TRANSPORTATION 

FOR OLDER ADULTS

Measuring Results 

Could Help Determine 

If Coordination Efforts 

Improve Mobility 

Report to Congressional Committees

December 2014

GAO-15-158

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-15-158, a report to 

congressional committees

December 2014

TRANSPORTATION FOR OLDER ADULTS

Measuring Results Could Help Determine If

Coordination Efforts Improve Mobility

Why GAO Did This Study

As the U.S. population ages, access to 

safe and reliable transportation 

alternatives is critical to helping older 

adults remain in their homes as long as 

possible. HHS, DOT, VA, and other 

federal agencies may provide funds to 

state and local entities to help older 

adults access transportation. GAO was

asked to review access to 

transportation services for older adults. 

This report examines (1) the federal

programs that provide funding for 

transportation services for older adults 

and the extent to which the programs 

that fund these services are 

coordinated, and (2) how state and 

local transportation agencies and aging 

network organizations in selected 

states coordinate transportation for 

older adults and the challenges they 

face in coordinating or providing these 

services. GAO reviewed past work on

programs for transportationdisadvantaged populations, reviewed 

federal program information, and

conducted interviews with HHS, DOT, 

and VA, as well as, state and local 

transportation agencies and aging 

organizations in selected states. GAO 

selected four states based on 

populations of older adults, federal 

funding received for transportation, and 

geography, among other factors.

What GAO Recommends

GAO recommends that DOT define 

and report on desired outcomes and 

collect related data to track and 

measure progress in achieving results, 

including the extent of coordination 

efforts under way. DOT partially 

concurred with the recommendation 

and plans to consider what information 

may be needed to measure and 

evaluate ongoing coordination efforts.

What GAO Found

Two key federal programs and several other programs identified by GAO provide 

funding for transportation services for older adults. The Administration on Aging

(AoA) within the Department of Health and Human Services (HHS) provides 

funding for supportive services—including transportation—to state and local 

agencies exclusively for older adults. Within the Department of Transportation 

(DOT), the Federal Transit Administration’s (FTA) Enhanced Mobility of Seniors 

and Individuals with Disabilities program is focused on improving the mobility of 

older adults as one of its two primary populations. Other federal agency 

programs, including some within the Department of Veterans Affairs (VA), can 

fund access to transportation services for eligible older adults, among other 

beneficiaries. The Interagency Coordinating Council on Access and Mobility 

(Coordinating Council) is responsible for leading federal efforts to improve the 

efficiency and effectiveness of human service transportation by coordinating

related programs. Federal agencies’ involvement in the council and its activities 

varies, with coordination on older adult transportation primarily occurring between 

AoA and FTA through working groups, initiatives, and technical assistance 

efforts. While some federal coordination activities are ongoing, current efforts do 

not identify desired outcomes, a key feature GAO has identified to consider when 

implementing interagency collaborative mechanisms. Specifically, the 

Coordinating Council’s latest strategic plan, which covers the period 2011 to 

2013, lacks clearly defined outcomes and measures to track progress toward 

those outcomes. Without defined outcomes and a clear method to collect data to 

monitor progress, it is difficult to determine whether current efforts of the council

are achieving their intended results and providing the benefits of coordination, 

such as improved access to transportation, for older adults. In a concurrent 

report (GAO-15-110), GAO is recommending that the council update its plan.

State and local transportation agencies and aging organizations in the four states

GAO visited used a variety of mechanisms to coordinate transportation services 

for older adults. For example, many state and local activities are currently 

focused on mobility management approaches—such as travel training 

programs—to help older adults identify and access the various transportation 

resources available. Some organizations GAO interviewed have also 

implemented more extensive approaches to coordination that are intended to 

help older adults access transportation services, such as offering a wide range of 

volunteer transportation. For example, Ride Connection—a transportation 

provider operating in Oregon—relies heavily on volunteers and service partners 

to provide over 400,000 rides a year to older adults and others, through travel 

training, community shuttles, and other programs. However, funding eligibility 

and reporting requirements for different programs, geographic boundaries, and 

limited data on the extent of need were identified as challenges that, at the state 

and local level, may inhibit coordination in the selected states. For example, 

officials in all four of the selected states noted that rural areas often have very 

few transportation options available to serve older adults and other residents, 

particularly for social and recreational outings. Examples from the selected states 

also suggest that funding for these types of life-enhancing activities may be

limited as states prioritize their funding to ensure life-sustaining trips, such as 

medical and nutrition services, are provided.

View GAO-15-158. For more information, 

contact David J. Wise at (202) 512-2834 or 

wised@gao.gov.
Page i GAO-15-158 Older Adult Transportation

Letter 1

Background 5

Transportation Funding Flows to Older Adults through Key 

Federal Programs, but Outcomes of Coordination Efforts Are 

Not Measured 10

State and Local Transportation Agencies and Aging Network 

Organizations Coordinate in Various Ways, but Challenges 

Continue 19

Conclusions 27

Recommendation 28

Agency Comments and Our Evaluation 28

Appendix I Objectives, Scope, and Methodology 30

Appendix II Identified Programs from the Department of Health and Human 

Services, Department of Transportation, and Department of Veterans 

Affairs That Fund or Provide Transportation for Older Adults 35

Appendix III GAO Contact and Staff Acknowledgments 38

Tables

Table 1: Older Americans Act Title III Part B Transportation 

Spending and Rides 2010 through 2012 (Spending and 

Rides in Millions) 12

Table 2: Types of State and Local Transportation Coordination 

Efforts GAO Identified 20

Table 3: State and Local Interviews 33

Figure

Figure 1: Custom Ride Solution Bus 24

Contents
Page ii GAO-15-158 Older Adult Transportation

Abbreviations

AAA area agencies on aging

ACL Administration for Community Living

ADA Americans with Disabilities Act

AoA Administration on Aging

CMS Centers for Medicare & Medicaid Services

Coordinating Council Interagency Coordinating Council on 

Access and Mobility

DOT Department of Transportation

Enhanced Mobility program Enhanced Mobility of Seniors and 

Individuals with Disabilities program

FTA Federal Transit Administration

HHS Department of Health and Human Services

MAP-21 The Moving Ahead for Progress in the 

21st Century Act

NEMT nonemergency medical transportation

OAA Older Americans Act of 1965

Project ACTION Easter Seals Project ACTION

VA Department of Veterans Affairs

VTCLI Veterans Transportation and Community 

Living Initiative

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Page 1 GAO-15-158 Older Adult Transportation

441 G St. N.W.

Washington, DC 20548

December 10, 2014

The Honorable Tom Harkin

Chairman

The Honorable Lamar Alexander

Ranking Member

Committee on Health, Education, Labor, and Pensions

United States Senate

The Honorable Bill Nelson

Chairman

The Honorable Susan M. Collins

Ranking Member

Special Committee on Aging

United States Senate

As the U.S. population ages, transportation is a service that is critical to 

helping older adults remain in their homes as long as possible. Although 

many older adults continue to rely on personal vehicles as their primary 

mode of travel, older adults are also increasingly using public and private 

transportation options to access a range of services. Older adults who are 

no longer able to drive rely on these transportation options for health and 

medical appointments, grocery shopping, social events, and other lifesustaining and life-enhancing activities. In addition, as people age, their 

physical, visual, and cognitive abilities may decline, making it more 

difficult for them to drive safely. A decline in mobility can severely 

decrease an older person’s quality of life, leading to issues such as fewer 

out-of-home activities, increases in health and nutrition problems, and 

isolation. With the older adult population projected to increase from 40 

million in 2010 to 72 million in 2030, having access to safe and reliable 

transportation alternatives can help this growing population age in place, 

particularly for those older adults who may face additional mobility 

challenges.1

 1

There is no standard definition of older adults. For the purposes of this report, we are 

defining older adults as those 65 years and above, as many federal programs that target 

seniors provide funding for services for those 65 and above. While the Older Americans 

Act of 1965, as amended, provides funding for eligible services for those 60 years and 

above, other federal programs targeting seniors provide funding for services for those 65 

and above.
Page 2 GAO-15-158 Older Adult Transportation

Federal agencies, including the Departments of Health and Human 

Services (HHS), Transportation (DOT), and Veterans Affairs (VA) play an 

important role in helping older adults access transportation services and 

increase their mobility options. In particular, these agencies administer 

programs that provide funds for a range of transportation services to state 

and local grantees that, in turn, offer transportation services either directly 

or through private or public transportation providers.2 State and local 

governments also provide substantial funding for programs providing 

transportation for older adults, and these entities, along with public or 

private providers, administer services at the local level. For example, 

federal program grantees may include state units on aging and local area 

agencies on aging (AAA), commonly referred to as the aging services 

network. Transportation services may be provided by contracting with 

private transportation providers or providing transit passes, taxi vouchers, 

or mileage reimbursement to program participants, or some combination 

of these methods. However, fiscal constraints at the national, state, and 

local levels may limit the funds that are available to provide transportation 

services to the growing population of older adults. We have previously 

found that people in need of transportation often benefit from greater and 

higher quality of services when transportation providers coordinate their 

operations.3

You asked us to review access to transportation services for older adults. 

This report examines (1) the federal programs that provide funding for 

transportation services for older adults and the extent to which the 

programs that fund these services are coordinated, and (2) how state and 

local transportation agencies and aging network organizations in selected 

states coordinate transportation for older adults and the challenges they 

face in coordinating or providing these services.

Additionally, federal coordination can lead to economic 

benefits, such as funding flexibility, reduced costs, or greater efficiency.

To identify federal programs that provide funding for transportation 

services for older adults, we reviewed our 2012 report on transportationdisadvantaged populations, which identified federal programs that provide 

 2

Some federal programs, such as those administered by VA, may provide transportation 

services directly to beneficiaries, as opposed to providing funds to state and local 

agencies to provide these services. 

3

GAO, Transportation Coordination: Benefits and Barriers Exist, and Planning Efforts 

Progress Slowly, GAO/RCED-00-1 (Washington, D.C.: Oct. 22, 1999). 
Page 3 GAO-15-158 Older Adult Transportation

funding for older adults, among other transportation services,4 and a 2013 

AARP report that identified federal programs that provide funding for older 

adults.5 In addition, we conducted a search of the Catalog of Federal 

Domestic Assistance.

