Case Studies: Value of Transportation to Social
Determinants of Health Destinations
June 2024

The National Center for Mobility Management (NCMM; nc4mm.org) is anational technical assistance center created to facilitate communities in
adopting mobility management strategies. NCMM is funded through a
cooperative agreement with the Federal Transit Administration (FTA) and isoperated through a consortium of three national organizations – theAmerican Public Transportation Association, the Community Transportation
Association of America, and Easterseals, Inc. NCMM is charged withsupporting FTA and its partners in carrying out the recommendations
suggested in the updated Coordinating Council on Access and Mobility*CCAM) Strategic Plan.
This information brief was prepared by NCMM staff who serve as Regional
Liaisons to FTA Regions 1, 4, 5, and 7. This information is disseminated in theinterest of information exchange. Neither the NCMM nor the FTA assumes
liability for its content or use. The opinions and conclusions expressed herein
are solely those of the authors and should not be construed as representing
the opinions or policy of any agency of the federal government.
Comments or questions about this document can be addressed to
edixon@easterseals.com
Thank you.

This document was prepared by [TA Center] with the financial assistanceof the U.S. Department of Transportation. The contents do not necessarily
represent the opinions or policy of any agency of the U.S. Government,
and the U.S. Government assumes no liability for the contents or use
thereof. It does not have the force and effect of law and is not meant tobind the public in any way.

About this Information Brief
Easterseals, through its work at the National Center for Mobility Management (NCMM), focuseson building connections across education, human services, and transportation sectors so that
individuals with disabilities can access school, work, health care, and other inclusive
community settings. In this work, NCMM has researched, and sourced instances of current anddiscontinued case studies on value of transportation to Social Determinant of Health (SDOH)
destinations the barriers to this practice in programs across all FTA regions. This guide will
highlight a diverse range of examples and is intended to be utilized by organizations andagencies as a guide to influence programs in their regions.
For questions about this product, please contact Judy Shanley, Ph.D. FTA Regions 1 & 5
Regional Liaison or Enjoli Dixon, FTA Regions 4 &7 Regional Liaison both from Easterseals.
Acknowledgments
NCMM would like to thank the following states and organizations for their contributions to thisproduct. They provided key insights, information, resources, and time to ensure this reportaccurately reflects the fundamental aspects of each example highlighted in this brief:
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Easterseals
River Cities Public Transit
STARS (Saginaw Transit Authority Regional Services)
St. Lawrence County Public Transit
State of Kansas Mobility Managers
Los Angeles County Aging & Disabilities Department
Harvesters Food Bank

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Overview of Social Determinants of Health
The Centers for Disease Control and Prevention, in collaboration with the World HealthOrganization, defines social determinants of health (SDOH) as the nonmedical factors that
affect health outcomes. These factors are related to an individual's environment, including
their place of residence, birth, work, education level, employment, housing, age, and otherexternal influences that shape their daily quality of life. Other barriers such as racism,
political agendas, cultural bias, and economic systems can also play a significant role. The
provided image focuses on various SDOH for different communities, but it does not include
an important factor: transportation access.

Image provided by USDHHS

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Program Listings
FTA
Region8

5

SDOH

Location

1.

Health Care
Access andQuality

Pierre,South
Dakota1.

Health Care
Access andQuality
Education
Access andQuality
Economic
Stability
Health Care
Access andQuality
Education
Access andQuality

Saginaw,
MI

2.
3.
2

1.
2.

Agency/Partner(s)River Cities Public
TransitDescriptionof programs
1. Veteran,
2. Medicaid
3. Youth

STARS (Saginaw
Transit Authority
Regional Services)

1.
2.
3.

Canton,NY

St. Lawrence
County Public
Transit

1.
2.

3.

7

1.
2.
3.

9

1.

Health Care
Access andQuality
Neighborhoodand Built
Environment
Social andCommunity
Context

Salina,KS

Health Care
Access andQuality

Los
Angeles,
California

City of Salina/Salina
Emergency Aid
Food Bank/CityGo/
Blue Cross and Blue
Shield of Kansas(BCBSKS)/Live Well
Salina1.

