 1973; 
U.S. Code or other provision cited as authorizing transportation: 29 
U.S.C. § 796k(e)(5); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit subsidies for public and private transportation, 
training in the use of public transportation; 
Purpose of trips as reported to GAO by program officials: To access 
independent living services. This may include medical services such as 
physical rehabilitation and therapeutic treatment; 
Target population reported to GAO as defined by program officials: 
Individuals who are blind and age 55 or older; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
for services to medical appointments. 

Catalog of Federal Domestic Assistance Number: 84.181; 
Program name: Special Education-Grants for Infants and Toddlers; 
Popular title or original source of program legislation: Individuals 
with Disabilities Education Act; 
U.S. Code or other provision cited as authorizing transportation: 20 
U.S.C. §§1433 and 1432(4)(E)(xiv); 
Typical use of transportation funds as reported to GAO by program 
officials: Various modes of transportation, including wheelchair 
accessible vans; 
Purpose of trips as reported to GAO by program officials: To access 
services, when transportation is specifically identified as an early 
intervention service on the eligible child's individualized family 
service plan. This may include medical services such as medical 
appointments to developmental pediatricians; 
Target population reported to GAO as defined by program officials: 
Infants and toddlers with disabilities or at risk, in need of early 
intervention services; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
for services to medical appointments. 

Catalog of Federal Domestic Assistance Number: 84.187; 
Program name: Supported Employment Services for Individuals with Most 
Significant Disabilities; 
Popular title or original source of program legislation: 
Rehabilitation Act of 1973; 
U.S. Code or other provision cited as authorizing transportation: 29 
U.S.C. §§ 795g and 705(36); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit subsidies for public and private transportation, 
training in the use of public transportation; 
Purpose of trips as reported to GAO by program officials: To access 
work, training, and vocational rehabilitation services. This may 
include medical services such as physical rehabilitation and 
therapeutic treatment.; 
Target population reported to GAO as defined by program officials: 
People with the most significant disabilities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
for services to medical appointments. 

Catalog of Federal Domestic Assistance Number: 84.250; 
Program name: Rehabilitation Services American Indians with 
Disabilities; 
Popular title or original source of program legislation: 
Rehabilitation Act of 1973; 
U.S. Code or other provision cited as authorizing transportation: 29 
U.S.C. §§ 741(a) and (b)(1)(B) and 723(a)(8); 
Typical use of transportation funds as reported to GAO by program 
officials: Vouchers for transportation services (e.g. fuel and taxi 
vouchers) and training in the use of transportation; 
Purpose of trips as reported to GAO by program officials: To access 
vocational rehabilitation services. This may include medical services 
such as physical rehabilitation and therapeutic treatment; 
Target population reported to GAO as defined by program officials: 
American Indians with disabilities who live on or near reservations 
served by the projects; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
for services to medical appointments. 

Department of Transportation: 

Catalog of Federal Domestic Assistance Number: 20.507; 
Program name: Urbanized Area Formula Program; 
Popular title or original source of program legislation: Mass 
Transportation Act of 1964; 
U.S. Code or other provision cited as authorizing transportation: 49 
U.S.C. § 5307; 
Typical use of transportation funds as reported to GAO by program 
officials: Funding for transportation service for transportation 
projects in cities; 
Purpose of trips as reported to GAO by program officials: Support 
transit service in cities over 50,000 population; 
Target population reported to GAO as defined by program officials: 
General public in urbanized areas; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: NEMT and 
any other type of trips are allowable, as general public 
transportation trips are not differentiated by purpose. 

Catalog of Federal Domestic Assistance Number: 20.509; 
Program name: Formula Grants for Rural Areas; 
Popular title or original source of program legislation: Federal 
Public Transportation Act of 1978; 
U.S. Code or other provision cited as authorizing transportation: 49 
U.S.C. § 5311; 
Typical use of transportation funds as reported to GAO by program 
officials: Funding for transportation service for public transit and 
intercity bus transportation projects in rural areas; 
Purpose of trips as reported to GAO by program officials: To increase 
and enhance public transportation service in rural areas and for 
tribes; 
Target population reported to GAO as defined by program officials: 
General public and federally recognized tribes; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: NEMT and 
any other type of trips are allowable, as general public 
transportation trips are not differentiated by purpose. 

Catalog of Federal Domestic Assistance Number: 20.513; 
Program name: Enhanced Mobility of Seniors and Individuals with 
Disabilities[D]; 
Popular title or original source of program legislation: Urban Mass 
Transportation Act of 1970; 
U.S. Code or other provision cited as authorizing transportation: 49 
U.S.C. § 5310; 
Typical use of transportation funds as reported to GAO by program 
officials: Purchase of capital and other activities to provide public 
transportation projects planned, designed, and carried out to meet the 
special needs of seniors and individuals with disabilities when public 
transportation is insufficient, inappropriate, or unavailable. 
Effective with MAP-21, New Freedom programs were included and project 
eligibility was expanded to include operating assistance in some 
circumstances; 
Purpose of trips as reported to GAO by program officials: General 
transportation services; 
Target population reported to GAO as defined by program officials: 
Elderly individuals and persons with disabilities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available; 
How can program funds be used for NEMT or to support NEMT: Grants and 
other programs can be developed at the local level through the locally 
developed coordinated planning process that can serve to address 
transportation gaps for seniors and people with disabilities and could 
include partnerships with NEMT funded programs like Medicaid. 