6 We limited our scope to member agencies of the 

Interagency Coordinating Council on Access and Mobility (Coordinating 

Council).7 Through these reviews, we identified three primary federal 

agencies (HHS, DOT, and VA) that administer programs that provide 

funds to older adults where transportation is an eligible expense or that 

target older adults among the eligible recipients for transportation funds. 

Other federal agencies may also have programs that provide funding for 

transportation for older adults. However, we did not systematically identify 

every program government-wide that could provide such funding as part 

of this review.8

 4

Transportation-disadvantaged populations include those who are elderly, have 

disabilities, or have low incomes and are unable to provide their own transportation or 

have difficulty accessing public transportation. GAO, Transportation-Disadvantaged 

Populations: Federal Coordination Efforts Could Be Further Strengthened,

We also asked federal program officials from the three 

agencies to review and verify the programs identified and the program 

information collected, including if transportation for older adults was an 

GAO-12-647

(Washington, D.C.: June 20, 2012).

5

AARP, Weaving it Together: A Tapestry of Transportation Funding for Older Adults

(Washington, D.C.: April 2013). The AARP Public Policy Institute provides public policy 

research, analysis and development focusing on a wide range of issues of concern to 

older Americans, from Social Security and Medicare to health reform, livable communities, 

consumer protection, long-term care, care-giving, financial security and more.

6

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 nonfinancial assistance programs 

administered by departments and establishments of the federal government.

7

Member agencies of the Coordinating Council are the Department of Agriculture, 

Department of Education, Department of the Interior, Department of Justice, Department 

of Labor, DOT, HHS, Department of Housing and Urban Development, National Council 

on Disability, Social Security Administration, and VA. 

8

Although we obtained Medicaid program and funding information from the Centers for 

Medicare & Medicaid Services, we did not focus on Medicaid coverage of nonemergency 

medical transportation (NEMT) in this review because issues related to the coordination of 

NEMT services are covered in a parallel GAO report, issued concurrently with this report. 

See GAO, Transportation Disadvantaged Populations: Nonemergency Medical 

Transportation Not Well Coordinated, and Additional Federal Leadership Needed, 

GAO-15-110 (Washington, D.C., Dec.10, 2014). In contrast to this report, which focuses 

on transportation for older adults, GAO-15-110 focuses on NEMT programs that benefit all 

eligible populations, including older adults, persons with disabilities, veterans, low-income 

individuals, and children.
Page 4 GAO-15-158 Older Adult Transportation

allowable use of program funds, and program spending or obligations for 

fiscal year 2013. Agency officials provided requested spending and 

obligation data when available, but we did not independently verify the 

data provided. To determine the extent to which these programs are 

coordinated, we reviewed policy and other guidance established to 

promote coordination of transportation services at the federal level and 

interviewed officials from HHS, DOT, and VA about the level of 

interagency coordination on transportation for older adults. We also 

reviewed Coordinating Council documents, such as its 2011 to 2013 

strategic plan and progress report on recommended actions for human 

service transportation coordination. We interviewed staff from federal 

technical assistance centers, university researchers, and stakeholder 

groups involved in transportation coordination efforts about federal 

coordination of services to meet the transportation needs of older adults. 

We also compared coordination efforts against leading practices GAO 

has identified for successful interagency collaboration and collaborative 

mechanisms, such as interagency groups and councils.9

To determine how selected state and local transportation agencies and 

aging network organizations coordinate transportation for older adults and 

the challenges they face in coordinating or providing these services, we 

conducted site visits in four states—Florida, Oregon, Pennsylvania, and 

Texas—to discuss the coordination of transportation services between 

transportation and aging network organizations. In particular, we 

interviewed officials from state and area agencies on aging, state 

transportation departments, metropolitan planning organizations, VA 

medical centers, and local transit providers about how they coordinate 

transportation services for older adults, challenges to providing and 

coordinating services, and any gaps in the current services provided. We 

selected these four states as they were among those with the greatest 

overall population of and the largest proportion of older adults and 

received the largest amounts of DOT funding for transportation services 

that can be used for older adults; within those states, we identified and 

visited metropolitan areas that provided transportation services to older 

 9

GAO, Managing for Results: Key Considerations for Implementing Interagency 

Collaborative Mechanisms, GAO-12-1022 (Washington, D.C.: Sept. 27, 2012). For this 

report, to identify the range of interagency collaborative mechanisms, as well as key 

issues for Congress and others to consider when implementing them, we interviewed 

experts in the field of collaboration and conducted detailed analysis of 45 GAO reports, 

published between 2005 and 2012. See the scope and methodology in GAO-12-1022 for 

additional details. 
Page 5 GAO-15-158 Older Adult Transportation

adults in both urban and rural portions of the states. Information obtained 

in the site visits is not generalizable to other states that coordinate 

transportation services for older adults. In addition, we interviewed federal 

agency officials within HHS, DOT, and VA as well as staff from the federal 

technical assistance centers about the challenges to coordination at the 

state and local levels. See appendix I for additional details on our scope 

and methodology.

We conducted this performance audit from March 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.

Older adults are considered among the transportation-disadvantaged 

population, or those millions of Americans who are unable to provide their 

own transportation or have difficulty accessing public transportation 

because of age, disability, or income. The total number of transportationdisadvantaged older adults is unknown, and groups of transit dependent 

riders can overlap because some older adults may also be disabled or 

low income, or both. However, the older adult population is growing more 

rapidly than any other age group in the United States. Specifically, 

according to 2010 U.S. Census data, the population aged 65 and older 

grew 15 percent from 2000 to 2010, compared to about a 10 percent 

growth in the overall population, and by 2030, older adults are expected 

to comprise about 20 percent of the overall population. In 2012, the 

estimated population of veterans 65 and older was 9.6 million. Although 

about 83 percent of older adults are licensed drivers, approximately 20 

percent of older adults no longer drive, according to the Federal Highway 

Administration’s 2009 National Household Travel Survey.10

A range of mobility options can allow older adults to maintain their 

independence and age in place in their communities. For example, for 

those older adults who no longer drive, some may walk, bike, or use 

 10AARP Public Policy Institute, How the Travel Patterns of Older Adults are Changing: 

Highlights from the 2009 National Household Travel Survey, Fact Sheet 218 (Washington, 

D.C.: April 2011).

Background
Page 6 GAO-15-158 Older Adult Transportation

public transportation to meet their mobility needs. Others, including those 

with disabilities, may require more specialized transportation, such as 

paratransit in order to access services. According to 2010 U.S. Census 

data, 50 percent of adults 65 and older had a disability. Paratransit 

service, broadly defined, is accessible, origin-to-destination transportation 

service that operates in response to calls or requests from riders. It is an 

alternative to fixed-route transit service, which operates according to 

regular schedules along prescribed routes with designated stops.11

The Older Americans Act of 1965 (OAA) was enacted to provide services 

to older adults to help them remain in their homes and communities for as 

long as possible.12 In particular, Title III of the OAA, as amended, 

authorizes federal funding for a variety of home- and community-based 

supportive services that allow older adults to maintain independence. For 

example, Part B of Title III provides funding for a variety of supportive 

services, including transportation for older adults with and without mobility 

impairments.13

Collectively, the aging services network is comprised of 56 state units on 

aging operated by various government agencies; 618 AAAs, which may 

In fiscal year 2014, about $1.2 billion in Title III grants 

were provided to states, of which $344 million were grants for supportive 

services. The OAA, as amended, established the Administration on Aging 

(AoA) within HHS as the chief federal advocate for older Americans and 

assigned responsibility for home- and community-based services to AoA. 

In 2012, HHS established the Administration for Community Living (ACL), 

which brought together AoA, the Office on Disability, and the 

Administration on Developmental Disabilities—within HHS—to better 

align the federal programs that address the community living service and 

support needs of both the aging and disability populations, among other 

things. AoA distributes funding through grants to state units on aging, 

which allocate these funds to AAAs that either directly provide services, 

or contract with local service providers.

 11Paratransit service is defined in DOT regulations as “comparable transportation service 

required by the Americans with Disabilities Act for individuals with disabilities who are 

unable to use fixed route transportation systems.” 49 C.F.R. § 37.3. See also GAO, ADA 

Paratransit Services: Demand Has Increased, but Little is Known about Compliance, 

GAO-13-17 (Washington, D.C.: Nov. 15, 2012).

1242 U.S.C. §§ 3001 and 3003. 

1342 U.S.C. § 3030d.
Page 7 GAO-15-158 Older Adult Transportation

include private nonprofit and government organizations; 244 tribal and 

Native American organizations; and 2 organizations serving Native 

Hawaiians.14 Nearly 20,000 local organizations provide services through 

this network. The state units on aging and AAAs are responsible for the 

planning, development, and coordination of an array of home- and 

community-based services within each state.15 In particular, the OAA 

requires state units on aging to submit plans to the AoA for 2, 3, or 4 

years.16 Among other types of information, the plans must evaluate older 

adults’ needs for home- and community-based services, which may 

include transportation. In addition, the OAA requires that state units on 

aging develop a standardized process to determine the extent to which 

public or private resources (including volunteers and programs and 

services of voluntary organizations) are capable of meeting needs.17

Within DOT, the Federal Transit Administration (FTA) is a key source of 

transportation funding and technical assistance for state and local entities 

and transportation providers. In particular, FTA’s Enhanced Mobility of 

Seniors and Individuals with Disabilities program (Enhanced Mobility 

program)—authorized at approximately $258 million for fiscal year 

201418

 14The 56 state agencies include the 50 states, the District of Columbia, Puerto Rico, 

American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. 

—provides formula funding to states to serve the special needs of 

transit-dependent populations beyond traditional public-transportation 

services. The Moving Ahead for Progress in the 21st Century Act (MAP21) of 2012 expanded the eligibility of the Enhanced Mobility program to 

15These home- and community-based services are available to all individuals age 60 and 

older, though delivery is targeted to the most vulnerable. 