Los Angeles County

1.

2.
3.
4.

2.
3.

7

1.
2.
3.

Health Care
Access andQuality
Neighborhoodand Built
Environment
Social andCommunity
Context

KansasCity, MO

Harvesters Food
Bank /Kansas City
Transit
Authority/Universityof Missouri – Kansas
City Health
Sciences District

6

1.
2.

For more information
Ron Baumgart, Executive Director
rbaumgart@rcptransit.com
https://www.rcptransit.com/veterans/

Rides toWellness –NEMT
Job Shuttles
University
Transportation

Robert Sims, Mobility Coordinatorrsimms@saginaw-stars.com
https://saginaw-stars.com/

College
Connector
VolunteerTransit First
Mile Last Mile
Program
Farmers
Market andHot Meals

Sonja Jensen, Mobility Manager(315) 748-5463

Accessible
sidewalks
Pathway forbikingAdditional
bike racks
Additional
parking

Michelle Coats, Director of Mobility
Management for North Central Kansas(785)826-1583x315
Accessible Pathways to Food BankNew Freedom
TaxicabNFT Critical
DeliveryServices (CDS)
NFT
Emergency
Food Box
DeliveryDavid Kochen
Human Services Administrator II
dkochen@ad.lacounty.gov
Los Angeles County – New Freedom
Transportation Programs

Pop UpPantries
Bus Stop PopUp Food
Pantries

Jessica Kejr, Director of Programs andFood+ at Harvesters-The Community
Food Network
jkejr@harvesters.org
https://www.harvesters.org
Bus Stop Pop-Up Food Pantries
UMKC Health Sciences District

II. Method and Response

NCMM developed a survey targeted at state Departments of Transportation, stateagencies, and regional commissions/councils and community organizations to gather
information about 1) transportation programs providing access to healthcare, work,school and other; and 2) Coordinating Council on Access and Mobility (CCAM)
partners and examples of braided funding braided.. NCMM used a variety of outreachmethods to obtain feedback, including reaching out to each state agencies andassociations to complete and aid in distributing the survey. Response to the online
survey was moderate, however, provided a wealth of information to help us
evaluate and determine the following: language used in applications, mobility
management education and resources, and activities in progress. NCMM gathered ageographically diverse set of respondents from both state agencies, planning
organizations, transit associations and nonprofits.
Qualitative examples of how increasing people's access to transportation increases theiraccess to vital SDOH destinations were collected. NCMM used the framework outlined
below to capture information about the implementation of programs to help communities
address SDOH. The conclusions described are based on interviews with state officials,
mobility managers, transit agencies and reviews of related state resources and websites.
These descriptions are intended to document the implementation phase of the state’s
mobility management network, regardless of where they are in the implementation phase,
we believe that other states can learn from these examples.
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FTA Region. Identifies the region of the continental USA this program is located. Thisis helpful when an organization is coordinating transportation efforts across regional
partners.
Agency or Organization/CCAM Partnerships. The Coordinating Council on Accessand Mobility (CCAM) has provided mobility management networks with theopportunity to develop new and innovative partnerships with non-transportation
agencies and organizations, and can assess the range and purpose of thesepartnerships.
Program Description. Describes the type of services and/or who the program
benefited in the community.
Contact Information/Resources. This provides the program contact information andfurther resources to gain information regarding the organizations administering the
program. Please note that this information was current at the time this information
brief was written. However, NCMM audiences

The following case studies highlight examples of how Coordinating Council on Access andMobility (CCAM) partners can work together on a local, state, and reginal level to limit thebarriers or obstacles related to SDOH.