Catalog of Federal Domestic Assistance Number: 20.521; 
Program name: New Freedom Program; 
Popular title or original source of program legislation: Safe, 
Accountable, Flexible, Efficient Transportation Equity Act: A Legacy 
for Users; 
U.S. Code or other provision cited as authorizing transportation: 49 
U.S.C § 5317; 
Typical use of transportation funds as reported to GAO by program 
officials: Capital and operating expenses for new public 
transportation services and new public transportation alternatives 
beyond those required by the American with Disabilities Act of 1990, 
that are designed to assist individuals with disabilities; 
Purpose of trips as reported to GAO by program officials: To enhance 
transportation systems and access to those systems; 
Target population reported to GAO as defined by program officials: 
Individuals with disabilities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Grants and 
other programs can be developed at the local level through the locally 
developed coordinated planning process that can serve to address 
transportation gaps for people with disabilities and could include 
partnerships with NEMT funded programs like Medicaid. 

Department of Health and Human Services: 

Catalog of Federal Domestic Assistance Number: 93.044; 
Program name: Special Programs for the Aging, Title III, Part B, 
Grants for Supportive Services and Senior Centers; 
Popular title or original source of program legislation: Older 
Americans Act of 1965; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 3030d(a)(2); 
Typical use of transportation funds as reported to GAO by program 
officials: Contract for services; 
Purpose of trips as reported to GAO by program officials: To access 
supportive services, such as nutrition services, and aging services; 
Target population reported to GAO as defined by program officials: 
Adults age 60 and older; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: These funds 
are flexible and can be used for both medical and non-medical 
transportation. 

Catalog of Federal Domestic Assistance Number: 93.047; 
Program name: Special Programs for the Aging, Title VI, Part A, Grants 
to Indian Tribes, Part B, Grants to Native Hawaiians; 
Popular title or original source of program legislation: Older 
Americans Act of 1965; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 3057, 3030d(a)(2); 
Typical use of transportation funds as reported to GAO by program 
officials: Purchase and operate vehicles; 
Purpose of trips as reported to GAO by program officials: To access 
supportive services, including medical care; 
Target population reported to GAO as defined by program officials: 
American Indian, Alaskan Native, and Native Hawaiian elders; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: 
Transportation to access needed services which may include medical 
appointments and medical treatments. 

Catalog of Federal Domestic Assistance Number: 93.104; 
Program name: Comprehensive Community Mental Health Services for 
Children with Serious Emotional Disturbances; 
Popular title or original source of program legislation: Public Health 
Service Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 290ff-1; 
Typical use of transportation funds as reported to GAO by program 
officials: Any transportation-related use; 
Purpose of trips as reported to GAO by program officials: To access 
supportive services, including medical care; 
Target population reported to GAO as defined by program officials: 
Children and families with serious emotional disturbance; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: 
Transportation to access needed services which may include medical 
appointments for a child with mental health issues. 

Catalog of Federal Domestic Assistance Number: 93.153; 
Program name: Coordinated Services and Access to Research for Women, 
Infants, Children and Youth; 
Popular title or original source of program legislation: Ryan White 
Comprehensive AIDS Resources Emergency Act of 1990/Ryan White HIV/AIDS 
Treatment Extension Act of 2009; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 300ff-71; 
Typical use of transportation funds as reported to GAO by program 
officials: Bus passes, tokens, taxis, vanpools, vehicle purchase/lease 
by providers, and mileage reimbursement; 
Purpose of trips as reported to GAO by program officials: To access 
health care services; 
Target population reported to GAO as defined by program officials: 
Persons living with HIV/AIDS; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $503,486; 
How can program funds be used for NEMT or to support NEMT: 
Transportation services for an eligible individual to access HIV-
related health services, including services needed to maintain the 
client in HIV Medical care, directly or through voucher. 

Catalog of Federal Domestic Assistance Number: 93.193; 
Program name: Urban Indian Health Services; 
Popular title or original source of program legislation: Snyder Act: 
Indian Health Care Improvement Act; 
U.S. Code or other provision cited as authorizing transportation: Act 
of Nov. 2, 1921, ch, 115, 42 Stat. 208, as amended, and Pub. L. No. 94-
437, as amended; 
Typical use of transportation funds as reported to GAO by program 
officials: Public transportation, mileage reimbursement, GSA lease, 
etc.; 
Purpose of trips as reported to GAO by program officials: Public 
transportation, mileage reimbursement, GSA lease, etc.; 
Target population reported to GAO as defined by program officials: 
American Indian/Alaska Natives; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Vehicle 
purchase or lease, bus token, taxi fare. 

Catalog of Federal Domestic Assistance Number: 93.224; 
Program name: Health Center Program; 
Popular title or original source of program legislation: Public Health 
Service Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 254b; 
Typical use of transportation funds as reported to GAO by program 
officials: Bus tokens, vouchers, transportation coordinators, and 
drivers; 
Purpose of trips as reported to GAO by program officials: To access 
health care services; 
Target population reported to GAO as defined by program officials: 
Medically underserved populations; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $32.8 million; 
How can program funds be used for NEMT or to support NEMT: Health 
centers are required to provide services that enable individuals to 
use the services of the health center (including outreach and 
transportation services). 

Catalog of Federal Domestic Assistance Number: 93.237; 
Program name: Special Diabetes Program for Indians Diabetes Prevention 
and Treatment Projects; 
Popular title or original source of program legislation: Indian Health 
Care Improvement Act: Balanced Budget Act of 1997; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 254c-3; 
Typical use of transportation funds as reported to GAO by program 
officials: Public transportation, mileage reimbursement, etc.; 
Purpose of trips as reported to GAO by program officials: To access 
diabetes prevention and cardiovascular disease services; 
Target population reported to GAO as defined by program officials: 
American Indian/Alaska Natives; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Public 
transportation, mileage reimbursement, and purchase of motor vehicles. 