1642 U.S.C. § 3027(a). 

17We reported in 2011 that AoA does not provide standardized definitions or 

measurement procedures for need and unmet need that all states are required to use. 

Therefore, we recommended that HHS develop consistent definitions of need and unmet 

need and propose interim and long-term uniform data collection procedures for obtaining 

information on older adults with unmet needs for services provided to them from sources 

like Title III. In response, HHS has reported that in 2014, ACL would begin a multi-year 

process to review and revise OAA program reporting, to include discussions regarding 

ways to measure need and unmet need for services. GAO, Older Americans Act: More 

Should Be Done to Measure the Extent of Unmet Need for Services, GAO-11-237

(Washington, D.C.: Feb. 28, 2011).

18MAP-21, Pub. L. No. 112-141, § 20028, 126 Stat. 405, 726, codified at 49 U.S.C. § 5338 

(a)(2)(D).
Page 8 GAO-15-158 Older Adult Transportation

include activities previously eligible under the New Freedom program and 

to public transportation projects that improve access to fixed-route service 

and decrease reliance by individuals with disabilities on complementary 

paratransit. In particular, Enhanced Mobility program funds can be used 

for capital planning and operations: 55 percent of all allocations for each 

grant recipient must be used for public transportation projects where 

traditional services are unavailable, inappropriate, or insufficient, while the 

remaining 45 percent can be used for other eligible services, including 

capital and operating expenses and projects previously eligible under the 

New Freedom program.19

The Enhanced Mobility program requires grantees to develop coordinated 

public transit-human services plans.

States typically distribute these funds to local 

nonprofit human service agencies to buy vehicles that transport older 

adults and people with disabilities, and the agencies funded may provide 

transportation to support a range of activities, such as visiting friends.

20

Other federal agencies, including HHS’s Centers for Medicare & Medicaid 

Services (CMS) and VA, also provide federal funding for transportation 

services for older adults, among other eligible recipients. For example, 

Medicaid is a joint federal-state health financing program for certain low 

The plan must undergo a 

development and approval process that includes seniors, people with 

disabilities, and transportation providers, among others, and is 

coordinated to the maximum extent possible with transportation services 

assisted by other federal departments and agencies. The program also 

allows other federal non-DOT funds, such as Title III Part B funds, to be 

used as matching funds in order to better meet the transportation needs 

of older adults and promote federal coordination.

 19MAP-21, Pub. L. No. 112-141 § 20009, 126 Stat., 675-680, codified at 49 U.S.C. § 

5310, consolidated DOT’s Elderly Individuals and Individuals with Disabilities program and 

New Freedom program into the Enhanced Mobility of Seniors and Individuals with 

Disabilities program. The New Freedom program was a formula grant program that, 

among other things, provided funding for capital and operating expenses that supported 

new public transportation services beyond those required by the Americans with 

Disabilities Act of 1990. Among other things, the Enhanced Mobility program provides for 

the apportionment of funds for urbanized and rural areas based on population distribution 

of seniors and individuals with disabilities.

20Human-service transportation refers to transportation services provided by or on behalf 

of a human service agency to provide access to agency services and to meet the basic, 

day-to-day mobility needs of transportation-disadvantaged populations, especially 

individuals with disabilities, seniors, and people with low incomes.
Page 9 GAO-15-158 Older Adult Transportation

income individuals. Medicaid programs, which are administered by each 

state subject to the oversight of CMS, are required to assure that program 

beneficiaries—such as low-income children, people with disabilities, and 

older adults, among others—have access to necessary Medicaid 

providers when the beneficiaries cannot transport themselves to these 

providers. Under federal regulations, VA also provides transportation to 

medical services for those veterans who have service connected injuries 

or disabilities and meet certain eligibility criteria.

Our past work on transportation-disadvantaged populations has found 

that federal coordination has the potential to reduce federal transportation 

program costs by clustering passengers; using fewer one-way trips; and 

sharing the use of personnel, equipment, and facilities.21 Federal efforts 

to coordinate transportation for the disadvantaged, including older adults, 

began in 1986 when DOT and HHS formed what is now known as the 

Coordinating Council. The Coordinating Council is chaired by the 

Secretary of Transportation and is charged with improving 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.22 In 2003, the Coordinating 

Council launched the “United We Ride” initiative to act as a forum for 

interagency communication and to help states and communities 

overcome obstacles to coordination. The Coordinating Council’s actions 

have included issuing publications such as policy statements and 

progress reports on efforts taken. However, our June 2012 report on 

transportation-disadvantaged populations concluded that insufficient 

federal leadership and a lack of guidance for furthering collaborative 

efforts might hinder coordination efforts among state and local 

providers.23

 21

To promote and enhance federal coordination efforts, we 

therefore recommended in 2012 that the Secretary of Transportation, as 

the Chair of the Coordinating Council, along with the council’s 11 member 

agencies, should meet and complete and publish a strategic plan 

outlining agency roles and responsibilities and articulate a strategy to help 

strengthen interagency collaboration and communication. In response to 

GAO-12-647.

22The Coordinating Council underwent several name changes since it was formed, but for 

the purposes of this report, we will refer to it as the Coordinating Council throughout its 

existence. 

23GAO-12-647. 
Page 10 GAO-15-158 Older Adult Transportation

our recommendations, the Coordinating Council’s member agencies 

issued a strategic plan for 2011 to 2013, which established agency roles 

and responsibilities and identified a shared strategy to reinforce 

cooperation.

Our prior work has shown that coordination can lead to improved quality 

and cost-effectiveness of transportation-disadvantaged services. In 

addition, we have previously identified key features and issues to 

consider when federal agencies collaborate and implement collaborative 

mechanisms, such as an interagency group or council.24 These key 

features include defining outcomes; monitoring progress to show 

accountability; establishing clear leadership; and determining key 

resources, such as funding.25 For example, various approaches can help 

enhance and sustain collaboration among federal agencies, such as 

developing a plan to identify short- and long-term outcomes and tracking 

progress toward those outcomes.

 24GAO-12-1022 and GAO, Managing for Results: Implementation Approaches Used to 

Enhance Collaboration in Interagency Groups, GAO-14-220 (Washington, D.C: Feb. 14, 

2014). 

25GAO-14-220. This report is part of a series of reports under our mandate in the GPRA 

Modernization Act of 2010 (GPRAMA) to periodically examine how agencies are 

implementing the law and examined how select interagency groups 1) defined their 

outcomes, 2) measured performance and ensured accountability, 3) established 

leadership approaches, and 4) used resources, such as funding, staff, and technology.

GPRAMA established a new framework aimed at taking a more crosscutting and 

integrated approach to focusing on results and improving government performance.

Transportation 

Funding Flows to 

Older Adults through 

Key Federal 

Programs, but 

Outcomes of 

Coordination Efforts 

Are Not Measured
Page 11 GAO-15-158 Older Adult Transportation

We identified two key federal agency programs, AoA’s Title III Part B 

Supportive Services and FTA’s Enhanced Mobility program, and six other 

federal agency programs that can provide funding or transportation 

services for older adults. These eight identified programs are not an 

exhaustive list of all existing programs, but rather we focused on 

programs administered by the three primary Coordinating Council 

member agencies that provide transportation funding or services that may 

benefit older adults. Not all of the programs we identified focus solely on 

the older adult population. (For additional information on how we 

identified these, see appendix I. Also, see appendix II for the complete 

program list, including program descriptions.) In addition, as we reported 

in 2012, total federal spending on transportation services for 

transportation-disadvantaged populations is unknown because in many 

cases federal agencies do not separately track spending for these 

services.26

Of the eight federal programs we identified, the only programs that 

specifically provide funding exclusively for older adults were established 

in the OAA, which includes Title III Part B Supportive Services.

As such, transportation spending for older adults is also 

unknown because the funds are used to provide transportation services 

for a broader population.

27

Specifically, Title III Part B provides funds to 11 categories of supportive 

services for older adults, including transportation and assisted 

transportation.28

 26

According to HHS officials, transportation can include a 

range of services such as shared rides and public transportation access, 

while assisted transportation serves eligible older adults who have 

difficulties using regular vehicular transportation and involves providing 

assistance, such as an escort, to those adults. Because this program 

targets services for older adults—including transportation—spending 

information for that population is available, as states are required to 

annually report their Title III Part B spending across the different 

GAO-12-647.

27In addition, AoA’s Special Programs for Aging Title VI, Part A, Grants to Indian Tribes 

Part B, Grants to Native Hawaiians also provides grants to eligible Indian Tribal 

Organizations and private or nonprofit organizations serving Native Hawaiians for services 

comparable to those provided under Title III Part B—including transportation services. For 

more information on this program see appendix II.

28The 11 Title III Part B Supportive Services are: Personal Care, Homemaker, Case 

Management, Transportation, Information and Assistance, Adult Day Care/Health, Legal 

Assistance, Outreach, Chore, Assisted Transportation, and Other.

Transportation Funding 

Can Flow to Older Adults 

through Two Targeted 

Federal Programs and 

Several Other Federal 

Programs That Serve 

Broader Populations
Page 12 GAO-15-158 Older Adult Transportation

supportive services. In fiscal year 2012, states reported spending a total 

of $68.8 million on transportation and $3.3 million on assisted 

transportation.29 Overall, states reported spending a total of $330 million 

on supportive services in 2012, making transportation and assisted 

transportation about 22 percent of total reported expenditures. This is 

similar to what states have previously reported spending on these two 

supportive service categories from 2010 and 2011 (see table 1). In 

addition, AoA collects information on the number of transportation service 

rides provided through Title III Part B, as well as both the number of rides 

and people receiving assisted transportation services through their 

programs.30

Table 1: Older Americans Act Title III Part B Transportation Spending and Rides 2010 through 2012 (Spending and Rides in 

Millions)

Year

Reported 

transportation 

spending

Reported 

transportation rides 

provided

Reported assisted 

transportation 

spending

Reported assisted 

transportation rides 

provided

Number of reported 

individuals served by 

assisted 

transportation (in 

thousands)

2010 $69.1 25.9 $4.5 1.5 39,763

2011 $68.7 24.7 $4.2 1.2 32,526

2012 $68.8 24.5 $3.3 1.2 31,950

Source: GAO analysis of Administration for Community Living (ACL) data. | GAO-15-158

Note: ACL does not collect data on the number of individuals receiving transportation service through 

Title III Part B. It only collects data about the number of people receiving assisted transportation 

services through its programs. ACL data was state reported data provided from the National Aging 

Program Information System State Program Performance Report data.

