Transportation-Disadvantaged Populations: Federal Coordination Efforts Could Be Further Strengthened
Released: 2012-06-20T00:00:00


Highlights: section_title: Why GAO Did This Study
paragraphs: Millions of Americans are unable to provide their own transportation or have difficulty accessing public transportation. Such transportation-disadvantaged individuals may include those who are elderly, have disabilities, or have low incomes. The Departments of Education, Health and Human Services (HHS), Labor (DOL), Transportation (DOT), Veterans Affairs (VA), and other federal agencies may provide funds to state and local entities to help these individuals access human service programs. As requested, GAO examined (1) federal programs that may fund transportation services for the transportation disadvantaged; (2) federal coordination efforts undertaken since 2003; and (3) coordination at the state and local levels. GAO analyzed information from the Catalog of Federal Domestic Assistance; interviewed federal officials; and interviewed state and local officials in five states, chosen based on a variety of characteristics, including geographic diversity.

section_title: What GAO Found
paragraphs: Eighty federal programs are authorized to fund transportation services for the transportation disadvantaged, but transportation is not the primary mission of most of the programs GAO identified. Of these, the Department of Transportation administers 7 programs that support public transportation. The remaining 73 programs are administered by 7 other federal agencies and provide a variety of human services, such as job training, education, or medical care, which incorporate transportation as an eligible expense in support of program goals. Total federal spending on transportation services for the transportation disadvantaged remains unknown because, in many cases, federal departments do not separately track spending for these services. However, total funding for the 28 programs that do track or estimate transportation spending, including obligations and expenditures, was at least $11.8 billion in fiscal year 2010.

The interagency Coordinating Council on Access and Mobility, which the Secretary of Transportation chairs, has led governmentwide transportation coordination efforts since 2003. The Coordinating Council has undertaken a number of activities through its “United We Ride” initiative aimed at improving coordination at the federal level and providing assistance for state and local coordination. For example, its 2005 Report to the President on Human Service Transportation Coordination outlined collective and individual department actions and recommendations to decrease duplication, enhance efficiencies, and simplify access for consumers. Key challenges to federal interagency coordination efforts include a lack of activity at the leadership level of the Coordinating Council in recent years—the Coordinating Council leadership has not met since 2008—and the absence of key guidance documents for furthering agency coordination efforts. For example, the Coordinating Council lacks a strategic plan that contains agency roles and responsibilities, measurable outcomes, or required follow-up. GAO has previously reported that defining and articulating a common outcome and reinforcing agency accountability through agency plans and reports are important elements for agencies to enhance and sustain collaborative efforts.

State and local officials GAO interviewed use a variety of planning and service coordination efforts to serve the transportation disadvantaged. Efforts include state coordinating councils, regional and local planning, one-call centers, mobility managers, and vehicle sharing. For example, state coordinating councils provide a forum for federal, state, and local agencies to discuss and resolve problems related to the provision of transportation services to the transportation disadvantaged. In other examples, one-call centers can provide clients with transportation program information and referrals for appropriate service providers and mobility managers may serve many functions—as policy coordinators, operations service brokers, and customer travel navigators. However, state and local governments face several challenges in coordinating these services—including insufficient federal leadership, changes to state legislation and policies that may hamper coordination efforts, and limited financial resources in the face of growing disadvantaged populations.

section_title: What GAO Recommends
paragraphs: To promote and enhance federal, state, and local coordination activities, the Secretary of Transportation and the Coordinating Council should meet to (1) complete and publish a strategic plan; and (2) report on progress of recommendations made by the Council in its 2005 Report to the President and develop a plan to address outstanding recommendations. Education and VA agreed with GAO’s recommendations. HHS, DOL, DOT, and other federal agencies neither agreed nor disagreed with the report. Technical comments were incorporated as appropriate.

section_title: Letter
paragraphs: Access to transportation services is essential for millions of Americans to  participate fully in society and be able to access human services,  including health, education, and job training programs. However, many  individuals are unable to provide their own transportation or have difficulty  accessing public transportation due to their age, disability, or income  constraints. We have previously identified a myriad of federal programs  that are authorized to use federal funds for transportation services to  assist these “transportation-disadvantaged” individuals in accessing  human service programs.

Federal agencies, including the Departments of Agriculture (USDA),  Education, Health and Human Services (HHS), Housing and Urban  Development (HUD), Interior, Labor (DOL), Transportation (DOT), and  Veterans Affairs (VA), provide funds to state and local agencies that can  be used for transportation to help individuals access federal programs,  including education, employment, medical care, or other human  services. In March 2011, we reported that improved coordination of  these programs and the transportation services they provide has the  potential to improve the quality and cost-effectiveness of these services,  while also reducing duplication, overlap, and fragmentation of services.Coordination of transportation services can take many forms, including  information sharing among programs, pooling resources, and  consolidating trips provided by various agencies. In our 2011 report, we  found that additional action by federal departments was necessary to  better coordinate their programs and eliminate the potential for duplication  and fragmentation.

Given these concerns, you asked us to review (1) which federal programs  provide funding for transportation services for the transportation  disadvantaged; (2) what federal coordination efforts have been  undertaken since 2003 and what challenges remain; and (3) what types  of coordination have occurred at the state and local levels.