Catalog of Federal Domestic Assistance Number: 93.275; 
Program name: Substance Abuse and Mental Health Services-Access to 
Recovery; 
Popular title or original source of program legislation: Public Health 
Service Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C §§ 290aa(d)(5), 290bb-2; 
Typical use of transportation funds as reported to GAO by program 
officials: Bus tokens/pass, cab fare, gas card; 
Purpose of trips as reported to GAO by program officials: To access 
substance abuse treatment or recovery support services; 
Target population reported to GAO as defined by program officials: 
Persons with substance use and/or mental disorders; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $4,581,719; 
How can program funds be used for NEMT or to support NEMT: Bus 
tokens/pass, cab fare, gas card. 

Catalog of Federal Domestic Assistance Number: 93.550; 
Program name: Transitional Living Program and Maternity Group Homes 
for Homeless Youth; 
Popular title or original source of program legislation: Runaway and 
Homeless Youth Act as Amended in 2008; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 5701, 5712; 
Typical use of transportation funds as reported to GAO by program 
officials: Information not collected; 
Purpose of trips as reported to GAO by program officials: Education, 
Employment, Training and Health Care; 
Target population reported to GAO as defined by program officials: 16 
to 21 year olds; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Transport 
to medical appointments, for employment training, school, and other 
services identified. 

Catalog of Federal Domestic Assistance Number: 93.600; 
Program name: Head Start; 
Popular title or original source of program legislation: Head Start 
Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
USCA § 9835(a)(5)(B); 
Typical use of transportation funds as reported to GAO by program 
officials: Information not provided; 
Purpose of trips as reported to GAO by program officials: Transporting 
children to Head Start and Early Head Start centers; 
Target population reported to GAO as defined by program officials: Low-
income children; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Head Start 
grantees have flexibility to provide nonemergency medical 
transportation to children to medical and dental appointments. 

Catalog of Federal Domestic Assistance Number: 93.667; 
Program name: Social Services Block Grants; 
Popular title or original source of program legislation: Social 
Security Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 1397a(a)(2)(A); 
Typical use of transportation funds as reported to GAO by program 
officials: Provide or arrange for travel, such as accessible vans; 
Purpose of trips as reported to GAO by program officials: Access 
services, or obtain medical care or employment; 
Target population reported to GAO as defined by program officials: 
Adults and children; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Travel to 
obtain medical care; 
may include special modes of transportation. 

Catalog of Federal Domestic Assistance Number: 93.767; 
Program name: Children's Health Insurance Program; 
Popular title or original source of program legislation: Social 
Security Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 1397jj(a)(26), (27); 
Typical use of transportation funds as reported to GAO by program 
officials: Emergency Transportation; 
and nonemergency medical transportation; 
Purpose of trips as reported to GAO by program officials: To access 
covered medical services; 
Target population reported to GAO as defined by program officials: 
Eligible children; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: 
Transportation to primary and preventative health care services for 
eligible low-income women. 

Catalog of Federal Domestic Assistance Number: 93.778; 
Program name: Medicaid; 
Popular title or original source of program legislation: Social 
Security Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 1396a, 1396n(e)(1)(A); 
Typical use of transportation funds as reported to GAO by program 
officials: Fixed route transportation, demand response transportation, 
mileage reimbursement, air transport and nonemergency medical 
transportation brokerage; 
Purpose of trips as reported to GAO by program officials: To access 
covered medical services; 
Target population reported to GAO as defined by program officials: 
Medicaid eligible beneficiaries who do not have any other means of 
transportation; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $1,321, 257,574; 
How can program funds be used for NEMT or to support NEMT: State 
Medicaid Agencies are required to assure transportation for 
beneficiaries to covered medical care when the beneficiary has no 
other means of transportation. Depending on the claiming authority, 
the state has many options to structure their NEMT program but Federal 
Financial Participation is only available for this specific purpose. 

Catalog of Federal Domestic Assistance Number: 93.912; 
Program name: Rural Health Care Services Outreach, Rural Health 
Network Development, and Small Health Care Provider Quality 
Improvement Program; 
Popular title or original source of program legislation: Public Health 
Service Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 254c; 
Typical use of transportation funds as reported to GAO by program 
officials: Volunteer drivers, private vehicles, vouchers, vanpools; 
Purpose of trips as reported to GAO by program officials: To access 
health care services, oral health care, elder day care services; 
Target population reported to GAO as defined by program officials: 
Elderly, migrant workers, and general population; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $120,325; 
How can program funds be used for NEMT or to support NEMT: Program 
funds can be used to support NEMT costs such as personnel, contractual 
services (with NEMT service providers) and/or promotion of NEMT 
services. 

Catalog of Federal Domestic Assistance Number: 93.914; 
Program name: HIV Emergency Relief Project Grants; 
Popular title or original source of program legislation: Ryan White 
Comprehensive AIDS Resources Emergency Act of 1990/Ryan White HIV/AIDS 
Treatment Extension Act of 2009; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 300ff-11-300ff-20; 
Typical use of transportation funds as reported to GAO by program 
officials: Bus passes, tokens, taxis, vanpools, vehicle purchase/lease 
by providers, and mileage reimbursement; 
Purpose of trips as reported to GAO by program officials: To access 
health care services; 
Target population reported to GAO as defined by program officials: 
Persons with HIV or AIDS; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $8,961,406; 
How can program funds be used for NEMT or to support NEMT: Program 
funds can be used for the provision of transportation services for an 
eligible individual to access HIV-related health services, including 
services needed to maintain the client in HIV Medical care, directly 
or through voucher. 