FTA’s Enhanced Mobility program also targets older adults as one of its 

primary populations and is focused on improving the mobility of seniors 

and people with disabilities. According to FTA officials, the agency 

obligated about $180.6 million in Enhanced Mobility program funds in 

 29AoA data also include the District of Columbia and U.S. territories.

30The difference in reporting requirements may be in part due to the differences in the 

older adult populations served by the service. Older adults needing assisted transportation 

have mobility difficulties and may need more specialized transportation service, while 

many rides given through transportation services are shared rides or public transportation 

where the population served could vary from day to day.
Page 13 GAO-15-158 Older Adult Transportation

fiscal year 2013.31 FTA officials stated that they do not track the 

proportion of funds going to transportation projects and services for older 

adults versus those with disabilities, and said that in many cases, the 

project to be funded would benefit both populations by responding to the 

same functional needs, whether the need is derived from age or a 

disability. For example, the cost to ride in taxicabs that meet the 

Americans with Disabilities Act (ADA) accessibility requirements are an 

eligible expense under the Enhanced Mobility program. Accessible taxis 

offer communities flexibility, and cost savings, compared to traditional 

ADA paratransit service,32

The remaining programs within CMS and VA do not specifically target 

older adults, but provide funds for transportation services that qualified 

older adults could benefit from. These programs are primarily focused on 

nonemergency medical transportation (NEMT). Specifically, CMS’s 

programs such as Medicaid NEMT and 1915(c) Home and Community 

Based Services waiver programs can provide transportation to eligible 

older adults. The Medicaid program provided health services to NEMT 

eligible populations. For example, it provided service to more than 4.6-

million low-income seniors, compared to 11-million non-disabled adults, 

8.8-million individuals with disabilities, and more than 31-million 

children.

and can benefit older adults and persons with 

disabilities regardless of age.

33 In addition, VA programs, including Veteran’s Medical Care 

Benefits (Beneficiary Travel) and Veteran’s Transportation Program can 

benefit eligible older adult veterans. For example, in 2013, VA officials 

told us that the Beneficiary Travel program reimbursed approximately 5-

million claims for mileage costs totaling about $168 million to veterans 

aged 65 or older.

 31The obligations include little, if any, MAP-21 authorized funding given the changes made 

to the program; most of the obligated funds were carried over from the previous program 

authorized under the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A 

Legacy for Users.

32ADA paratransit broadly defined, is accessible, origin-to-destination transportation 

service that operates in response to calls or requests from riders. It is an alternative to 

fixed-route transit service.

33We discuss NEMT-related programs and examine issues related to NEMT coordination 

in greater detail in GAO-15-110.
Page 14 GAO-15-158 Older Adult Transportation

Federal agency involvement in the Coordinating Council varies, with 

coordination on older adult transportation primarily occurring between 

FTA and AoA, the two primary agencies involved in human services 

transportation planning activities. The Coordinating Council’s Executive 

Committee has not met since 2007, but Coordinating Council officials told 

us that the lack of meetings is not a sign of inactivity, as working groups 

comprised of staff-level program officials from some of the 11 member 

agencies have developed initiatives intended to further federal 

coordination efforts. According to Coordinating Council officials, working 

groups are activated in response to specific needs that arise for 

collaboration between partner agencies. For example, current working 

group initiatives have focused on mobility management tools, such as 

one-call one-click centers, to better connect transportation service 

providers and riders.34 In particular, Coordinating Council officials stated 

that the Health, Wellness and Transportation working group, which 

includes participation from DOT, VA, HHS, and the Department of Labor35

Coordinating Council officials identified two recent initiatives developed 

and currently being implemented by selected member agencies to 

facilitate transportation coordination for certain populations. The first 

initiative is the 2012 Research and Demonstration Program to Improve 

Coordinated Transportation Systems for People with Disabilities and 

Older Adults. This initiative was developed by ACL and FTA officials to 

empower people with disabilities and older adults to be actively involved 

in the design and implementation of coordinated transportation systems.

is the focal point for current coordination activities and has incorporated 

earlier initiatives, such as veterans transportation efforts, into this group.

36

 34One-call or one-click centers support human service and other specialized

transportation service by enabling customers to make one phone call or search one 

website to receive information about all transportation services available in their 

community, including service characteristics, eligibility criteria, and referrals for 

appropriate service providers.

It includes a Small Grants program to test replication of proven practices 

35The Emergency Preparedness working group is also active and includes participation 

from DOT and HHS.

36This research and demonstration program also included contributions from the 

Community Transportation Association of America, Easter Seals, and the National 

Association of Area Agencies for Aging—industry associations representing transportation 

providers, older adults, and people with disabilities, as well as the aging services network, 

respectively.

Federal Coordination 

Efforts Vary and Outcome 

Measures Are Not Clearly 

Identified or Tracked
Page 15 GAO-15-158 Older Adult Transportation

as well as new and innovative models for addressing the needs of older 

adults and those with disabilities.37 According to DOT officials, the Small 

Grants program was initially funded in fiscal year 2012 for $1 million, 

about $950,000 in fiscal year 2013, and $1 million in fiscal year 2014. The 

program has finished its first phase and is currently funding its second 

phase of grant projects. One such grant was awarded to Montgomery 

County, Maryland to help increase participation by older adults in a local 

transportation advisory committee, and to train high school and 

community college students to assist older adults and persons with 

disabilities in accessing and navigating public transportation systems. The 

second initiative was the Veterans Transportation and Community Living 

Initiative (VTCLI) grant, a coordinated effort by the Departments of 

Defense, HHS, Labor, DOT, and VA.38

Mobility management was also identified as an objective in the 

Coordinating Council’s 2011 to 2013 strategic plan, with an emphasis on 

increasing the use of cost-effective and efficient mobility management 

principles, in part by expanding training for state and local officials. 

According to Coordinating Council officials, FTA’s Enhanced Mobility 

program, which includes allowing mobility management as an eligible 

expense, provides opportunities for innovative programs and practices at 

the state and local level, such as helping support mobility manager 

positions or other mobility management tools. According to these officials, 

mobility managers are seen as a key position that can help connect the 

various stakeholders in a coordinated transportation system.

VTCLI grants were intended to 

help veterans and others identify and access locally available 

transportation services that connect them with work, education, health 

care, and other vital services in their communities. While the primary goal 

was to support veterans and military families, the grants are structured to 

fund transportation projects that will potentially benefit anyone living 

within the jurisdiction of a grant recipient—including older adults. 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.

 3742 U.S.C. § 1110.

3849 U.S.C. § 5339.
Page 16 GAO-15-158 Older Adult Transportation

In addition to supporting mobility management activities, the Coordinating 

Council’s strategic plan highlights the importance of providing technical 

assistance to support Coordinating Council coordination goals and 

strengthen state- and local-coordination efforts. Coordinating Council 

officials highlighted three national technical assistance centers that 

receive funding from FTA and are affiliated with other Coordinating 

Council agencies, and have been established to share coordination 

information and resources with state and local entities.

• Easter Seals Project ACTION (Project ACTION) provides technical 

assistance related to accessible community transportation for persons 

with disabilities and older adults through research, online training, and 

outreach efforts to individuals or communities. For example, a Project 

ACTION white paper for FTA on access to public transit found that 

increased coordination of healthcare and transportation programs can 

produce reduced costs, increased accessibility to transportation 

options, and more positive health outcomes for older adults and 

persons with disabilities.

• The National Center for Mobility Management provides support to 

FTA grantees, with a focus on direct technical assistance and sharing 

information with state and local entities.39 As a part of its efforts, the 

center is collecting data on transportation coordination plans and 

mobility management approaches from state and local providers for 

inclusion in a database and as case studies published on its 

website.40

• The National Center for Senior Transportation facilitates local 

partnerships that help provide transportation to older adults, 

administers grant programs, and provides information and technical 

assistance support to communities.

For example, the center has developed publications 

identifying promising practices in mobility management areas, 

including coordinated transportation planning and technology use in 

transportation coordination.

41

 39The National Center for Mobility Management is operated through a consortium of three 

national organizations—Project ACTION, the American Public Transit Association, and the 

Community Transportation Association of America.

FTA is the primary funding 

agency, and according to center officials, AoA has been a primary 

40http://nationalcenterformobilitymanagement.org/ncmm-products/. 

41The National Center for Senior Transportation is a partnership between Easter Seals 

and the National Association for Area Agencies on Aging—part of AoA’s aging network.
Page 17 GAO-15-158 Older Adult Transportation

partner in program development and activities. The center’s technical 

assistance activities have included administering a series of grants 

intended to encourage aging organizations and public and private 

transportation providers to involve older adults and people with 

disabilities in the public-transit planning process. For example, the 

center implemented a grant program under a cooperative agreement 

with FTA that focuses on person-centered mobility management. In 

2012, NCST awarded 9 grants totaling about $500,000 to local 

communities, which included grants to provide travel training and 

counseling on travel options for older adults.

We found that some agencies are more engaged in coordinating 

transportation for older adults than others. In particular, AoA and FTA 

have shown continuing coordination through Coordinating Council 

working groups, initiatives, and technical assistance efforts as described 

above. Both agencies also help facilitate coordination through their 

respective programs. Specifically, the planning requirements and funding 

flexibility in both the Title III Part B and the Enhanced Mobility programs 

help involve stakeholders and coordinate federal resources for human 

service transportation by, for example, allowing Title III Part B funds to be 

used as the non-federal match for Enhanced Mobility program funds. 