To identify the universe of federal programs that provide funding for  transportation services for the transportation disadvantaged, we  examined our prior work on the topic, conducted a search of the Catalog  of Federal Domestic Assistance, reviewed program information provided  by federal officials, and reviewed relevant federal laws governing the use  of federal funds for transportation services. To determine what federal  coordination efforts have taken place since 2003 and what challenges  remain, we conducted interviews with officials from eight federal  agencies—USDA, Education, HHS, HUD, Interior, DOL, DOT, and VA— and reviewed relevant documentation provided by agency officials. We  chose these agencies because they administered programs that were  authorized to provide funding for transportation services for the  transportation disadvantaged in fiscal year 2010 and were identified by  executive ordertransportation researchers and officials from relevant industry and  advocacy groups. To identify the types of coordination that have occurred  at the state and local level, we conducted interviews with state and local  officials from five states—Florida, Texas, Virginia, Washington, and  Wisconsin. We chose these states based on a variety of characteristics,  including target populations who use these services, existence of a state  coordinating body, and geographic diversity. As part of our site visit  interviews, we spoke with officials from state and local human service and  transportation agencies, metropolitan planning organizations,  transportation providers, and interest and advocacy groups. Appendix I  contains a more detailed discussion of our objectives, scope, and  methodology.   to participate in coordination. We also interviewed  We conducted this performance audit from June 2011 to June 2012 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.
subsections: section_title: Background
paragraphs: Transportation-disadvantaged populations, including those that cannot  provide their own transportation due to age, disability, or income  constraints, may face challenges in accessing transportation, such as  lack of access to public transportation or a private vehicle. For example,  according to a 2011 report by the National Council on Disability, people  with disabilities are more likely than people without disabilities to report  that they have inadequate transportation (34 percent versus 16 percent,  respectively). We have previously reported that people in need of  transportation often benefit from greater and higher quality services when  transportation providers coordinate their operations. In addition, we have  reported that 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.

Federal agencies, including USDA, Education, HHS, HUD, Interior, DOL,  DOT, and VA, play an important role in helping transportation- disadvantaged populations access federal programs by providing funds to  state and local grantees. Federal programs that provide funding for  transportation cover a variety of services, including education, job  training, employment, nutrition, health, medical care, or other human  services. As we have previously reported, many federally funded  programs purchase transportation services from existing private or public  providers. This includes contracting for services with private transportation providers or providing transit passes, taxi vouchers, or  mileage reimbursement to program participants, or some combination of  these methods. Some programs may use federal funds to purchase and  operate their own vehicles.

DOT and HHS formed the Coordinating Council on Human Services  Transportation (Coordinating Council) in 1986 to improve the efficiency  and effectiveness of human service transportation by coordinating  related programs at the federal level and promoting the maximum feasible  coordination at the state and local levels. In 2003, we reported that  coordination efforts at the federal, state, and local levels varied greatly,  and while some coordination efforts showed promising results, obstacles  continued to impede coordination. As a result, we recommended that,  among other things, the Coordinating Council be expanded to include  additional federal agencies. The Coordinating Council was expanded to  11 federal agencies in 2004 by Executive Order 13330 and renamed the  Interagency Transportation Coordinating Council on Access and  Mobility. The expanded Coordinating Council was charged with, among  other things, promoting interagency cooperation and establishing  appropriate mechanisms to minimize duplication and overlap of federal  programs and services so that transportation-disadvantaged persons  have access to improved transportation services.

More recently, in 2011, we reported that reducing or eliminating  duplication, overlap, and fragmentation among government programs and  activities could save tax dollars and help agencies to provide more  efficient and effective services. With regard to transportation services for  the transportation disadvantaged, we found that, while some federal  agencies were developing guidance and technical assistance for  transportation coordination, federal departments still had more work to do  in identifying and assessing their transportation programs, working with  other departments to identify opportunities for additional coordination, and  developing and disseminating policies and grantee guidance for  coordinating transportation services. As we have previously reported,  many federal efforts transcend more than one agency, yet agencies face  a range of challenges and barriers when they attempt to work  collaboratively. Both Congress and the executive branch have  recognized this, and in January 2011, the GPRA Modernization Act of  2010 was enacted, updating the almost two-decades-old Government  Performance and Results Act (GPRA). This act establishes a new  framework aimed at taking a more crosscutting and integrated approach  to focusing on results and improving government performance. As we  reported in February 2012, effective implementation of this act could play  an important role in clarifying desired outcomes; addressing program  performance spanning multiple organizations; and facilitating future  actions to reduce unnecessary duplication, overlap, and fragmentation.

In recent years, Congress has supported increased transportation  coordination, as reflected in the Safe, Accountable, Flexible, Efficient  Transportation Equity Act: A Legacy for Users (SAFETEA-LU). Enacted  in 2005, SAFETEA-LU amended several human services transportation  coordination provisions sharpening the focus on transportation services  for persons with disabilities, older adults, and individuals with lower  incomes. Currently, the law requires the establishment of a locally  developed, coordinated, public transit-human services transportation plan  for all of DOT’s human service transportation programs administered by  the Federal Transit Administration (FTA). Further, it requires the plan to  be developed by a process that includes representatives of public,  private, and nonprofit transportation and human services communities,  including the public. Federal law also has promoted coordinated funding  for non-DOT programs to be used as matching funds for specific  transportation programs. More recently, FTA’s fiscal year 2013 budget  request proposed consolidating some existing programs to give  communities more flexibility in designing and coordinating FTA-sponsored  human service programs.

section_title: Eighty Federal Programs Fund Transportation Services for the Transportation Disadvantaged and Total Spending Is Unknown
subsections: section_title: Federal Programs
paragraphs: We identified 80 federal programs that fund a variety of transportation  services for transportation-disadvantaged populations (see fig. 1). Thirty- one of these programs are administered by HHS. The Departments of  Education and HUD each administer 12 programs; DOT administers 7  programs; and DOL, VA, Interior, and USDA administer 18 programs  combined. Out of the 80 federal programs identified, 4 programs focus  expressly on supporting transportation services for transportation- disadvantaged populations, including DOT’s Capital Assistance Program  for Elderly Persons and Persons with Disabilities, Job Access and  Reverse Commute Program, Capital and Training Assistance Program for  Over-the-Road Bus Accessibility, and the New Freedom Program. A full  list of programs is in appendix II.