Catalog of Federal Domestic Assistance Number: 93.917; 
Program name: HIV Care Formula Grants; 
Popular title or original source of program legislation: Ryan White 
Comprehensive AIDS Resources Emergency Act of 1990/Ryan White HIV/AIDS 
Treatment Extension Act of 2009; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 300ff-21-31; 
Typical use of transportation funds as reported to GAO by program 
officials: Bus passes, tokens, taxis, vanpools, vehicle purchase/lease 
by providers, and mileage reimbursement; 
Purpose of trips as reported to GAO by program officials: To access 
health care services; 
Target population reported to GAO as defined by program officials: 
Persons with HIV or AIDS; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $4,029,843; 
How can program funds be used for NEMT or to support NEMT: Program 
funds can be used for the provision of transportation services for an 
eligible individual to access HIV-related health services, including 
services needed to maintain the client in HIV Medical care, directly 
or through voucher. Services are conveyance services provided, 
directly or through a voucher, to a client to enable him or her to 
access health care services. 

Catalog of Federal Domestic Assistance Number: 93.918; 
Program name: HIV Early Intervention Services; 
Popular title or original source of program legislation: Ryan White 
Comprehensive AIDS Resources Emergency Act of 1990/Ryan White HIV/AIDS 
Treatment Extension Act of 2009; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. §§ 300ff-51, 300ff-67; 
Typical use of transportation funds as reported to GAO by program 
officials: Bus passes, tokens, taxis, vanpools, vehicle purchase/lease 
by providers, and mileage reimbursement; 
Purpose of trips as reported to GAO by program officials: To access 
health care services; 
Target population reported to GAO as defined by program officials: 
Persons living with HIV/AIDS (PLWHA); 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $774,273; 
How can program funds be used for NEMT or to support NEMT: Program 
funds can be used for the provision of transportation services for an 
eligible individual to access HIV-related health services, including 
services needed to maintain the client in HIV Medical care, directly 
or through voucher. 

Catalog of Federal Domestic Assistance Number: 93.926; 
Program name: Healthy Start Initiative; 
Popular title or original source of program legislation: Public Health 
Service Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 254c-8; 
Typical use of transportation funds as reported to GAO by program 
officials: Bus tokens, taxi vouchers, reimbursement for use of own 
vehicle; 
Purpose of trips as reported to GAO by program officials: To access 
health care services; 
Target population reported to GAO as defined by program officials: 
Residents of areas with significant perinatal health disparities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Program 
funds can be used for bus tokens, taxi vouchers, reimbursement of own 
vehicle. 

Catalog of Federal Domestic Assistance Number: 93.958; 
Program name: Community Mental Health Services Block Grant; 
Popular title or original source of program legislation: ADAMHA 
Reorganization Act of 1992; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 300x-1(b)(1); 
Typical use of transportation funds as reported to GAO by program 
officials: Any transportation-related use; 
Purpose of trips as reported to GAO by program officials: To access 
program services; 
Target population reported to GAO as defined by program officials: 
Adults with mental illness and children with emotional disturbance; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: If the 
individual requires this services and it cannot or is not funded by 
Medicaid, States can use the funding for this service. 

Catalog of Federal Domestic Assistance Number: 93.959; 
Program name: Substance Abuse Prevention and Treatment Block Grant; 
Popular title or original source of program legislation: ADAMHA 
Reorganization Act of 1992; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 300x-21; 
Typical use of transportation funds as reported to GAO by program 
officials: Any transportation-related use; 
Purpose of trips as reported to GAO by program officials: To access 
program services; 
Target population reported to GAO as defined by program officials: 
Persons with a substance related disorder; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available; 
How can program funds be used for NEMT or to support NEMT: Authorizing 
legislation neither prescribes nor prohibits funding of NEMT. The 
exception is Interim Final Rule (45 CFR 96. 120-137) explicitly 
prescribes transportation for substance using pregnant women and women 
with dependent children. 

Catalog of Federal Domestic Assistance Number: 93.994; 
Program name: Maternal and Child Health Services Block Grant to the 
States; 
Popular title or original source of program legislation: Social 
Security Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 701(a); 
Typical use of transportation funds as reported to GAO by program 
officials: States have broad discretion in implementing program; 
Purpose of trips as reported to GAO by program officials: To access 
prenatal care visits, medical appointments and other health care 
services; 
Target population reported to GAO as defined by program officials: 
Maternal and Child Health population; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available; 
How can program funds be used for NEMT or to support NEMT: If a state 
identifies this service as one that relates to an identified priority 
need, it may choose to support such an activity. 

Department of Housing and Urban Development: 

Catalog of Federal Domestic Assistance Number: 14.170; 
Program name: Congregate Housing Services program; 
Popular title or original source of program legislation: Congregate 
Housing Services Act of 1978; 
U.S. Code or other provision cited as authorizing transportation: 42 
USCA § 8004; 
Typical use of transportation funds as reported to GAO by program 
officials: Accessible taxis, local transportation programs, buses, 
etc.; 
Purpose of trips as reported to GAO by program officials: To access 
medical appointments, work, shopping, and other services; 
Target population reported to GAO as defined by program officials: 
Elderly and people with disabilities; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available; 
How can program funds be used for NEMT or to support NEMT: The grant 
can be used for up to 40 percent of the cost of supportive services 
which can include NEMT. 

Catalog of Federal Domestic Assistance Number: 14.218; 
Program name: Community Development Block Grants/Entitlement Grants; 
Popular title or original source of program legislation: Housing and 
Community Development Act of 1974; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 5305(a)(8); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit services; 
Purpose of trips as reported to GAO by program officials: To access 
social services, medical services, jobs, etc.; 
Target population reported to GAO as defined by program officials: Low-
and moderate-income persons, mobility-impaired persons, and job-
seekers; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available[E]; 
How can program funds be used for NEMT or to support NEMT: NEMT could 
qualify as an eligible service. 