However other agencies, such as VA and CMS, have not been as active 

in federal coordination efforts that affect the transportationdisadvantaged. For example, the Coordinating Council’s activities have 

been limited to staff-level working group activities that do not involve all 

member agencies, and lack participation by key players, such as those 

primarily involved in NEMT. As we previously found, agencies can use 

their strategic plans as tools to drive collaboration with other agencies 

and partners by ensuring consistent and complementary goals and 

strategies.42 Our concurrent report related to the coordination of NEMT 

services recommended that the Council update its strategic plan, which 

covered the period from 2011 through 2013.43

 42GAO, Results-Oriented Government: Practices That Can Help Enhance and Sustain 

Collaboration among Federal Agencies, 

An updated strategic plan 

could be used to outline a strategy for coordinating NEMT across all 

federal agencies funding this type of service, which could benefit all 

transportation-disadvantaged populations, including older adults.

GAO-06-15 (Washington, D.C.: Oct. 21, 2005).

43Our concurrent report on NEMT issues will have a recommendation related to updating 

the strategic plan, which will benefit broader transportation-disadvantaged populations, 

including older adults. See GAO-15-110.
Page 18 GAO-15-158 Older Adult Transportation

In addition, current federal coordination efforts do not identify or 

incorporate clear short- and long-term desired outcomes, a key issue to 

consider when implementing interagency collaborative mechanisms to 

ensure participation from all member agencies.44 The Coordinating 

Council identified high-level strategies, related objectives, and proposed 

performance indicators supporting these objectives in the 2011 to 2013 

strategic plan as a guide for the council’s activities over the two-year 

period. However, the Coordinating Council did not clearly define desired 

outcomes, measures to track progress towards achieving its objectives, 

or timeframes for implementing its strategies and communicating results.

For example, the strategic plan identifies deploying mobility management 

as one of the objectives for implementing the strategy to expand 

coordinated human-service transportation infrastructure in order to 

improve the capacity of communities to deliver integrated transportation 

and improved customer service. The objective identifies action steps and 

performance indicators, including tracking the number of mobility 

managers and the number of mobility managers receiving training and 

technical assistance. However, according to Coordinating Council 

officials, no data associated with these indicators are currently being 

collected that would help the council determine whether its efforts to 

deploy mobility management are resulting in an increased use of costeffective and efficient mobility management principles in local 

communities. Additionally, because Coordinating Council officials said 

there are currently no plans to renew or revise the now-expired strategic 

plan, it is not clear which, if any, of the proposed objectives are applicable 

to current Coordinating Council activities or whether the performance 

indicators will be tracked. Coordinating Council officials said the 

objectives and performance indicators outlined in the strategic plan were 

intended to demonstrate potential outcomes and ways of measuring 

progress, and officials plan to explore specific measures and 

opportunities for data collection through the technical assistance centers 

in the future. However, the Coordinating Council has not yet established a 

specific time frame for doing so. We have previously found that 

monitoring and evaluating federal collaborative efforts to identify areas of 

improvement can help key decision makers within the agencies, as well 

as clients and stakeholders obtain feedback for improving both policy and 

operational effectiveness.45

 44

Without clearly defined outcomes and related 

GAO-14-220.

45GAO-06-15.
Page 19 GAO-15-158 Older Adult Transportation

performance measures, it is difficult to assess the effectiveness of 

activities related to transportation for older adults currently under way in 

improving mobility options and access to transportation services or to 

make decisions about future coordination efforts. Additionally, without a 

clear method to collect and track information and data to demonstrate 

progress, it is difficult to show the benefits of coordination, and whether 

current Coordinating Council efforts are achieving the outcomes intended 

to improve transportation coordination for transportation-disadvantaged 

populations, including older adults.

State and local transportation agencies and aging network organizations 

in the four states we selected used a variety of different mechanisms to 

coordinate transportation services for older adults. These mechanisms 

are similar to those we previously found are being used by a number of 

other regions, states, or localities for coordinating transportation.46

 46

In our 

selected states, they were also being used to help older adults access 

transportation services (see table 2). For example, state level 

coordination councils may be created by statute, executive order, or 

governor initiative to oversee coordinated transportation for 

transportation-disadvantaged populations within a given state. In addition, 

mobility management efforts—which include individual level education 

and counseling on transportation options and systems level coordination 

GAO-12-647. 

State and Local 

Transportation 

Agencies and

Aging Network 

Organizations 

Coordinate in Various 

Ways, but Challenges 

Continue

A Variety of State and 

Local Coordination Efforts 

Are Under Way
Page 20 GAO-15-158 Older Adult Transportation

among transportation and human service providers—are being promoted 

nationwide, including in our selected states.

Table 2: Types of State and Local Transportation Coordination Efforts GAO Identified

Coordination activity Description

State coordinating bodies Statewide coordinating bodies (often called councils) oversee the implementation of coordinated 

transportation. About half of the 50 states have created these bodies. Of the 4 states we selected, only 

Florida currently has a designated state-level coordinating body. Florida’s Commission for the 

Transportation Disadvantaged has a structured system with county-level community transportation 

coordinators, local advisory boards, and extensive stakeholder involvement from transportationdisadvantaged populations, including older adults.

Regional and local planning Regional councils typically bring together human service agencies and transportation organizations 

within a geographic region, and local councils bring together entities that provide transportation 

services to a wide variety of users. Three of our 4 selected states had regional task forces or similar 

mechanisms for bringing stakeholders together. For example, the North Central Texas Council of 

Governments—which serves a 16-county region, centered around Dallas and Fort Worth—facilitates 

communication across the counties that serve as the basis for the public transit-human service 

coordination plans. Officials told us they are currently working on establishing coordinating 

communities within each county. The council also includes the Area Agency on Aging of North Central 

Texas, representing 14 of the member counties by participating in social service coordination 

meetings and helping to coordinate older adults’ access to transit.

Mobility management Federal government efforts and many state and local activities are currently focused on mobility 

management approaches to help people identify and access transportation resources. While designed 

for the general public, mobility management may be particularly applicable to the aging population, 

where these approaches may help increase awareness of transportation options. These may include:

• One-call or one-click center: As previously discussed, FTA awarded $64 million in grants for the 

Veterans Transportation and Community Living Initiative program, which a number of recipients 

have used to develop one-call or one-click centers. For example, in Texas, the Dallas Area Rapid 

Transit is using this funding to help develop a web-based resource to help the public identify 

community transportation options.

• Mobility manager: Florida has a designated statewide mobility manger and a small number of 

county-level service providers, such as St. John’s Council on Aging, also have mobility manager 

positions. Mobility managers often provide individualized information, resources, and education to 

help riders plan trips and identify alternative transportation options.

• Travel training: Transit providers or closely affiliated groups help older adults understand a 

number of factors such as how to plan a ride and schedule rides, identify the routes, and plan for 

transfers. For example, both Dallas Area Rapid Transit and St. John’s Council on Aging have 

implemented travel-training programs to help older adults access transportation as part of their 

respective mobility-management efforts. According to a Transit Cooperative Research Program 

report, training in the skills needed to travel safely and independently using public transportation 

services, particularly fixed-route services, has the potential to maintain or increase older adults’

mobility.a 

Vehicle sharing Vehicle-sharing programs can allow an agency to provide transportation for clients of multiple 

programs or may allow a specific program to loan its vehicles to another organization for use by 

another program. One of our 4 selected states uses vehicle-sharing programs to help meet older 

adults’ transportation needs. Through Oregon’s Ride Connection, local public human service agencies 

make vehicles that they are not currently using available to other agencies and nonprofit groups to 

help maximize opportunities to serve community members. For example, vehicles have been made 

available for social events at a senior center. 
Page 21 GAO-15-158 Older Adult Transportation

Coordination activity Description

Dedicated state funding 

streams for older adult 

transportation

Some states have dedicated funding sources that can be used, in part, to meet the transportation 

needs of older adults. Three of our 4 selected states are using state dollars to provide transportation 

for older adults and other transportation-disadvantaged populations. In Pennsylvania, for example, 

state lottery funds are used for the Shared-Ride Program, which provides those 65 and older with 

shared-ride, demand-responsive transportation. Older adults or an approved third-party sponsor pay 

15 percent of the fare, and the state lottery proceeds administered by the Pennsylvania Department of 

Transportation are used to reimburse the provider up to 85 percent of the fare.

Source: GAO. | GAO-15-158

a

Transit Cooperative Research Program Report 168, Travel Training for Older Adults Part I: A 

Handbook ( Washington, D.C.: 2014).

Building from the efforts described above, some selected transportation 

and aging network organizations have implemented or are piloting more 

extensive or innovative approaches to coordination intended to help older 

adults access transportation services, such as offering a wide range of 

volunteer transportation and expanded mobility management services. 

For example, Ride Connection—a transportation provider operating in 

Oregon—relies heavily on volunteers and a network of service partners 

throughout the region to provide over 400,000 rides a year to older adults, 

people with disabilities, and those living in rural areas through a range of 

programs. These include travel training and coaches, community shuttles, 

a shared vehicle program, as well as fare assistance and relief programs.