Transportation is not the primary mission for the vast majority of the  programs we identified. Except for the 7 DOT programs, where all funds  are used to support public transportation, the remaining 73 programs we  identified primarily provide a variety of human services, such as job  training, employment, education, medical care, or other services, which  incorporate transportation as an eligible program expense to ensure  participants can access a service. In addition, the types of transportation  services provided to the transportation-disadvantaged population through  these federal programs vary, and may include capital investments (e.g.,  purchasing vehicles), reimbursement of transportation costs (e.g., transit  fares, gas, bus passes), or direct provision of transportation service to  program clients (e.g., operating vehicles). Examples of transportation  services authorized for funding include the following:

HHS’s Medicaid program reimburses states that provide Medicaid  beneficiaries with bus passes to access eligible medical services,  among other transportation options.

DOL’s Workforce Investment Act-funded programs can provide  funding for transportation services so that recipients can access  employment and participate in required work activities. Types of  transportation services include bus passes and cab fare.

DOT’s Job Access and Reverse Commute Program allows for grantee  agencies to purchase vehicles such as vans to improve access to  transportation for employment-related services.

VA’s Beneficiary Travel Program, as part of Veterans Medical Care  Benefits, can provide mileage reimbursement to low-income or  disabled veterans for travel to receive medical services at their VA  hospital.

section_title: Federal Spending
paragraphs: Total spending on transportation services for the transportation  disadvantaged remains unknown because, in many cases, federal  departments do not separately track spending for these services. Of the  80 programs we identified, roughly two-thirds of the programs were  unable to provide spending information for eligible transportation services.  However, total expenditures and obligations for the 28 programs that do  track or estimate transportation spending were at least $11.8 billion in  fiscal year 2010 (see table 1). DOT’s 7 programs accounted for about  $9.5 billion of this total amount. Of the non-DOT programs, HHS’s  Medicaid program and VA’s Veterans Medical Care Benefits program  each reported spending over $700 million in fiscal year 2010.

Most of the programs we identified do not separately track transportation  spending. According to federal officials, transportation spending may not  be tracked for several reasons, including the following:

Some programs allow for transportation spending as an optional  service, but it is not required so they do not ask grantees to provide  spending information. For example, HHS’s Head Start program, which  provides comprehensive child development services to low-income  children and their families, reported that many of its grantees may  provide transportation, but the agency does not collect specific data  on transportation spending.

Some federal programs give states and localities broad flexibility to  administer program funds, and the program structure may not lend  itself to tracking transportation expenses. For example, Education  provides grants to states under the Individuals with Disabilities  Education Act (IDEA) for special education and related services to  children with disabilities. State education agencies allocate most of  these grant funds to local education agencies, usually school  systems, to provide these services.on the amount of funds expended by local education agencies for  specific services, including transportation services.

Education does not collect data

Some agencies may consider transportation services to be an  administrative expense, and may include transportation spending with  other eligible administrative expenses. As a result, transportation- specific spending is not fully known. For example, HHS’s Medicaid  program has two allowable methods for states to report the costs of  transportation services to the program—as expenditures for  nonemergency medical transportation benefits or as an administrative expense, which is combined with other nontransportation expenses.As a result, HHS does not fully capture the total transportation costs  provided under its Medicaid program.

Resources necessary to track this information in some federal  departments may outweigh the potential benefits, according to HUD  officials who told us that for some HUD programs, requiring grantees  to report transportation expenses would require a new reporting effort  and that the resulting information may not be analyzed due to  resource constraints.

section_title: Federal Coordination Efforts Are Led by an Interagency Council, but Key Challenges Remain
subsections: section_title: Coordinating Council
paragraphs: The interagency Coordinating Council, chaired by DOT, has been  charged with leading governmentwide transportation coordination efforts  since 2003. The Coordinating Council launched the “United We Ride”  initiative in fall 2003, designed to establish an interagency forum for  communication and help states and communities overcome obstacles to  coordination. The Coordinating Council undertook a number of activities  through its United We Ride initiative, largely between 2003 and 2007.

Coordinating Council actions included issuing publications such as policy  statements and progress reports on efforts taken, providing funding  through FTA to help states and localities promote coordinated services  and planning, and supporting technical assistance efforts (see table 2).  For example, the Coordinating Council’s 2005 Report to the President  outlined the council’s action plan for implementing the 2004 executive  order, reported on the council’s accomplishments, and made specific  recommendations to improve human services transportation coordination.  The Coordinating Council is structured in several levels, including the  Secretary-level members, an Executive Council consisting of senior-level  appointees from each member agency, and interagency working groups  (seven in fiscal year 2011) that cut across issue areas at the  programmatic level. The Coordinating Council is staffed by officials from  FTA. The Secretary-level members of the Coordinating Council last met  in 2008.Council efforts have taken place at the working group level.