Catalog of Federal Domestic Assistance Number: 14.225; 
Program name: Community Development Block Grants/Special Purpose 
Grants/Insular Areas; 
Popular title or original source of program legislation: Housing and 
Community Development Act of 1974; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 5305(a)(8); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit services; 
Purpose of trips as reported to GAO by program officials: To access 
social services, medical services, jobs, etc.; 
Target population reported to GAO as defined by program officials: Low-
and moderate-income persons, mobility-impaired persons, and job-
seekers; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available[E]; 
How can program funds be used for NEMT or to support NEMT: NEMT could 
qualify as an eligible service. 

Catalog of Federal Domestic Assistance Number: 14.228; 
Program name: Community Development Block Grants/State's program and 
Non-Entitlement Grants in Hawaii; 
Popular title or original source of program legislation: Housing and 
Community Development Act of 1974; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 5305(a)(8); 
Typical use of transportation funds as reported to GAO by program 
officials: Transit services; 
Purpose of trips as reported to GAO by program officials: To access 
social services, medical services, jobs, etc.; 
Target population reported to GAO as defined by program officials: Low-
and moderate-income persons, mobility-impaired persons, and job-
seekers; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available[E]; 
How can program funds be used for NEMT or to support NEMT: NEMT could 
qualify as an eligible service. 

Catalog of Federal Domestic Assistance Number: 14.241; 
Program name: Housing Opportunities for Persons with AIDS; 
Popular title or original source of program legislation: AIDS Housing 
Opportunity Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. § 12907(a)(3); 
Typical use of transportation funds as reported to GAO by program 
officials: Bus tokens, taxi fares, and any related organizational 
transportation expenses; 
Purpose of trips as reported to GAO by program officials: To access 
supportive services, such as medical treatment, employment or job 
training, etc.; 
Target population reported to GAO as defined by program officials: Low 
to extremely low income persons living with HIV/AIDS; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available; 
How can program funds be used for NEMT or to support NEMT: NEMT could 
qualify as an eligible service. 

Catalog of Federal Domestic Assistance Number: 14.870; 
Program name: Resident Opportunity & Self-Sufficiency Program; 
Popular title or original source of program legislation: Section 34 of 
the U.S. Housing act of 1937, as amended by Quality Housing and Work 
Responsibility Act; 
U.S. Code or other provision cited as authorizing transportation: 42 
U.S.C. 1437z-6; 
Typical use of transportation funds as reported to GAO by program 
officials: Reasonable out-of-pocket expenses for local transportation 
for residents to assist in meeting self-sufficiency goals.; 
Purpose of trips as reported to GAO by program officials: 
Transportation related to purpose of the program, i.e. to get to a job 
interview, or medical appointments that can assist with employment, 
i.e. for eyeglasses, dental needs. Ongoing transportation needs for 
any resident would not be considered eligible; 
Target population reported to GAO as defined by program officials: 
Public housing residents including adults, elderly/disabled.; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information Not Available; 
How can program funds be used for NEMT or to support NEMT: Expenses to 
support residents participating in the program obtain medical services 
such as obtaining eyeglasses for work. 

Catalog of Federal Domestic Assistance Number: 64.009; 
Program name: Veterans Medical Care Benefits[F]; 
Popular title or original source of program legislation: Veterans 
Benefits Act of 1957; 
U.S. Code or other provision cited as authorizing transportation: 38 
U.S.C. § 111; 
Typical use of transportation funds as reported to GAO by program 
officials: Mileage reimbursement; 
special mode (ambulance, wheelchair van); 
common carrier (air, bus, train, boat, taxi); 
Purpose of trips as reported to GAO by program officials: To access VA 
or VA authorized non-VA health care; 
Target population reported to GAO as defined by program officials: Low-
income and service-connected Veterans and certain other special group 
beneficiaries; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $470 million (obligated)[G]; 
How can program funds be used for NEMT or to support NEMT: The 
Beneficiary Travel Program (BT) has authority to provide both 
emergency and nonemergency transport to eligible beneficiaries in 
relation to VA or VA authorized non-VA care. 

Catalog of Federal Domestic Assistance Number: 64.024; 
Program name: VA Homeless Providers Grant and Per Diem Program; 
Popular title or original source of program legislation: Homeless 
Veterans Comprehensive Service Programs Act of 1992; 
U.S. Code or other provision cited as authorizing transportation: 38 
U.S.C. §§ 2011(b)(1)(B), 7721 Note; 
Typical use of transportation funds as reported to GAO by program 
officials: Purchase vans; 
Purpose of trips as reported to GAO by program officials: Outreach to 
and transportation of homeless Veterans by community-based providers; 
Target population reported to GAO as defined by program officials: 
Homeless Veterans; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: Information not available; 
How can program funds be used for NEMT or to support NEMT: Funds 
granted to community homeless providers may be used to purchase 
vehicles to provide NEMT. 

Catalog of Federal Domestic Assistance Number: 64.035; 
Program name: Veterans Transportation Program[H]; 
Popular title or original source of program legislation: Veterans 
Transportation Service Act; 
U.S. Code or other provision cited as authorizing transportation: 38 
U.S.C. 111A; 
Typical use of transportation funds as reported to GAO by program 
officials: Fund Mobility Management, Americans with Disabilities Act 
Vehicles, Drivers and Transportation Coordinator; 
Purpose of trips as reported to GAO by program officials: Provide 
transportation to VA Medical Facilities/CBOC enrolled veterans; 
Target population reported to GAO as defined by program officials: 
Veterans; 
Fiscal year 2012 federal spending on non emergency medical 
transportation[A]: $28.3 million (obligated); 
How can program funds be used for NEMT or to support NEMT: 
Transportation of Veterans to VA Medical Centers and CBOC's. 

Source: GAO analysis of information from the Departments of 
Agriculture, Education, Health and Human Services, Housing and Urban 
Development, Transportation and Veterans Affairs, the Catalog of 
Federal Domestic Assistance, and applicable statutes and regulations. 
GAO-15-110. 