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Case Studies
River Cities Public Transit, Pierre South Dakota
River Cities Public Transit, previously known as Community Coordinated Transportation
Systems, was established in 1998 with the aim of coordinating transportation services
among various providers. It originated from the collaboration between St Mary's Hospital,
Capitol Area Counseling, and other agencies that provided their own transportation services.
These founders laid the foundation for what would later become River Cities Public Transit,
although they could not have anticipated the extent of coordination that exists today. The
organization plays a crucial role in coordinating transportation for numerous agencies andbusinesses in the Pierre – Fort Pierre area. They are responsible for providing transportation
services to healthcare facilities such as Golden Living Center, St Mary's Hospital, Maryhouse
Nursing Home, Kelley Assisted Living Apartments, and Parkwood Assisted Living Center. As
a Medicaid licensed transportation provider, River Cities Public Transit is authorized to assist
medical centers in transporting their patients.
They also collaborate with clinics in the Pierre-Fort Pierre area, allowing patients toschedule their own rides or have clinics arrange transportation for them. In addition to
healthcare services, River Cities Public Transit coordinates rides for various programs andinstitutions including Career One Stop, Right Turn, Growing Up Together, Missouri Shores
Domestic Violence Center, Senior Meals Program, and the South Dakota Women's Prison.
Another program, which supports the future ridership of the system is the Youth Transit
services. Parents or guardians may register their child each year for transportation services
to various destinations after school each day. Children and their parents learn how to ride
public transit, and the agency pays fares as they are transported to the following
destinations daily; Boys and Girls Club, YMCA or extracurricular activities (band, choir, etc.).
River Cities Public Transit coordination efforts extend to smaller communities in Central
South Dakota as well. For instance, they offer medical trips from Gettysburg to medical
centers throughout the week and work closely with local commissions, councils, and seniorcenters in places like Blunt, Harrold, and Highmore to assess transportation needs andcoordinate rides. River Cities Public Transit also operates a job shuttle from Highmore to the
Pierre area on weekdays, ensuring individuals have reliable transportation to work. The
organization firmly believes in the value of transportation coordination and actively
practices it within the communities they serve.
STARS – Saginaw Transit Authority Regional Services, Saginaw, MI
STARS is a public transportation system in the Urbanized Saginaw Area. It covers around 1.5
million miles annually and serves over 3,300 people daily for various purposes such as
work, doctor visits, shopping, and school. It plays a vital role in meeting basic transportationneeds and contributing to economic development in the Saginaw Region. STARS offers
mobility options to over 48,000 senior citizens and individuals with disabilities through the
LIFT service, but not limited to just these populations.
Another program, the Rides to Wellness, a non-emergency medical program that serves
the entire county. It is designed for passengers who are affiliated with partner agencies.
8Individuals can access this service through STARs’ community partner, Michigan
Transportation Connection (MTC).
In addition to the providing medical services transportation, STARS provides a solution for
those who need to access employment and education. STARS offers transportation
services to Delta College students, allowing them to conveniently attend classes at both the
Delta Main Campus and Downtown Saginaw Center. This program operates during the Falland Winter Semester only. To ride for free, Delta students or employees need to present avalid ID to the driver. Aside from students, this transportation route is also available to the
public for regular fare. Michigan Reconnect is a program that grants tuition-free access tocommunity college for individuals aged 25 or older without college degrees. It enables
them to pursue associate degrees or occupational certificates that are eligible for Pell
grants.
Lastly, the Stars Job Shuttles, operated by STARS, offers specialized transportation services
that cater to the specific needs of businesses. These job shuttles ensure that employees
can commute to work reliably and on time, resulting in benefits such as reduced turnover,decreased training costs, access to a larger pool of potential employees, increased
employee reliability, lower employee stress levels, and reduced transportation costs for
employees. The job shuttles can be customized according to the requirements of thebusiness and can be financed by the employer, employee, or a combination of both. They
are not limited by county lines, operate 24/7, and can be serviced by either a single van orseveral large buses.
St. Lawrence Couty Public Transit, Canton, NY
St. Lawrence County Public Transit (embed link slcnypublictransit.com), which is operated by