However, according to DOT officials, more recent Coordinating  identifies agency roles and responsibilities, measurable outcomes, or  required follow-up. According to agency officials, the Coordinating  Council is drafting a strategic plan, but officials were unable to provide  an estimate for when the plan might be finalized. As previously  discussed, the executive order contained reporting and  recommendation requirements, resulting in the 2005 Report to the  President and the 2007 Progress Report. However, since those  reports, no other guidance document has been created, or is required,  to report on actions taken or to plan additional actions. We have  previously reported that defining and articulating a common outcome,  agreeing on agency roles and responsibilities, and reinforcing agency  accountability through agency plans and reports are important  elements for agencies to enhance and sustain collaborative efforts.  Further, we have reported that federal agencies engaged in  collaborative efforts need to create the means to monitor, evaluate,  and report on their efforts to enable them to identify areas for  improvement. There are several practices involved in strategic  planning that could be useful to help the Council determine and  communicate its long-term goals and objectives.  However, without  a plan to help reinforce agency goals and responsibilities, the  Coordinating Council may be hampered in articulating a strategy to  help strengthen interagency collaboration and lack the elements  needed to remain a viable interagency effort.

Cost-sharing policy: A joint cost-sharing policy has not been endorsed  by all Coordinating Council members, even though development of a  cost allocation policy was one of the recommendations of the  Coordinating Council in its 2005 Report to the President. According  to the 2005 report, a major obstacle to sharing transportation  resources has been the difficulty of reaching agreements at the local  level about the appropriate allocation of costs to each agency.  Federal, state, and local agency officials that we spoke with noted that  this continues to be a significant impediment. Further, as part of a  discussion hosted by the National Academy of Public Administration  in 2009, which brought together key stakeholders to discuss ways to  improve access to reliable transportation for the transportation  disadvantaged, explicit and clear guidance for cost sharing was said  to be needed in order to address significant federal policy barriers to  coordination.

Coordinated transportation planning: Coordinating Council members  pledged to take actions to accomplish federal program grantee  participation in locally developed, coordinated planning processes as  part of their 2006 Coordinated Human Service Transportation  Planning Policy Statement, but it is unclear if the Coordinating  Council’s members have consistently followed through on their 2006  pledge. According to the Coordinating Council’s 2006 policy  statement, federal grantees’ participation in their local human services  transportation planning process is necessary to reduce duplication of  services, increase service efficiency, and expand access for  transportation-disadvantaged populations. However, the discussion  hosted by the National Academy of Public Administration in 2009  indicated that the process for creating coordinated transportation  plans continues to need improvement and recommended that  Coordinating Council members with grant programs create incentives  for their grantees to participate in coordinated planning at the state  and local levels.  According to participants, while the Coordinating Council has issued a joint policy on coordinated planning, challenges  remain to fully engage agencies that are not funded by DOT in the  planning process at the local levels. DOT’s FTA is the only agency  that has adopted a coordinated human services transportation  planning requirement, which has resulted in broadened participation in  the transportation planning processes.

Coordination of services is also challenging due to differences in federal  program requirements and perceived regulatory or statutory barriers,  according to officials. For example, coordinated planning is generally only  a requirement for FTA-funded human service transportation programs,  and while a handful of programs may encourage coordination, other  federal program rules are unclear about coordination of transportation  services between programs. Also, programs may have perceived or  actual statutory or regulatory barriers related to sharing costs, or have  differences in service requirements and eligibility. For example, HHS’s  Medicaid program is the largest source of federal funds for  nonemergency medical transportation for qualified low-income  beneficiaries; however, the Centers for Medicare & Medicaid Services  (CMS) officials expressed concern about coordinating transportation  services due to concerns about commingling federal program funds and  the potential for fraud. CMS has issued rules that allow states to  contract with one or more transportation brokers to manage their  Medicaid transportation to, among other things, reduce costs. However,  these rules could result in fragmented transportation services at the state  and local levels because some brokers transport only Medicaid-eligible  beneficiaries, and may not coordinate their transportation services with  other programs. In another example, VA officials explained that VA only  has the authority to provide transportation at the agency’s expense to  certain qualifying veterans and nonveterans in relation to VA health care,  but has no legal authority to transport nonbeneficiaries.

section_title: State and Local Efforts Include Transportation Planning and Service Coordination, but Challenges Continue
subsections: section_title: State and Local Transportation Coordination Efforts
paragraphs: State and local officials in the five states we selected used a variety of  coordinated planning and service efforts to serve the transportation  disadvantaged. One way that states facilitate coordination efforts is  through statewide coordinating bodies—some created by legislative  actions and others by executive order or initiative—to oversee the  implementation of coordinated transportation for transportation- disadvantaged populations in their states. State coordinating bodies can  help to facilitate collaboration between federal, state, and local agencies  by providing a venue for agencies to discuss and resolve transportation  issues to better coordinate transportation activities related to the provision  of human services and enhance services for transportation- disadvantaged populations. Three of the five states we selected had state  coordinating bodies in 2010. In addition to state coordinating councils,  efforts include regional and local planning, one-call centers, mobility  managers, and vehicle sharing (see table 3).