[A] For the purposes of this work, we are defining Nonemergency 
Medical Transportation (NEMT) as "federal programs that provide 
nonemergency, non-military, surface transportation services of any 
kind to beneficiaries or clients for the purposes of receiving medical 
care. This includes programs that fund infrastructure-related costs 
for NEMT as well as those that fund the actual transport." 

[B] On July 22, 2014, this program was transferred to HHS by the 
Workforce Innovation and Opportunity Act and is being administered by 
the Department of Education during this transition. 

[C] On July 22, 2014, this program was transferred to HHS by the 
Workforce Innovation and Opportunity Act and is being administered by 
the Department of Education during this transition. 

[D] The Over-the-Road Bus Program was repealed by MAP-21, effective 
October 2012. The Federal Public Transportation Act of 2012 repealed 
the New Freedom program (49 U.S.C. § 5317) as a separate program and 
instead merged the program into the Enhanced Mobility of Seniors and 
Individuals with Disabilities program (49 U.S.C. § 5310), effective 
October 2012. 

[E] According to HUD, information was not available for NEMT but for 
all three Community Development Block Grant components transportation 
services were 0.1 percent of total disbursements in fiscal year 2012. 

[F] Fiscal year 2012 federal spending for Catalog of Federal Domestic 
Assistance program 64.009 includes Veterans Transportation Program/ 
Beneficiary Travel only. 

[G] Figure includes mileage reimbursement for non-emergency care. In 
addition, $391 was obligated for Special Mode Transport. However, 
Special Mode Transport can include non emergency medical 
transportation and emergency medical transportation and a breakdown is 
not available nationally. 

[H] Fiscal year 2012 federal spending for Catalog of Federal Domestic 
Assistance program 64.035 includes Veterans Transportation Program/ 
Veterans Transportation Service only. 

[End of table] 

[End of section] 

Appendix III: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

David J. Wise, (202) 512-2834, wised@gao.gov: 

Staff Acknowledgments: 

In addition to the individual named above, other key contributors to 
this report were Heather MacLeod, Assistant Director; Rashmi Agarwal; 
Lorraine Ettaro; Delwen Jones; Richard Jorgenson; Michael Mgebroff; 
Cheryl Peterson; Lisa G. Shibata; Hemi Tewarson; Sarah Veale; and 
Carolyn Yocom. 

[End of section] 

Footnotes: 

[1] The Census Bureau categorizes disability into one of three 
domains: communicative, physical, or mental. Communicative disability 
includes such things as being blind or deaf. Physical disability 
includes such things as difficulty walking, and having heart trouble 
or diabetes. Mental disability includes such things as difficulty 
learning and dementia. 

[2] GAO, Transportation Disadvantaged Populations: Federal 
Coordination Efforts Could Be Further Strengthened, [hyperlink, 
http://www.gao.gov/products/GAO-12-647] (Washington, D.C.: June 20, 
2012. "Transportation disadvantaged" populations include those who 
cannot provide their own transportation due to age, disability, or 
income constraints. NEMT is defined in this report as those federal 
programs that provide nonemergency, nonmilitary, surface 
transportation services of any kind to beneficiaries or clients for 
the purpose of receiving medical care. This includes transportation in 
a private vehicle or public transportation, such as a bus, to medical 
appointments or services. 

[3] Some federal programs, such as those administered by VA, may 
provide direct transportation services to beneficiaries, as opposed to 
state and local agencies providing these services. 

[4] [hyperlink, http://www.gao.gov/products/GAO-12-647]. 

[5] GAO, 2014 Annual Report: Additional Opportunities to Reduce 
Fragmentation, Overlap, and Duplication and Achieve Other Financial 
Benefits, [hyperlink, http://www.gao.gov/products/GAO-14-343SP] 
(Washington, D.C.: Apr. 8, 2014). Duplication occurs when two or more 
agencies or programs are engaged in the same activities or provide the 
same services to the same beneficiaries. Overlap occurs when agencies 
or programs have similar goals, engage in similar activities or 
strategies to achieve them, or target similar beneficiaries. 
Fragmentation refers to those circumstances where more than one 
federal agency (or more than one organization within an agency) is 
involved in the same broad area. 

[6] Issues related to coordination of transportation programs for 
older adults are addressed in a related GAO report. See GAO, 
Transportation for Older Adults: Measuring Results Could Help 
Determine If Coordination Efforts Improve Mobility, [hyperlink, 
http://www.gao.gov/products/GAO-15-158] (Washington, D.C.: Dec. 10, 
2014). 

[7] The Catalog of Federal Domestic Assistance is a governmentwide 
compendium of federal programs, projects, services, and activities 
that provide assistance or benefits to the American public. It 
contains financial and nonfinancial assistance programs administered 
by departments and other entities of the federal government. 

[8] States may contract with brokers to provide NEMT services for 
Medicaid beneficiaries to access medical care or services. NEMT 
services may be provided under contract with public or private 
individuals or entities and transportation services can include, among 
other things, wheelchair vans, taxis, stretcher cars, or bus passes. 
Brokers are required to be selected through a competitive bidding 
process. 

[9] These population estimates cannot be added since individuals could 
be in one or more of the population groups. According to the Census 
Bureau, the 2010 poverty threshold for a family of 4 with 2 children 
was annual income of $22,113. 

[10] 49 U.S.C. § 5307. 

[11] 49 U.S.C. § 5310. Through legislation enacted in 2012, the 
Formula Grants for the Enhanced Mobility of Seniors and Individuals 
with Disabilities Program incorporated the previous New Freedom 
Program. Moving Ahead for Progress in the 21ST Century Act (MAP-21), 
Pub. L. No. 112-141 § 20009. 126 Stat. 405, 675-680. Among other 
things, the Formula Grants for the Enhanced Mobility of Seniors and 
Individuals with Disabilities program provides for the apportionment 
of funds to large urban, smaller urban, and rural areas based on the 
population distribution of seniors and people with disabilities. 