According to Ride Connection officials, approximately two thirds of the 

organization’s 600 drivers are volunteers, and the officials view the 

volunteer model as an important component of helping older adults age in 

place. Transportation organizations in other areas of the country are also 

seeking to leverage volunteer networks. The Independent Transportation 

Network America, an organization created to help expand the range of 

services available to older adults needing transportation, has explored 

innovative approaches and a volunteer network specifically targeted at 

serving older adults. Founded in Maine, this organization has 26 affiliate 

locations nationwide, offering rides 24 hours a day, 7 days a week, for 

any purpose. As members, the individuals also have the option to trade in 

their vehicles in exchange for credits that can be used to pay for future 

rides. The Independent Transportation Network also provides doorthrough-door service to better meet the mobility needs of frail older 

adults.47

 47Door-through-door service helps passengers from the vehicle through the doors of their 

residences or destinations, and may include the service of the driver or an escort to 

physically assist the passenger if needed.
Page 22 GAO-15-158 Older Adult Transportation

All of the states we selected were also pursuing pilot projects to refine 

long-standing services or conducting research to better assess unmet 

needs and potential additional coordination mechanisms. For example, 

the Pennsylvania Department of Transportation and stakeholders, 

including AAA officials, have begun a pilot project to explore adjustments 

and alternative approaches for the state’s lottery-funded Shared-Ride 

program. In part, this is an effort to use stakeholder input to address 

issues with many counties’ inability to cover the full cost of the senior 

transportation service. Other selected states have engaged in research 

and assessments to better identify unmet needs and potential 

approaches for furthering coordination efforts among transportationdisadvantaged groups, including older adults. For example, officials at the 

Florida Commission for the Transportation Disadvantaged worked with 

academic researchers to define the unmet and latent travel demand to 

better understand the mobility needs of the transportation-disadvantaged 

population in the state.48

Some of the transportation agencies and aging network organizations we 

met with described examples of areas where existing coordination efforts 

have been particularly helpful, but data or information quantifying the 

effects of coordination are lacking. For example, officials involved in 

regional coordination efforts in Texas told us that standard performance 

measures may not adequately capture the complexity of successful 

transportation coordination efforts, and they are working on developing 

performance measures to help identify geographic service gaps, which 

they know are issues in the region. Generally, examples of the benefits of 

Oregon and Texas have also undertaken 

initiatives to further explore opportunities for increased coordination. Both 

states completed reports in 2013 that included recommendations for 

developing performance metrics and both reports highlighted the need to 

collect and share information on gaps in service and unmet need, efforts 

that officials in these states continue to pursue. For example, the Texas 

coordination report proposed that state and regional stakeholders 

collaborate to develop statewide performance indicators for 

demonstrating that individuals throughout the state have improved access 

to an effective and efficient network of public transportation services, 

especially for seniors and people with disabilities.

 48Latent or induced travel refers to trips that occur as a result of the transportation service 

that might not otherwise have been made absent that service. In general, these are new 

trips that are generated because a new travel option exists. 
Page 23 GAO-15-158 Older Adult Transportation

coordination in our selected states, including those below, were limited to 

anecdotal examples.

• Ride Solution officials in Florida noted their county-level coordinated 

system was designed to deliver any type of rider to any location—

serving the general public, human service agencies, and 

transportation-disadvantaged populations with the same fleet of 

vehicles. Ride Solution officials also designed their own vehicle, which 

can accommodate 5 wheelchairs, 25 passengers, and has a low floor 

feature eliminating the need for stairs, which can be difficult for older 

adults to navigate (see fig.1). According to Ride Solution officials, the 

overall level of coordination resulting from their deviated-route format 

combining different types of riders has enabled them to provide over 

double the trips than the state paratransit average for many years.49

• Others noted that coordination can help improve the logistics 

necessary for coordination by offering, for example, one shared call 

center and scheduling system. One Oregon transportation provider 

we met with, Lane Transit District, described operational efficiencies 

and benefits to the customer resulting from coordination. For example, 

this provider established a one-stop call center for human service 

transportation, which handles requests for transportation for a variety 

of programs including ADA paratransit, Medicaid NEMT, as well as 

senior and disabled services community transportation. According to 

officials, this simplified one-stop access to transportation breaks down 

what was once a complex administration of programs, putting 

individuals in direct contact with resources to help identify 

transportation options available to them.

 49Deviated-fixed routes allow for minor route deviations in response to passenger calls, a 

type of service typical in rural areas.
Page 24 GAO-15-158 Older Adult Transportation

Figure 1: Custom Ride Solution Bus

Note: This custom bus can accommodate wheelchairs and features a low floor, eliminating the need 

for stairs.

We identified funding eligibility and reporting requirements for different 

programs, geographic boundaries, and limited data on the extent of need 

given the growing population of older adults as challenges at the state 

and local levels that may inhibit coordination in our selected states.50

 50Many of the challenges identified in our selected states were similar to those we 

previously found related to coordinating transportation services for broader transportationdisadvantaged populations. See 

For 

example, a number of state and local officials in each of our four selected 

states told us that it is difficult to co-mingle funds from different federal 

funding streams because of eligibility requirements, including both 

programmatic requirements on how funds can be used (i.e., certain 

beneficiaries) as well as perceptions about how funds can be used within 

those requirements. We previously found there is a disconnect between 

GAO-12-647 and GAO, Public Transportation: Federal 

Role Key to Rural and Tribal Transit, GAO-14-589 (Washington, D.C.: June 24, 2014). 

Challenges May Inhibit 

Coordination and Make It 

Difficult to Meet Older 

Adults’ Needs
Page 25 GAO-15-158 Older Adult Transportation

transportation providers and human service agencies.51 In other words, 

transportation providers are generally focused on making transportation 

services available for a wide population, including the general public, 

older adults, and people with disabilities. In contrast, human service 

agencies are often focused on meeting the specific needs of a narrower 

population (i.e., an eligible program beneficiary). For example, a 

transportation provider we met with in Florida said there is a perception in

Northeast Florida, including the Jacksonville area, that OAA funding can 

only be used to provide a specific service, transporting older adults to 

congregate meal sites.52 These officials stressed that these perceptions 

need to be overcome so the region can pursue additional opportunities to 

coordinate transportation services and share resources. Similarly, in the 

locations we visited, VA officials were generally not involved in regional or 

local coordination efforts.53

Coordination among providers serving different geographic boundaries 

can be challenging in both rural and urban areas. Officials in Oregon and 

Florida identified transportation to medical centers in other counties as a 

transportation need. For example, transportation officials in Oregon told 

us that in areas outside the urban core or in more rural areas, a rider may 

need to access more than one transportation provider to make such a trip 

and cross county lines in order to access that service. This situation may 

be further complicated for older adults, because it can be more difficult to 

In Pennsylvania, for example, VA NEMT 

programs operate outside the coordinated transportation planning 

process. According to VA officials we met with, from the agency’s 

perspective, if veterans are not eligible for VA-provided NEMT, they are 

essentially on their own in finding transportation. In certain circumstances 

for a specific patient, VA officials may reach out to local entities to try to 

identify transportation alternatives, but the officials said there is no formal 

structure or process in place for this type of activity. Pittsburgh’s VA 

Medical Center currently does not participate in any type of coordination 

with non-VA transportation planning or human service-transportation 

coordination, according to Medical Center officials.

 51GAO-12-647.

52Congregate meals are meals served at group sites such as senior centers, schools, 

churches, or senior housing complexes and serve older adults’ social interaction needs, in 

addition to nutrition. 

53Our concurrent report on NEMT discusses issues related to the lack of Medicaid and VA 

NEMT involvement in transportation coordination efforts in more detail. See GAO-15-110. 
Page 26 GAO-15-158 Older Adult Transportation

physically manage transfers or long waits. In addition, available service 

days and hours may be limited in rural areas, further affecting older 

adults’ ability to access different types of activities.54

Another challenge that may hinder coordination is limited data on the 

extent of older adults’ transportation needs given the growing population 

of older adults. While recipients of Enhanced Mobility program funding 

are required to develop coordinated public transit-human service plans 

and aging network organizations are required to develop plans that 

include planned strategies and priorities to address the growing number 

of older adults, state and regional transportation and aging plans include 

limited systematically-collected data on unmet needs or projected future 

needs. For example, one selected state’s aging plan indicated that it does 

not have a formal needs-assessment process. According to the plan, 

other sources, such as focus groups and interviews with providers, 

helped identify transportation as a service need. Another plan we 

reviewed stated that satisfaction surveys and focus groups were used to 

help determine needs and ways in which services—including 

transportation—could be improved. AAA officials in Florida, Pennsylvania, 

and Oregon also told us there is very little concrete data identifying the 

extent of unmet transportation needs beyond anecdotal information, and 

there is no systematic data collection to identify unmet needs at the local 

level. As a result, limited data and information are available to help 

determine whether the coordination that is occurring is meeting additional 

needs or filling gaps in the provision of transportation services for older 

adults. For example, officials at an AAA in Florida explained that there is 

no repository of information for collecting data to identify the extent of all 

older adults’ needs, but noted that transportation is always raised as a 

major challenge in needs assessments and outreach conducted by the 

AAA.

Officials in all four of 

our selected states noted that rural areas often have very few 

transportation options available to serve older adults and other residents. 

For example, an AAA in rural Pennsylvania noted that the lack of 

transportation service options on Sundays has a direct impact on older 

adults’ ability to get to church, which can be a very important outing for 

some riders.

 54For additional information related to rural and tribal transit issues, see GAO-14-589.
Page 27 GAO-15-158 Older Adult Transportation

Older adults may require certain types of service to meet their specific 

mobility and daily living needs as illustrated by examples from the states 

and localities we visited. For example, an AAA in Pennsylvania discussed 

working with the primary transportation provider in the region to find ways 

to better meet older adults’ mobility needs. In this case, door-to-door 

transportation assistance is available, but the officials are interested in 

exploring opportunities to provide door-through-door service to better 

serve the older adult community. In addition, examples from our selected 

states suggest that transportation for life-sustaining needs in those states 

are being met (e.g., to access medical and nutrition services), but there is 

a significant gap in transportation for social and recreational purposes. As 

a transportation provider in Florida explained, demand for older adult 

rides in its service area always exceeds available funding, and there are 

limits on how the existing funds can be used. For example, the 

transportation provider prioritizes its state Transportation Disadvantaged 

Trust Fund dollars for life-sustaining activities, such as transportation to 

congregate meal sites or medical trip appointments. As a result, this 

provider stated that very little funding remains for social outings like going 

to church or shopping with friends, which officials noted are very 

important components to helping older adults age in place and remaining 

connected to their community.