Several state and local agency officials said that federal requirements for  the establishment of locally developed, coordinated public transit-human  services transportation plans for FTA’s human service transportation  programs have had a positive impact on transportation coordination in  their state. According to officials, these planning efforts help to bring  relevant stakeholders to the table to discuss needs for the transportation  disadvantaged and to resolve problems. For example, in Virginia, the  Department of Rail and Public Transportation has taken the lead in  implementing this requirement, assisting 21 planning district commissions  to formulate human services transportation coordination plans for their  districts, and formulating a statewide plan which draws from these local  plans. According to officials of a regional planning commission in Virginia,  transportation coordination in the state would not be at the same point it is  currently without these requirements. These officials said that the federal  requirements created one place for people to come together to learn what  programs are available, raise awareness, and avoid duplication. Also, a  Virginia Regional Transit official told us that the increased communication  among agencies due to coordinated planning efforts made it possible for  providers to transport more people, including those who were not  currently being served, thus opening access to larger and broader groups  of people.

section_title: Challenges to State and Local Efforts
paragraphs: State and local entities’ efforts to coordinate services for the  transportation disadvantaged are not without challenges. According to  officials, challenges include insufficient federal leadership, changes to  state legislation and policies, and limited financial resources in the face of  growing unmet needs.

Several state and local officials told us that there is not sufficient federal  leadership and guidance on how to coordinate transportation services for  the transportation disadvantaged and that varying federal program  requirements may hinder coordination of transportation services. State  and local officials in four out of the five states we selected said that with  the exception of DOT, other federal agencies were not actively  encouraging transportation coordination. For example, Texas Department  of Transportation officials told us there is a disconnect between human  services and transportation agencies and that the general perception is  that other human services programs, such as some of those funded by  HHS, are exempt from coordination. These officials also said that federal  leadership is needed to promote buy-in for transportation coordination  among human services agencies and transportation agencies at the state  level.

Officials in each of the five states that we selected said that the federal  government could provide state and local entities with improved guidance  on transportation coordination—especially as it relates to instructions on  how to share costs across programs (i.e., determining what portion of a  trip should be paid by whom). State and local officials in Virginia, Texas,  and Washington identified a fear of losing federal funding if they  improperly shared funding with other federal programs. These officials  said that federal cost-sharing guidance would help facilitate transportation  coordination between programs. Further, state Medicaid officials said that  their main priority is to make sure they are following Medicaid  requirements, and some officials expressed concerns about their ability to  ensure Medicaid funds are being appropriately spent and properly  accounted for if they coordinated with other programs. For example,  Medicaid officials in one state said that they would need to obtain  approval from CMS before adopting any cost-sharing strategies with other  programs to ensure the appropriateness of their state program’s  expenditures. When we spoke with CMS officials, they told us that CMS is  not opposed to coordinating transportation services; however, the agency  does have concerns that coordination would result in Medicaid funds  being improperly commingled with other federal program funds.

Several state and local officials said that varying federal government  program requirements may hinder the provision of transportation services  and act as barriers to coordination. A regional planning official in  Washington told us that varying program requirements may discourage  transportation coordination as one program’s requirements may not be  suitable for another program’s clients. For example, if two different  program clients were to share school vehicles for special needs  populations, each program might have a separate set of rules and  requirements. Determining whether drivers meet drug and alcohol testing  requirements for both programs could be a challenge, according to this  official. Similarly, an official from the Florida Department of  Transportation told us that the federal government could do more to  identify standards and requirements that act as barriers to coordination. In  Wisconsin, a Department of Transportation study found that key  challenges to coordinating transportation services in the state include  program regulations or requirements that impede coordination, including  different guidance and restrictions on how federal funding could be  spent.

Officials we interviewed in four states identified recent changes in state  legislation or state policies as potential challenges to coordinating  services for the transportation disadvantaged in their states. According to  these officials, such changes have caused some uncertainty in their  efforts to coordinate human services transportation in the future. For  example, some state coordinating bodies’ authority has not been renewed  or is about to expire:

Executive order not renewed: In Wisconsin, the governor charged a  group of individuals from a number of state agencies to form a state  coordinating council in 2005—the Interagency Council on  Transportation Coordination (ICTC). In addition to sponsoring a  statewide coordination conference in 2007, ICTC contracted with a  national consultant to develop a Wisconsin Model of Coordination with  implementation strategies. Intended outcomes of this model included  increasing the quantity and quality of existing transportation  resources, supporting and encouraging local coordination efforts, and  improving transportation service for users. However, due to a  downturn in the economy and a change in the state’s administration  after the model’s completion, its findings were not implemented.

Because the new administration did not renew the executive order  establishing ICTC’s authority, ICTC has been inactive since January  2011.

Enabling legislation to expire: In Washington, the state legislature  created the Agency Council on Coordinated Transportation (ACCT) in  1998 to coordinate with state and local agencies and organizations to  provide affordable and accessible transportation choices for the  transportation disadvantaged. Over the years, ACCT has facilitated  coordination by helping to form transportation coalitions that include  human services representatives, transit services, and community  transportation providers. These coalitions plan regional public  transportation, evaluate and prioritize project proposals, and  implement local coordination strategies. However, enabling legislation  for ACCT expires in June 2012 and officials do not expect the  legislation to be renewed.