The Arc Jefferson – St. Lawrence, has achieved a huge milestone in 2023 by surpassing
100,000 rides. This exceeds the previous year's total ridership of 97,740. The public transit
system in St. Lawrence County collaborated with the Volunteer Transportation Center and theCounty's First Mile Last Mile program, along with providing Mobility Management services.
The St. Lawrence County Planning Office oversees these three programs. The increase inridership is due to the updated routes and additional stops on routes 67, 68, and 71.
Currently, the County's bus system operates 19 routes, and most run on weekdays, except
for Route #67, which runs daily and includes stops at SUNY Potsdam. There are also fourroutes that offer weekly or bi-weekly service. In 2018, the bus system provided a total of
50,922 one-way trips to riders. The number of riders varied each month, with the lowest
ridership of 2,756 in February and the highest ridership of 6,882 in October. The buses
traveled a total distance of 583,192 miles throughout the county. The increase in ridershipand mileage during the second half of 2018 can be attributed to the addition of four new
routes, the creation of the Ogdensburg shuttle, and the use of buses to transport The Arc
clients, which were funded by Formula 5310 and NYS Office of Persons with Developmental
Disabilities (OPWDD) monies. In Spring 2020, the Massena Shuttle Service was introduced
to offer transportation to medical services, shopping areas, dining establishments, thelibrary, the Department of Motor Vehicles, Akwesasne Mohawk Casino Resort, and more.
The St. Lawrence County Public Transit, operated by The Arc Jefferson - St. Lawrence, has a9variety of programs to support SDOH. For those in the community to access higher
education opportunities, the "College Connector" route was introduced, which is available
for both students and the public. This service allows easy travel between SUNY Canton,
Clarkson University, and SUNY Potsdam campuses. The route connects the bus lines ofeach college through a central hub located at Walmart in Potsdam. The service operates
seven days a week. Schedules can be accessed at each college, the St. Lawrence County
Chamber of Commerce, and slcnypublictransit.com. Students can ride their college line forfree using their student ID, while rides on other lines cost $2. Public riders are charged thestandard fee of $2 per trip. The College Connector goal is to improve access to classes,
campus events, and provide additional shopping and dining experiences. Public Transit
provides free Wi-Fi service throughout the system.
In addition to the bus service, St. Lawrence County offers the "First Mile Last Mile" connector
service. This service helps transport public transit riders to and from designated bus stops
that are at least ¾ mile away from their locations. However, due to the limited number ofdesignated stops and the large size of the county, some riders must make their own
arrangements to reach the bus stops. To address this issue, the First Mile Last Mile program
was introduced. It relies on volunteers who use their personal vehicles to transport bus
riders. The Volunteer Transportation Center, Inc. coordinates the service by acting as thedispatcher and scheduling the rides in advance.
Between April and December 2018, the First Mile Last Mile program provided 885 one-way
trips for transit riders, which accounted for 2% of the total number of bus trips in 2018. The
volunteer drivers involved in the program traveled a total of 20,069 miles to transport transit
riders to and from designated stops.
Another special program provided, per a partnership between the St. Lawrence County
Office for the Aging and St. Lawrence County Public Transit was transportation to accesslocal farmers markets exclusively for older adults. Seniors who are 60 years and older are
cordially invited to partake in this exciting opportunity, which includes a complimentaryround-trip ride and a delectable lunch at the farmers markets. The main objectives of these
trips are to acquaint clients with our local public transit system, distribute NYS Farmers
Market Coupons to income-eligible seniors, and actively contribute to the support of local
farmers within our community. All those who wanted to participate were encouraged to sign
up to ensure that they would receive a free bagged lunch. This is a wonderful chance forseniors to get outside to explore the farmers markets, connect with others, and enjoy fresh,
local produce!
Accessible Pathways to Food Bank, Salina, KS
The Salina Emergency Aid Food Bank is receiving significant support from Pathways to a
Healthy Kansas, backed by Blue Cross and Blue Shield of Kansas. This initiative has
provided $200,000 to enhance accessibility, including funding for new sidewalks linking thefood bank to CityGo bus stops and improvements to parking facilities. These upgrades aim
to address challenges faced by locals who walk or bike to the food bank, while also
highlighting the community's commitment to inclusive access to essential services. Throughcollaborative efforts with Live Well Saline County, this transformative initiative reflects a
broader commitment to improving health and well-being in the area.