As the population of older adults continues to grow, having access to a 

variety of transportation options is critical to ensure older adults’ access to 

health care, social and recreational events, and other instrumental 

activities of daily living. When flexible transportation services exist and 

are accessible, older adults can more comfortably age in place in their 

homes and communities for as long as possible. Furthermore, when 

these transportation operations are coordinated, older adults may benefit 

from improved and more cost-effective services. A number of federal 

agencies provide funding that can be used for transportation for older 

adults, and FTA and AoA have been coordinating and are involved in 

facilitating initiatives, such as technical assistance efforts and community 

grants, to help meet older adults’ mobility needs. However, federal 

coordination efforts by the Coordinating Council lack clear, desired 

outcomes for its current coordination activities. In addition, there are no 

efforts under way to collect performance data that could help the 

Coordinating Council and its member agencies better plan and execute 

coordination strategies to ensure that its efforts are resulting in improved 

mobility and access to transportation services for transportationdisadvantaged populations, including older adults. In particular, defining 

desired outcomes could help the Coordinating Council determine whether 

Conclusions
Page 28 GAO-15-158 Older Adult Transportation

its current activities are effective in facilitating coordination and help 

inform planning and decision-making about future coordination efforts.

Furthermore, tracking performance data on its activities will help the 

Coordinating Council demonstrate the benefits of coordination and 

encourage more widespread participation.

As we concluded in 2012, a comprehensive strategy that outlines goals 

and desired outcomes for federal coordination efforts is needed to ensure 

that relevant stakeholders are actively engaged and participating in 

coordination efforts.55 While the Coordinating Council developed a 

strategic plan for 2011 to 2013, it is now out of date, and little else is in 

place to provide overall strategic guidance for federal efforts to coordinate 

transportation for older adults. Coordinating Council officials said that 

there are no plans to update or renew the existing strategic plan. We 

continue to believe that a current strategic plan, as recommended in our 

concurrent report on NEMT, could enhance coordination and 

collaboration among the federal agencies that provide funding that can be 

used to meet older adults’ transportation needs.

To promote and enhance federal, state, and local 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 define and report on desired outcomes and 

collect related data to track and measure progress in achieving results, 

including the extent of coordination efforts that are under way, such as 

improved services for older adults. This effort could be conducted as a 

part of the Coordinating Council’s process to update its strategic plan, 

which we have also recommended in a concurrent report.56

We provided a draft of this report to DOT for review and comment. DOT 

partially concurred with our conclusions and recommendation in an email 

response. Specifically, DOT stated that the Coordinating Council’s

working groups and affiliated technical assistance centers have ongoing 

activities related to coordination. DOT also stated that FTA is developing 

a 2-year implementation strategy for the Coordinating Council and will 

 55GAO-12-647.

56See GAO-15-110. 

Recommendation

Agency Comments 

and Our Evaluation
Page 29 GAO-15-158 Older Adult Transportation

determine policy objectives and information that may be needed to 

measure progress and evaluate coordination efforts that are under way. 

While we agree that these are important steps toward improved 

coordination, we believe it is important that any framework FTA 

establishes for the Coordinating Council articulates clear, desired 

outcomes and measures that the Coordinating Council can use to collect 

data and assess the effectiveness of its coordination activities in 

improving access to and mobility options for transportation-disadvantaged 

populations, including older adults.

We also provided a draft of this report to VA and HHS for review and 

comment. VA commented that the agency welcomes opportunities to 

participate in additional coordination efforts and supports the 

establishment of performance measures among federal, state, and local 

agency coordination efforts. VA also commented that the agency’s 

priority for its transportation programs is to ensure timely access to 

medical care for veterans. HHS did not have any comments on the draft 

report.

We are sending copies of this report to the appropriate congressional 

committees and the Administrator of FTA, the Secretaries of the 

Department of Transportation, HHS, VA, and interested congressional 

committees. In addition, the report is available at no charge on GAO’s 

Web site at http://www.gao.gov.

If you or your staff members have any questions about this report, please 

contact me at (202) 512-2834 or wised@gao.gov. Contact points for our 

Offices 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.

David J. Wise

Director, Physical Infrastructure Issues
Appendix I: Objectives, Scope, and 

Methodology

Page 30 GAO-15-158 Older Adult Transportation

This report addresses the following questions:

1. What federal programs provide funding for transportation services for 

older adults, and to what extent are the programs that fund these 

services coordinated?

2. How do state and local transportation agencies and aging network 

organizations in selected states coordinate transportation for older 

adults and what challenges do they face in coordinating or providing 

these services?

To identify federal programs that provide funding for transportation 

services for older adults, we reviewed our 2012 report on transportationdisadvantaged populations, which identified federal programs that provide 

funding and services for transportation-disadvantaged populations, which 

includes older adults,1 a 2013 AARP report that that identified federal 

programs that provide funding for older adults,2 and conducted a search 

of the Catalog of Federal Domestic Assistance.

3 These programs may 

fund infrastructure-related costs for transportation or transportation 

services. We limited our scope to federal agencies that are members of 

the Interagency Coordinating Council on Access and Mobility 

(Coordinating Council)4 because these agencies were identified by 

executive order to participate in coordination.5

 1

Transportation-disadvantaged populations include those who are elderly, have 

disabilities, or have low incomes and are unable to provide their own transportation or 

have difficulty accessing public transportation. GAO, Transportation-Disadvantaged 

Populations: Federal Coordination Efforts Could Be Further Strengthened,

Through these reviews, we 

identified three primary federal agencies—the Departments of Health and 

GAO-12-647

(Washington, D.C.: June 20, 2012). 

2

AARP, Weaving it Together: A Tapestry of Transportation Funding for Older Adults

(Washington, D.C.: April 2013).

3 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 nonfinancial assistance programs 

administered by departments and establishments of the Federal government.

4

Member agencies of the Coordinating Council are the Department of Agriculture, 

Department of Education, Department of the Interior, Department of Justice, Department 

of Labor, Department of Transportation, Department of Health and Human Services, 

Department of Housing and Urban Development, National Council on Disability, Social 

Security Administration, and Department of Veterans Affairs. 

5

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

Appendix I: Objectives, Scope, and 

Methodology
Appendix I: Objectives, Scope, and 

Methodology

Page 31 GAO-15-158 Older Adult Transportation

Human Services (HHS), Transportation (DOT), and Veterans Affairs 

(VA)—that administer programs that provide funds to older adults where 

transportation is an eligible expense or that target older adults among the 

eligible recipients for transportation funds.6 Other federal agencies may 

also have programs that provide funding for transportation for older 

adults. However, we did not systematically identify every program 

government-wide that could provide such funding as part of this review.7

To determine the extent to which these federal programs are coordinated, 

we reviewed policy and other guidance established to promote 

coordination of transportation services at the federal level and interviewed 

officials from HHS, DOT, and VA about the level of interagency 

coordination on transportation for older adults. For example, we met with 

DOT agency officials involved with Coordinating Council activities. We 

also reviewed Coordinating Council documents, such as the 2011 to 2013 

strategic plan and the Council’s progress report on recommended actions 

for human service transportation coordination. We also interviewed 

officials from relevant stakeholder groups, academic researchers, and 

technical assistance centers, such as the National Association of Areas 

Agencies on Aging, AARP Public Policy Institute, Center for Urban 

Transportation Research at the University of South Florida, Easter Seals 

Project ACTION, the National Center for Senior Transportation, and the 

We subsequently asked federal program officials from the three agencies 

to review and verify the programs identified and the program information 

collected, including if transportation for older adults was an allowable use 

of program funds, and program spending or obligations for fiscal 2013. 

For HHS’s Title III B program we asked for spending data from fiscal year 

2010 to 2013. We also asked agency officials to include any relevant 

programs we may have missed in our search. Agency officials provided 

requested spending and obligation data when available, but we did not 

independently verify the data provided.

 6

We also initially identified HUD as a potential agency providing transportation services to 

older adults, but after further review the only program related to older adults has no 

transportation benefit. 

7

Although we obtained Medicaid program and funding information from the Centers for 

Medicare & Medicaid Services, we did not focus on Medicaid coverage of nonemergency 

medical transportation (NEMT) in this review. See GAO, Transportation Disadvantaged 

Populations: Nonemergency Medical Transportation Not Well Coordinated, and Additional 

Federal Leadership Needed, GAO-15-110 (Washington, D.C.: Dec. 10, 2014) for further 

information on NEMT coordination.
Appendix I: Objectives, Scope, and 

Methodology

Page 32 GAO-15-158 Older Adult Transportation

National Center for Mobility Management. In addition, we reviewed 

literature since 2009 on the coordination of transportation services for 

older adults, and interviewed staff from federal technical assistance 

centers and other stakeholder groups involved in transportation 

coordination efforts about federal coordination of services to meet the 

transportation needs of older adults. For example, we reviewed National 

Center for Senior Transportation grant programs and initiatives. We also 

compared coordination efforts against leading practices GAO has 

identified for successful interagency collaboration and collaborative 

mechanisms, such as interagency groups and councils.8

To determine how selected state and local transportation agencies and 

aging network organizations coordinate transportation for older adults and 

the challenges they face in coordinating or providing these services, we 

conducted site visits in four states—Florida, Oregon, Pennsylvania, and 

Texas—to discuss the coordination of transportation services between 

transportation agencies and aging network organizations. In particular, we 

interviewed officials from state and area agencies on aging, state 

transportation departments, metropolitan planning organizations, VA 

medical centers, and local transit providers about the coordination of 

transportation services for older adults, challenges to providing and 

coordinating services, and any gaps in the current services provided. We 

selected these four states as they were among those with the greatest 

overall population of and the largest proportion of older adults and 

received the largest amounts of DOT funding for transportation services 

that can be used for older adults. We also selected states with a mix of 

state coordination mandates and coordinating councils, and identified and 

visited metropolitan areas within the states that provided transportation 

services to older adults in both urban and rural portions of the states. 

Information obtained in the site visits is not generalizable to other states 

that coordinate transportation services for older adults. In addition, we 

interviewed federal agency officials within HHS, DOT, and VA as well as 

staff from the federal technical assistance centers about the challenges to 

coordination at the state and local levels. We also reviewed selected state 

 8

GAO, Managing for Results: Key Considerations for Implementing Interagency 

Collaborative Mechanisms, GAO-12-1022 (Washington, DC: Sept. 27, 2012). To identify 

the range of interagency collaborative mechanisms, as well as key issues for Congress 

and others to consider when implementing them, we interviewed experts in the field of 

collaboration and conducted detailed analysis of 45 GAO reports, published between 2005 

and 2012. See the scope and methodology in GAO-12-1022 for additional details. 
Appendix I: Objectives, Scope, and 

Methodology

Page 33 GAO-15-158 Older Adult Transportation

and local aging plans and local and regional transportation coordination 

plans for selected sites. Table 3 provides more detailed information about 

the state and local entities we interviewed.