[12] 49 U.S.C. § 5311. 

[13] In general, Medicaid beneficiaries are low income individuals, 
including individuals over 65 and those with disabilities. 

[14] Medicaid can also include the State Children's Health Insurance 
Program (CHIP). This is a joint federal-state program that was 
established by law in 1997 that finances health insurance for over 8-
million children in families whose household incomes are too high for 
Medicaid eligibility but too low to afford private insurance. States 
can operate CHIP as a separate program or include CHIP-eligible 
children in their Medicaid program. For purposes of this report, when 
we refer to Medicaid, we are also referring to those portions of CHIP 
that are designated as expansions of Medicaid. 

[15] Member agencies of the Coordinating Council are the Department of 
Agriculture, Department of Education, Department of the Interior, 
Attorney General, Department of Labor, DOT HHS, HUD, National Council 
on Disability, Social Security Administration, and VA. The council 
does not have its own budget. 

[16] [hyperlink, http://www.gao.gov/products/GAO-12-647]. 

[17] [hyperlink, http://www.gao.gov/products/GAO-12-647] and Pub. L. 
No. 109-59, 119 Stat. 1144 (2005). 

[18] Pub. L. No. 109-59, 119 Stat. 1144, 1591. 

[19] Pub. L. No. 112-141, 126 Stat. 405, 679 (2012). The Formula 
Grants for the Enhanced Mobility of Seniors and Individuals with 
Disabilities is the revised name of the previous Formula Grants for 
Special Needs of Elderly Individuals and Individuals with Disabilities 
program authorized in SAFETEA-LU. For purposes of this report we refer 
to the current program as the Enhanced Mobility of Seniors and 
Individuals with Disabilities program. 

[20] Pub. L. No. 112-141, 126 Stat. 405, 678-679. 

[21] Pub. L. No. 112-141 (MAP-21) authorized surface transportation 
programs through fiscal year 2014. Legislation was enacted in August 
2014 extending highway and other transportation programs and funding 
through May 31, 2015, for programs authorized under MAP-21. Highway 
and Transportation Funding Act, Pub. L. No. 113-159, 128 Stat. 1839 
(2014). 

[22] GAO, Opportunities to Reduce Potential Duplication in Government 
Programs, Save Tax Dollars, and Enhance Revenue, [hyperlink, 
http://www.gao.gov/products/GAO-11-318SP] (Mar. 1, 2011). 

[23] See GAO, 2012 Annual Report: Opportunities to Reduce Duplication, 
Overlap, and Fragmentation, Achieving Savings, and Enhance Revenue, 
[hyperlink, http://www.gao.gov/products/GAO-12-342SP] (Washington, 
D.C.: Feb. 28, 2012). 

[24] Pub. L. No. 111-352, 124 Stat. 3866 (2011), amending 5 U.S.C. §§ 
301 and 306 and 31 U.S.C. §§ 1115, 1116, and adding 31 U.S.C. §§ 1120-
1125 (GPRA). 

[25] [hyperlink, http://www.gao.gov/products/GAO-12-342SP]. 

[26] For purposes of this report, "spending" is the same as 
expenditures. 

[27] The eight programs include Medicaid; Coordinated Services and 
Access to Research for Women, Infants, Children and Youth; Health 
Center Program; Substance Abuse and Mental Health Services-Access to 
Recovery; Rural Health Care Services Outreach, Rural Health Network 
Development, and Small Health Care Provider Quality Improvement 
Program; HIV Emergency Relief Project Grants; HIV Care Formula Grants; 
HIV Early Intervention Services. GAO did not independently verify 
spending information provided by federal agencies. 

[28] In fiscal year 2012, VA also obligated $28.3 million for the 
Veterans Transportation Program for NEMT. VA also obligated $470 
million for mileage reimbursements in its Beneficiary Travel Program. 
VA did not provide the amount that was spent. 

[29] VA also reported an additional $391 million was obligated for 
special mode transport--for example, transportation via ambulance or 
wheelchair van. However, VA said this was a mix of emergency and NEMT, 
and the agency was unable to provide a breakout between the two. 

[30] Data on the number of states that report NEMT as an optional 
service, an administrative expense, or both were not available since 
CMS does not break out this information. It should be noted that CMS 
began tracking NEMT expenses for states that cover this cost as an 
administrative expense in the fourth quarter of fiscal year 2013. 

[31] [hyperlink, http://www.gao.gov/products/GAO-12-647]. 

[32] [hyperlink, http://www.gao.gov/products/GAO-12-647]. 

[33] Report to the President, Human Service Transportation 
Coordination, Executive Order 13330, Coordinating Council on Access 
and Mobility, 2005. 

[34] 49 USC § 5309 authorizes FTA to make grants through its Bus and 
Bus Facilities program for this purpose. 

[35] This initiative is formally called the Research and Demonstration 
Program to Improve Coordinated Transportation Planning for People with 
Disabilities and Older Adults. According to HHS officials, initial 
funding for this program was $1 million. 

[36] The other interagency working group was the Emergency 
Preparedness group. 

[37] [hyperlink, http://www.gao.gov/products/GAO-12-647]. 

[38] GAO, Results-Oriented Government: Practices That Can Help Enhance 
and Sustain Collaboration among Federal Agencies, [hyperlink, 
http://www.gao.gov/products/GAO-06-15] (Washington, D.C.: Oct. 21, 
2005). 