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New Freedom Transportation, Los Angeles, California
The Los Angeles County Aging & Disabilities Department received funding from the Los
Angeles County Metropolitan Transportation Authority (METRO) to enhance transportation
services throughout Los Angeles County. Their aim is to exceed the requirements outlinedin the Americans with Disabilities Act (ADA) of 1990 and improve transportation options forolder adults and individuals with disabilities.
The New Freedom Transportation Program, managed by METRO, receives funding from theU.S Department of Transportation (DOT) Federal Transit Authority (FTA) and operates incompliance with all relevant federal, state, and local regulations.
Within New Freedom Transportation, clients can choose from three specialized programs;
the Taxicab, Volunteer Driver and Door Assistance program. The Volunteer Driver Mileage
Reimbursement Program is available to eligible individuals monthly at no cost. While allservices are accessible to the general public, eligibility criteria and service priorities havebeen implemented to ensure that assistance is provided primarily to those in the greatest
need.
Those with the greatest need required special services during the pandemic. In response to
the COVID-19 Pandemic, New Freedom Transportation swiftly addressed the needs of its
aging and disability communities with new programming by establishing the Critical
Delivery Services (CDS) Program. This initiative facilitated over 55,300 deliveries
encompassing groceries, medication, household essentials, emergency food supplies,
meals, and other vital necessities. Additionally, CDS offered urgent transportation services
for medical appointments, voting, testing, and access to vaccination sites. The CDS initiative
highlighted the substantial demand for delivery services among older adults and individuals
with disabilities, shedding light on a previously unrecognized need prior to the pandemic.
Harvesters Food Bank (Bus Stop Pop-Up Food Pantries), Kansas City, MO
When discussing food insecurity, a common concern we often encounter is the lack oftransportation to access pantries or food distribution centers. Harvesters is actively tackling
this obstacle by experimenting with novel distribution approaches and utilizing a mapping
tool to showcase available community food resources.
Harvester’s transports food to various bus stops in the area. Through this innovative mobile
food pantry model, individuals have full autonomy in selecting their food items, and theofferings are customized to meet the specific needs of bus commuters. As this initiative is
still in its early stages, Harvesters is excited to continue expanding to additional locations.
To enhance support for community members dependent on public transit, the agency
teamed up with the Kansas City Area Transit Authority, Lawrence Transit, and Topeka Metro.
Together, they developed a mapping tool that showcases Harvester’s partner agency foodpantries conveniently located near bus stops in these metropolitan regions.
Harvesters is currently finalizing the development of this exciting new tool and will provide
more information soon.
11Conclusion
Social determinants of health (SDOH) place a large strain and influence on individuals'
health, well-being, and overall quality of life. SDOH influences a wide range of factors,
including the availability of safe housing, transportation, and safe and accessibleneighborhoods. Community conditions such as Education, and job opportunities, income,access to nutritious foods, opportunities for physical activity, exposure to polluted air andwater, and language and literacy skills all influence SDOH outcomes. Without addressingthese areas, these determinants contribute to the consistent health disparities andinequities in society.
The case studies included in this report demonstrate successful programming incoordination with community partners that aim to solve mobility challenges as it relates tobeing SDOH in many communities. For example, individuals lacking access to grocery
stores or farmers markets (like the seniors in St. Lawrence County in Canton, New York) withhealthy options are more likely to have poor nutrition, which can increase their risk ofdeveloping conditions such as heart disease, diabetes, and obesity. This will most likely can
result in their life expectancy being lower compared to those who have access to healthy
foods.
Therefore, because transportation has repeatedly been listed as the number one barrier, thefocus of the Coordinating Council on Access and Mobility (CCAM) main goal is to develop
relationships through coordinated transportation encouraging the collective efforts ofmultiple entities or agencies to enhance their ability to provide transportation services. This
includes activities like sharing passenger trips and vehicles, sharing facilities, or services,collaborating on grant applications and training, and even braiding federal funds. The goal is
to improve the availability, accessibility, and efficiency of transportation options, ultimately
benefiting end users and serving a larger population and geographical area. Each of thecase studies demonstrates interagency partnerships, whether at a local or state level that
fosters innovation, leading to the development and implementation of future transportation
models that provide improved customer service.