Table 3: State and Local Interviews

State Organization Description

Florida Capital Region Transportation Planning Agency Regional metropolitan planning organization

Commission for the Transportation Disadvantaged State transportation coordinating body

Eldersource Area agency on aging

Florida Agency for Health Care Administration State health agency

Florida Department of Elder Affairs State unit on aging

Florida Department of Transportation State transportation department

Jacksonville Transportation Authority Local transportation provider

Lake City Veterans Affairs Medical Center Veterans Affairs Medical Center

North Florida Transportation Planning Organization Local transportation provider

Ride Solution Local transportation provider

St. Johns Council on Aging Area agency on aging and local transportation provider

Oregon Clackamas County Social Services Area agency on aging

Lane Transit District Local transportation provider

Oregon Department of Human Services, Aging, and People 

with Disabilities

State unit on aging

Oregon Health Authority State health agency

Oregon Department of Transportation State transportation department

Oregon Metro Regional metropolitan planning organization 

Portland Veterans Affairs Medical Center Veterans Affairs Medical Center

Ride Connection Local transportation provider

Tri-County Metropolitan Transportation District Local transportation provider

Pennsylvania Access Transportation Local transportation provider

Allegheny County Area Agency on Aging Area agency on aging

Allegheny County Department of Human Services Local health agency

Pennsylvania Department of Transportation State transportation department

Pennsylvania Agency on Aging State unit on aging

Pittsburgh Veterans Affairs Medical Center Veterans Affairs Medical Center

Port Authority of Allegheny County Local transportation provider

Southwestern Pennsylvania Area Agency on Aging Area agency on aging

Southwestern Pennsylvania Regional Commission Regional metropolitan planning organization

Texas Dallas Area Agency on Aging Area agency on aging

Dallas Area Rapid Transit Local transportation provider
Appendix I: Objectives, Scope, and 

Methodology

Page 34 GAO-15-158 Older Adult Transportation

State Organization Description

Dallas Veterans Affairs Medical Center Veterans Affairs Medical Center

Logisticare Local transportation provider

North Central Texas Council of Governments Regional metropolitan planning organization

STAR Transit Local transportation provider

TAPS Public Transit Local transportation provider

Texas Department of Aging and Disability Services State unit on aging

Texas Department of Transportation State transportation department

Texas Health and Human Services Commission State health agency

Source: GAO. | GAO-15-158

We conducted this performance audit from March 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.
Appendix II: Identified Programs from the 

Department of Health and Human Services, 

Department of Transportation, and Department 

of Veterans Affairs That Fund or Provide 

Transportation for Older Adults

Page 35 GAO-15-158 Older Adult Transportation

Program Title Agency

Legal 

authority

Target 

population

served Program description

Department of Health and Human Services

Special 

Programs for the 

Aging Title III 

Part B Grants for 

Supportive 

Services and 

Senior Centers

Administration 

for Community 

Living

Older 

Americans Act 

of 1965;

42 U.S.C. § 

3030d(a)(2)

Adults aged 

60 or older

Title III Part B is a formula grant program established in the 

Older Americans Act of 1965. Its purpose it to encourage 

state units on aging and area agencies on aging to 

concentrate resources to develop and implement 

comprehensive and coordinated community-based systems of 

service for older individuals via statewide planning and area 

planning and provision of supportive services. The program is 

intended to serve those aged 60 or older. There are a number 

of supportive services these funds can be applied to, including 

providing both transportation and assisted-transportation 

services. These funds are flexible and can be used for both 

medical and nonmedical transportation.

Special 

Programs for 

Aging Title VI, 

Part A, Grants to 

Indian Tribes 

Part B, Grants to 

Native Hawaiians

Administration 

for Community 

Living

Older 

Americans Act 

of 1965;

42 U.S.C. §§

3057, 3030d 

(a)(2)

Adults aged 

60 or older

Title VI Part A is a project grants program established in the 

Older Americans Act of 1965. Funds are available through 

grants to eligible Indian Tribal Organizations for services 

comparable to those provided under Title III. Services must 

include nutrition services and information and referral, and 

may include transportation and other services authorized 

under Title III. Grants also are available to private or nonprofit 

organizations having the capacity to provide services to older 

Native Hawaiians.

Medicaid 

Nonemergency 

Medical 

Transportation 

(NEMT)a

Centers for 

Medicare & 

Medicaid 

Services

Social Security 

Act: 42 U.S.C. 

§§ 1396a, 

1396n(e)(1)(A)

Eligible 

Medicaid 

beneficiaries

Federal law requires states to ensure that eligible Medicaid 

beneficiaries have transportation to and from health care 

services. The program is focused on those who cannot 

provide their own transportation to and from appointments. 

NEMT programs and ride scheduling procedures vary from 

state to state. Generally, beneficiaries must contact the 

Medicaid transportation provider in their area to arrange for 

rides. Medicaid NEMT rides can be provided through a 

number of methods such as through mass transit systems as 

well as taxis, cars, or vans.

1915 (c) Home 

and Community 

Based Services 

waivers for 

transportationb

Centers for 

Medicare & 

Medicaid 

Services 

Social Security 

Act: 42 U.S.C.

§ 1396n(c)(3)

Eligible 

Medicaid 

beneficiaries

The Medicaid Home and Community Based Services waiver 

program was authorized under Section 1915 (c) of the Social 

Security Act. Through this program, states can assist 

Medicaid beneficiaries by providing a wide array of services 

that permit them to live in their homes or community and 

avoid institutionalization in a nursing-home facility. Among the 

services that can be provided under the waiver are 

transportation services approved to help a beneficiary access 

a service that may not be a traditional Medicaid plan service.

Appendix II: Identified Programs from the 

Department of Health and Human Services, 

Department of Transportation, and 

Department of Veterans Affairs That Fund or 

Provide Transportation for Older Adults
Appendix II: Identified Programs from the 

Department of Health and Human Services, 

Department of Transportation, and Department 

of Veterans Affairs That Fund or Provide 

Transportation for Older Adults

Page 36 GAO-15-158 Older Adult Transportation

Program Title Agency

Legal 

authority

Target 

population

served Program description

Department of Transportationc

Enhanced 

Mobility of 

Seniors and 

Individuals with 

Disabilities

(Enhanced 

Mobility program)

Federal Transit 

Administration

Urban Mass 

Transportation 

Act of 1970; 49 

U.S.C. § 5310

Older adults 

and individuals 

with disabilities

The Enhanced Mobility program is a formula grant program 

established in 1975 to provide financial assistance in meeting 

the transportation needs of elderly persons and persons with 

disabilities where public transportation services are 

unavailable, insufficient, or inappropriate. Funds can be used 

for capital planning and operations. The Enhanced Mobility 

program is designed to supplement the Federal Transit 

Administration’s other capital assistance programs by funding 

transportation projects for elderly persons and persons with 

disabilities in all areas—urbanized, small urban, and rural. 

The program was renamed under the Moving Ahead for 

Progress in the 21st Century Act and modified to include New 

Freedom Program activities as eligible projects.

Department of Veterans Affairs (VA)

Veterans Medical 

Care Benefits 

(Beneficiary 

Travel)

VA Health 

Administration 

Center

Veterans 

Benefit Act of 

1957; 38 

U.S.C. § 111

Low-income 

and serviceconnected 

veterans and 

certain other 

special group 

beneficiaries

VA provides transportation funds and services to qualified 

veterans needing to access a VA medical facility. The 

program provides transportation through mileage 

reimbursement, purchase of transportation service contracts, 

or medically necessary specialized transportation.

Veterans 

Transportation 

Program 

(Veterans 

Transportation 

Service and 

Grants for 

Transportation in 

Highly Rural 

Areas )

VA Health 

Administration 

Center

Caregivers and 

Veterans 

Omnibus 

Health Services 

Act of 2010, 

Pub. L No. 111-

163 

Eligible 

veterans

VA provides grants to eligible recipients to assist veterans in 

highly rural counties through innovative transportation 

services to travel to VA Medical Centers, and to otherwise 

assist in providing transportation services in connection with 

the provision of VA medical care to these veterans.

VA Homeless 

Providers Grant 

and Per Diem 

Program

VA Health 

Administration 

Center

Homeless 

Veterans 

Comprehensive 

Service 

Programs Act 

of 1992, Pub. L 

No. 102-590; 

38 U.S.C. § 

7721 note

Homeless 

veterans

VA provides funding for housing and services in the 

community to help veterans out of homelessness.

Source: GAO analysis of agency and Catalog of Federal Domestic Assistance information. | GAO-15-158

a

Medicaid transportation for older adults is provided under the Nonemergency Medical Transportation 

program benefit.

b

The Centers for Medicare and Medicaid Services’ 1915 (c) Home an Community Based Services

waivers is a program within Medicaid. For the purposes of our report, as this is a program focused on 

assisting older adults in living independently and provides transportation funding and services, we 

have presented it separately from Medicaid NEMT.
Appendix II: Identified Programs from the 

Department of Health and Human Services, 

Department of Transportation, and Department 

of Veterans Affairs That Fund or Provide 

Transportation for Older Adults

Page 37 GAO-15-158 Older Adult Transportation

c

The Department of Transportation had other formula funding programs for transportation services, 

such as the Urbanized Area Formula program and formula grants for rural areas. These are general 

transit program funds that serve a number of populations, but they may also be applied to 

transportation for older adults.
Appendix III: GAO Contact and Staff 

Acknowledgments

Page 38 GAO-15-158 Older Adult Transportation

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

In addition to the individual named above, the following individuals made 

important contributions to this report: Lorelei St. James (Director), Nancy 

Lueke (Assistant Director), Lorraine Ettaro, Delwen Jones, Maria Wallace, 

Betsey Ward-Jenks, Cheryl Peterson, and Sarah Veale.

Appendix III: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments

(544205)
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