In some states, officials were uncertain about how recent developments  may affect their state Medicaid program’s participation in state and local  efforts to coordinate transportation services for the transportation  disadvantaged. For example, in an effort to control program costs, state  legislation was signed into law in Florida in June 2011 that moves the  responsibility for Medicaid nonemergency medical transportation from the  coordinated transportation system run by the Florida Commission for the  Transportation Disadvantaged to a private managed care system. An  official with the Florida Commission for the Transportation Disadvantaged  said that it is not known whether the managed care system will choose to  operate within the state’s coordinated transportation system or contract  with private transportation brokers outside of the coordinated system,  which could result in duplication of transportation services. Similarly,  officials in Texas and Wisconsin told us that, in an effort to control costs,  their state Medicaid program is moving to a transportation brokerage  system. According to some state and local officials, these brokers  typically only transport Medicaid-eligible clients and do not often  coordinate their transportation services with other federally funded  programs. CMS maintains that their brokerage rule does not preclude  state Medicaid agencies from coordinating transportation services, as  long as they comply with all applicable Medicaid policies and rules and  ensure that Medicaid funds are only used for Medicaid services provided  to eligible beneficiaries.

A number of state and local officials in our five selected states told us that  limited financial resources and growing unmet needs were challenges for  them. In Texas, state and local officials told us that although it is believed  that coordination will save costs in the mid- to long-term, state budgets  are being reduced in transit and social services agencies, as well as in  municipal programs and nonprofit organizations. According to these  officials, some agencies and their potential partners find it difficult to come  up with funding, even when it is a modest local match for grants.  Similarly, state and local officials in Virginia told us that state and local  match requirements may preclude some entities from applying for federal  funds. State and local officials also mentioned that limited financial  resources often promote turf battles—or a mistrust and unwillingness to  share resources for fear of losing control of them. Conversely, some  officials told us that limited resources were an incentive to coordinate  because coordination made the best use of limited resources.

In the face of limited financial resources, state and local officials are also  concerned about growing disadvantaged populations and unmet needs— both now and in the future. As part of the discussion hosted by the  National Academy of Public Administration in 2009, participants identified  continuing transportation gaps in programs across the federal  government. Several state and local officials that we spoke with also  expressed concern about their ability to adequately address expected  growth in elderly, disabled, low-income, and rural populations. A local  transit agency official in Virginia, for example, told us that there is a great  need for transportation services for the elderly and disabled and that the  need is increasing. This agency official questioned whether transportation  providers will have adequate funding and resources to meet this growing  demand. In a presentation before the state Senate in 2011, Florida’s  Commission for the Transportation Disadvantaged reported that,  statewide, 3.75 million trips had been denied to passengers in the  coordinated transportation system during the past 5 years due to a lack of  funding or for other reasons. Nevertheless, the commission expects the  state’s transportation-disadvantaged population to undergo steady growth  over the next decade. In addition, a number of state and local entities  were concerned about populations in rural areas—primarily because  public transportation availability was limited in these areas.

section_title: Conclusions
paragraphs: The Coordinating Council was created to, among other things, promote  interagency cooperation and minimize duplication and overlap of federal  programs providing transportation services to transportation- disadvantaged populations. While some member agencies, including  DOT, have remained active in pursuing these goals, sustained  interagency activity through the Coordinating Council has lost momentum  in recent years. The 11 Coordinating Council members have not met  since 2008 and the Executive Council designees have not met since  2007. According to some federal officials, this lack of leadership at the  Coordinating Council poses challenges to federal-, state-, and local-level  coordination efforts.

Further, the Coordinating Council has been operating without a strategic  plan to help determine and communicate its long-term goals and  objectives. While Executive Order 13330 spurred Coordinating Council  activity beginning in 2004, sustained agency commitment has proved  challenging. We have previously reported that articulating a common  outcome, agreeing on agency roles and responsibilities, and reinforcing  agency accountability through agency plans and reports are important  elements for agencies to sustain and improve collaborative efforts. A  collaborative interagency strategic planning effort could help to provide  the direction and momentum the Coordinating Council needs at this time.

Finally, we have previously reported that federal agencies engaged in  collaborative efforts need to create the means to monitor, evaluate, and  report on their efforts to enable them to identify areas for improvement. It  is difficult to fully assess activities of the Coordinating Council, in part,  because the council has not reported on its activities or reported on  progress implementing its own recommendations since 2007. At that  time, the Coordinating Council reported that it was working to establish  cost-sharing principles for transportation coordination that federal human  service and transportation agencies could endorse; however, we found  that the council had not accomplished this goal as of June 2012. Also in  2007, the council reported it had issued a policy statement encouraging  federally assisted grantees involved in human services transportation to  participate in local coordination planning processes. As part of that policy  statement, members of the Coordinating Council agreed to take action to  implement the policy within 6 months of council adoption; however, it is  unclear what implementation actions agencies have taken to date.  Despite recent actions that some agencies have taken to encourage  coordination and provide technical assistance, without any means to  monitor, evaluate, or report on interagency efforts, the Coordinating  Council may face barriers to identifying areas for improvement and  pursuing its goal of improving transportation services for transportation- disadvantaged populations.

section_title: Recommendations for Executive Action
paragraphs: To promote and enhance federal, state, and local coordination activities,  we recommend that the Secretary of Transportation, as the chair of the  Coordinating Council on Access and Mobility, and the Secretaries of the  Departments of Agriculture, Education, Health and Human Services,  Housing and Urban Development, Interior, Labor, and Veterans Affairs,  as member agencies of the Coordinating Council, should meet and take  the following actions:

Complete and publish a strategic plan for the Coordinating Council,  which should, among other things, clearly outline agency roles and  responsibilities and articulate a strategy to help strengthen  interagency collaboration and communication.