[39] Transit Cooperative Research Program, Transportation Research 
Board, Sharing the Costs of Human Services Transportation, Volume 1: 
The Transportation Services Cost Sharing Toolkit, TCRP Report 144, 
(2011), and Transit Cooperative Research Program, Transportation 
Research Board, Sharing the Costs of Human Services Transportation, 
Volume 2: Research Report, TCRP Report 144, (2011). 

[40] 49 U.S.C. § 5310(e)(2). 

[41] Inclusive Coordinated Transportation Partnership Project: Year 1 
Evaluation, Westat, May 9, 2014. 

[42] "Highly rural" was considered to be an area consisting of a 
county or counties with a population of less than seven persons per 
square mile. 

[43] VTS, Beneficiary Travel, and Highly Rural Areas grant program are 
a part of the Veterans Transportation Program. 

[44] [hyperlink, http://www.gao.gov/products/GAO-11-318SP]. 

[45] [hyperlink, http://www.gao.gov/products/GAO-11-318SP]. 

[46] [hyperlink, http://www.gao.gov/products/GAO-12-647]. 

[47] As previously discussed, projects funded by FTA's Enhanced 
Mobility of Seniors and Individuals with Disabilities program must be 
included in a locally developed, coordinated public transit-human 
services transportation plan. Also, the services funded under this 
program must be coordinated with transportation services assisted by 
other federal departments and agencies. Pub. L. No. 112-141, 126 Stat. 
405, 679. 

[48] See, for example, Medicaid in Schools: Improper Payments Demand 
Improvements in HCFA Oversight, [hyperlink, 
http://www.gao.gov/products/GAO/HEHS/OSI-00-69] (Washington, D.C.: 
Apr. 5, 2000). 

[49] Brokers can be global or nationwide companies that manage and 
provide a range of transportation services, including bus and rail 
transportation, to cities, airports, schools, government agencies, and 
hospitals, among other entities. One of the private brokers we spoke 
with said it manages NEMT services in 41 states, including all 5 of 
the states we visited. 

[50] 38 U.S.C. § 111(a). 

[51] 38 U.S.C. § 111(b). The threshold for 2014 ranged from $31,443 
for veterans with no dependents to $44,216 for veterans with four 
dependents. 

[52] The Catalog of Federal Domestic Assistance is a government-wide 
compendium of Federal programs, projects, services, and activities 
that provide assistance or benefits to the American public. It 
contains financial and non-financial assistance programs administered 
by departments and establishments of the federal government. 

[53] Member agencies of the Coordinating Council are the Department of 
Agriculture, Department of Education, Department of the Interior, 
Attorney General, Department of Labor, Department of Transportation 
(DOT), Department of Health and Human Services (HHS), Department of 
Housing and Urban Development (HUD), National Council on Disability, 
Social Security Administration, and the Department of Veterans Affairs 
(VA). We identified programs authorized to fund nonemergency medical 
transportation that are administered by 6 of the 11 Coordinating 
Council member agencies. 

[54] Human Service Transportation Coordination, Exec. Order No. 13330 
(Feb. 24, 2004). 

[55] DOT and HHS formed the Coordinating Council in 1986 to improve 
the efficiency and effectiveness of human service transportation by 
coordinating related programs at the federal level and promoting the 
maximum feasible coordination at the state and local levels. In 2004, 
Executive Order 13330 expanded council membership to 11 agencies. The 
expanded Coordinating Council was charged with, among other things, 
promoting interagency cooperation and establishing appropriate 
mechanisms to minimize duplication and overlap of federal programs and 
services so that transportation-disadvantaged persons have access to 
improved transportation services. 

[End of section] 

GAO's Mission: 

The Government Accountability Office, the audit, evaluation, and 
investigative arm of Congress, exists to support Congress in meeting 
its constitutional responsibilities and to help improve the 
performance and accountability of the federal government for the 
American people. GAO examines the use of public funds; evaluates 
federal programs and policies; and provides analyses, recommendations, 
and other assistance to help Congress make informed oversight, policy, 
and funding decisions. GAO's commitment to good government is 
reflected in its core values of accountability, integrity, and 
reliability. 

Obtaining Copies of GAO Reports and Testimony: 

The fastest and easiest way to obtain copies of GAO documents at no 
cost is through GAO's website [hyperlink, http://www.gao.gov]. Each 
weekday afternoon, GAO posts on its website newly released reports, 
testimony, and correspondence. To have GAO e-mail you a list of newly 
posted products, go to [hyperlink, http://www.gao.gov] and select 
"E-mail Updates." 

Order by Phone: 

The price of each GAO publication reflects GAO's actual cost of 
production and distribution and depends on the number of pages in the 
publication and whether the publication is printed in color or black 
and white. Pricing and ordering information is posted on GAO's 
website, [hyperlink, http://www.gao.gov/ordering.htm]. 

Place orders by calling (202) 512-6000, toll free (866) 801-7077, or 
TDD (202) 512-2537. 

Orders may be paid for using American Express, Discover Card, 
MasterCard, Visa, check, or money order. Call for additional 
information. 

Connect with GAO: 

Connect with GAO on facebook, flickr, twitter, and YouTube.
Subscribe to our RSS Feeds or E mail Updates. Listen to our Podcasts.
Visit GAO on the web at [hyperlink, http://www.gao.gov]. 

To Report Fraud, Waste, and Abuse in Federal Programs: 

Contact: 
Website: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]; 
E-mail: fraudnet@gao.gov; 
Automated answering system: (800) 424-5454 or (202) 512-7470. 

Congressional Relations: 

Katherine Siggerud, Managing Director, siggerudk@gao.gov: 
(202) 512-4400: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7125: 
Washington, DC 20548. 

Public Affairs: 

Chuck Young, Managing Director, youngc1@gao.gov: 
(202) 512-4800: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7149: 
Washington, DC 20548. 

[End of document]