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Resources
U.S. Department of Health and Human Services and Office of Disease Prevention and
Health Promotion• Social Determinants of Health
On October 27, 2022, the FTA convened the Coordinating Council on Access and Mobility(CCAM), a federal interagency council that coordinates funding and provides expertise on
human services transportation for people with disabilities, older adults, and individuals of
low income, and officially adopted
Coordinating Council on Access and Mobility (CCAM) Resources• CCAM Strategic Plan 2023-2026
On October 27, 2022, the FTA convened the Coordinating Council on Access and Mobility(CCAM), a federal interagency council that coordinates funding and provides expertise on
human services transportation for people with disabilities, older adults, and individuals of
low income, and officially adopted the 2023-2026 CCAM Strategic Plan. The plan prioritizes
expanding safe access to transit, providing affordable mobility options and sets aframework for collaboration among CCAM grantees at all levels and across jurisdictions.
• CCAM Program Inventory
The CCAM Program Inventory identifies 130 Federal programs that can provide funding forhuman services transportation for people with disabilities, older adults, and/or individuals of
low income. In 2018 and 2019, CCAM agency representatives determined which programs
to include via internal agency program validation efforts and the CCAM Program Analysis
Working Sessions. The CCAM Program Inventory includes detailed program information,such as CFDA numbers, statutory references, types of recipients and beneficiaries, andeligible transportation activities. The CCAM Program Inventory Summary document,
available in PDF and Excel formats, contains limited program details, and is formatted foreasy printing.
• CCAM Federal Fund Braiding Guide
Federal fund braiding for local match allows grant recipients to use funds from one federal
program to meet the match requirements of another. The CCAM Federal Fund Braiding
Guide provides information to potential grantees as well as CCAM agency program
managers on acceptable Federal fund braiding arrangements on transportation-related
projects. The guide defines Federal fund braiding for local match and examines whether
Federal fund braiding is allowable for 61 programs across CCAM agencies that may fundtransportation.
• CCAM Cost-Sharing Policy Statement
The CCAM Cost-Sharing Policy Statement provides key transportation cost-sharing
information to encourage greater State and local cost sharing. This includes information
about vehicle and ride sharing as well as Federal fund braiding. Within the vehicle and ridesharing information, the CCAM Cost-Sharing Policy Statement includes 15 principles toguide State and local stakeholders’ equitable allocation of shared costs, including two
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principles specific to the provision of Medicaid non-emergency medical transportation(NEMT) and four specifics to the Veterans Health Administration’s (VHA) Highly Rural
Transportation Grants (HRTG) program, which provides NEMT for Veterans living in highly
rural areas.
National Federal Technical Assistance Resource Centers
The following FTA-funded national technical assistance centers can provide free supportand resources to help improve mobility options for individuals and communities.
National Rural Transit Assistance Program (RTAP) produces technical briefs and toolkits that
support rural and tribal transportation programs.
www.nationalrtap.org | 888-589-6821 | info@nationalrtap.org
National Center for Mobility Management (NCMM) promotes customer-centered strategies
to support mobility management networks to advance good health, economic vitality, selfsufficiency, and community.
www.nc4mm.org | 866-846-6400 | info@nc4mm.org
National Aging and Disability Transportation Center (NADTC), supports small urban and rural
5310 transportation providers to assist accessibility and enhanced mobility of older adults
and people with disabilities.
www.nadtc.org | 866-983-3222 | contact@nadtc.org
National Center for Applied Transit Technology (N-CATT), provides support to programs tounderstand emerging technologies for states and local entities across the U.S.
www.n-catt.org | carpenter@ctaa.org
Shared Use Mobility Center (SUMC) is dedicated to achieving equitable, affordable, andenvironmentally sound mobility across the U.S., through the efficient use of transportation
assets and policy or technical expertise.
www.sharedusemobilitycenter.org | info@sharedusemobilitycenter.org
Transit Workforce Center (TWC) is the Federal Transit Administration’s first ever national
technical assistance center for transit workforce development. Its mission is to help urban,
suburban, tribal, and rural public transportation entities recruit, hire, train, and retain thediverse workforce needed now and in the future.
www.transitworkforce.org | twc@transportcenter.org

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