Report on the progress of Coordinating Council recommendations  made as part of its 2005 Report to the President on Implementation of  Executive Order 13330 and develop a plan to address any  outstanding recommendations, including the development of a cost- sharing policy endorsed by the Coordinating Council and the actions  taken by member agencies to increase federal program grantee  participation in locally developed, coordinated planning processes.

section_title: Agency Comments
paragraphs: We provided USDA, Education, HHS, HUD, Interior, DOL, DOT, and VA  with a draft of this report for their review and comment. In commenting on  a draft of this report, Education and VA generally agreed with our  conclusions and recommendations. Education also provided technical  and written comments, which appear in appendix III. HHS, HUD, and  DOT neither agreed nor disagreed with the report and provided technical  comments. In their technical comments, DOT officials stated that, as chair  of the Coordinating Council, they have been working with the council to  refocus its efforts away from policy discussions to the coordination of on- the-ground services, such as through the Veterans Transportation and  Community Living Initiative Grant Program, which is discussed in this  report. USDA, Interior, and DOL did not comment on our report. We  incorporated the technical and clarifying comments that we received from  the agencies, as appropriate.

We are sending copies of this report to interested congressional  committees and the Secretaries of Agriculture, Education, Health and  Human Services, Housing and Urban Development, Interior, Labor,  Transportation, and Veterans Affairs. We also will make copies available  to others upon request. In addition, this report will be available at no  charge on GAO’s website at http://www.gao.gov.

If you or your staff have any questions about this report, please contact  David Wise at 202-512-2834 or WiseD@gao.gov. Contact points for our  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 IV.

section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: To identify federal programs that provide funding for transportation  services for the transportation disadvantaged, we examined prior GAO  work on the topic, conducted an online search of the Catalog of Federal  Domestic Assistance, and requested program information from federal  agency officials for the programs identified. We included only federal  programs that provide nonemergency, nonmilitary, surface transportation  services of any kind, targeted to transportation-disadvantaged  populations. We then asked program administrators to review and verify  the programs identified and the program information collected, including  the general target population, types of transportation services and trips  typically provided, and program spending on transportation services in  fiscal year 2010. We supplemented and modified the inventory based on  this information. In addition, we reviewed the relevant federal laws  governing these programs including their popular title or original source of  program legislation and U.S. Code or other provision cited as authorizing  transportation.

To determine what federal coordination efforts have taken place since we  last fully reported on this issue in 2003 and what challenges remain, we  conducted interviews with program officials from eight federal agencies— the Departments of Agriculture, Education, Health and Human Services,  Housing and Urban Development, Interior, Labor, Transportation, and  Veterans Affairs—and reviewed relevant documentation provided by  agency officials. We chose these agencies because they administered  programs that were authorized to provide funding for transportation  services for the transportation disadvantaged in fiscal year 2010 and were  identified by executive order to participate in coordination. We also  interviewed officials from the National Resource Center for Human  Service Transportation Coordination and interviewed or corresponded  with transportation researchers and representatives from relevant industry  and advocacy groups, including the following:

American Public Transportation Association

Association of Metropolitan Planning Organizations

Easter Seals Project ACTION

National Conference of State Legislatures  To identify the types of coordination that have occurred at the state and  local levels, we conducted interviews with state and local officials from  five states—Florida, Texas, Virginia, Washington, and Wisconsin. We  based our selection of these states on a variety of characteristics,  including size of target populations per state, geographic diversity,  existence of a state coordinating body, and states deemed notable for  their transportation coordination efforts. As part of our state and local  interviews, we spoke with officials from state and local human services  and transportation agencies, metropolitan planning organizations,  transportation providers, interest and advocacy groups, and others and  reviewed relevant documentation. Because we used a nongeneralizable  sample of states, our findings cannot be used to make inferences about  other states. However, we determined that the selection of these states  was appropriate for our design and objectives and that the selection  would generate valid and reliable evidence to support our work. Table 4  provides more detailed information about the state and local entities we  interviewed.

We also interviewed the appropriate United We Ride Regional  Ambassadors for each state. In addition, we reviewed relevant literature  and prior GAO and Congressional Research Service reports, as  appropriate.

We conducted this performance audit from June 2011 to June 2012 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.

section_title: Appendix II: Inventory of Federal Programs Providing Transportation Services to the Transportation Disadvantaged
paragraphs: Food Stamp Act  of 1977   7 U.S.C.  § 2015(d)(4)(I)(i) (I)

Routine  medical  appointments,  shopping,  entertainment,  etc.

Individuals with  Disabilities  Education Act  20 U.S.C.  §§ 1411(a)(1) and  1401(26)

No actual data  or estimate  available from  the federal  agency  29 U.S.C.  § 723(a)(8)

To access  vocational  rehabilitation  services  $81,000,000(estimate)

29 U.S.C.  §§ 796f-4(b)(2) and  705(18)(xi)

Fiscal year  2010 federal  spending on  transportation 29 U.S.C.  §§ 796e-2(1) and  705(18)(xi)

Individuals with  Disabilities  Education Act  20 U.S.C.  §§1419(a) and  1401(26)

No actual data  or estimate  available from  the federal  agency  29 U.S.C.  § 796k(e)(5)

Individuals with  Disabilities  Education Act  20 U.S.C. §§1433  and 1432(4)(E)(xiv)

No actual data  or estimate  available from  the federal  agency  29 U.S.C.  §§ 795g and  705(36)

No actual data  or estimate  available from  the federal  agency  42 U.S.C.  § 11433(d)(5)

Fiscal year  2010 federal  spending on  transportation 29 U.S.C.  §§ 741(a) and  (b)(1)(B) and  723(a)(8)

Elementary and  Secondary  Education Act of  1965  20 U.S.C.  § 7173(a)(10)

Elementary and  Secondary  Education Act of  1965  20 U.S.C.  § 7225a(a)

Department of Health and Human Services   Older  Americans Act  of 1965   42 U.S.C.  § 3030d(a)(2)

Adults age 60  and older  $73,585,717(expended)

Older  Americans Act  of 1965  42 U.S.C.  §§ 3057,  3030d(a)(2)

Public  transportation,  mileage  reimbursement,  GSA lease, etc. $7,318  (estimate)

To access  health care  services   $26,300,000(expended)

Indian Health  Care  Improvement  Act: Balanced  Budget Act of  1997  42 U.S.C. § 254c-3   Public  transportation,  mileage  reimbursement,  etc.

To access  diabetes  prevention and  cardiovascular  disease  services  $419,247  (estimate)

Persons with  substance use or  mental disorders  $3,800  (estimate)

Personal  Responsibility  and Work  Opportunity  Reconciliation  Act of 1996   42 U.S.C.  § 604(a), (k)

To access  work,  employment  training, and  child care  providers  $445,118,725  (expended)

8 U.S.C. §§  1522(b)(7)(D),  1522(c)

Fiscal year  2010 federal  spending on  transportation 8 U.S.C. §§  1522(b)(7)(D),  1522(c)

No actual data  or estimate  available from  the federal  agency  8 U.S.C. §§  1522(b)(7)(D),  1522(c)

No actual data  or estimate  available from  the federal  agency  8 U.S.C. §§  1522(b)(7)(D),  1522(c)

Fiscal year  2010 federal  spending on    transportation No actual data  or estimate  available from  the federal  agency  42 USCA  § 9835(a)(5)(B)

No actual data  or estimate  available from  the federal  agency  42 U.S.C.  § 1397a(a)(2)(A)

Access  services, or  obtain medical  care or  employment  $22,863,512(estimate)

No actual data  or estimate  available from  the federal  agency  42 U.S.C.  § 1397jj(a)(26),  (27) (partial)

Target  population as  defined by  program  officials  42 U.S.C.  §§ 1396a,  1396n(e)(1)(A)

Fiscal year  2010 federal  spending on  transportation $786,966,682(partial)

Persons with HIV  or AIDS   $10,750,025(estimate)

Ryan White  Comprehensive  AIDS Resources  Emergency Act  of 1990   42 U.S.C.   §§ 300ff-21, 300ff- 23(a)(2)(B)

Persons with HIV  or AIDS   $5,598,234(estimate)

ADAMHA  Reorganization  Act of 1992  42 U.S.C.  § 300x-1(b)(1)

No actual data  or estimate  available from  the federal  agency  42 U.S.C.  § 701(a)

Department of Housing and Urban Development  12 U.S.C.  1701g(g)(1)

To access  supportive  services, such  as medical  treatment,  employment,  or job training,  etc.

Accessible  taxis, local  transportation  programs,  buses, etc.

Housing and  Community  Development  Act of 1974   42 U.S.C.  § 5305(a)(8) social  services,  medical  services, jobs,  etc.

Low- and  moderate-income  persons,  mobility-impaired  persons, and  jobseekers  (expended)

Housing and  Community  Development  Act of 1974   42 U.S.C.  § 5305(a)(8) social  services,  medical  services, jobs,  etc.

Low- and  moderate-income  persons,  mobility-impaired  persons, and  jobseekers  $0  (expended)

Housing and  Community  Development  Act of 1974   42 U.S.C.  § 5305(a)(8) social  services,  medical  services, jobs,  etc.

Low- and  moderate-income  persons,  mobility-impaired  persons, and  jobseekers  $19,211  (expended)

No actual data  or estimate  available from  the federal  agency  42 U.S.C.  § 12907(a)(3)

To access  supportive  services, such  as medical  treatment,  employment,  job training,  etc.

Low to extremely  low- income  persons living  with HIV/AIDS  $1,530,187  (expended)

No actual data  or estimate  available from  the federal  agency  42 U.S.C. §  1437v(d)(1)(L),  (i)(3)

Native American  Housing  Assistance and  Self  Determination  Act of 1996  25 U.S.C.  § 4132(3)

No actual data  or estimate  available from  the federal  agency  42 U.S.C. §  1437v(d)(1)(L),  (i)(3)

No Child Left  Behind Act of  2001  25 U.S.C.  § 2001(b)(8)(C)(v)

To access  school and  educational  activities  $373,368  (estimate)

No Child Left  Behind Act of  2001  25 U.S.C.  § 2001(b)(8)(C)(v)

To access  school,  educational  activities, and  for use in  emergency  situations  $52,637,635  (obligated)

Workforce  Investment Act  of 1998   29 U.S.C. §  2864(d)(2)

At-risk youth,  ages 16-24, who  meet low-  income criteria  $24,100,000  (estimate)

Older  Americans Act  of 1965  42 U.S.C.  § 3056(c)(6)(A) (iv)

Fiscal year  2010 federal  spending on  transportation 19 U.S.C.  § 2296(b)

Workforce  Investment Act  of 1998   29 U.S.C.  § 2864(d)(2)

Workforce  Investment Act  of 1998   29 U.S.C.  § 2854(a)(4)

Workforce  Investment Act  of 1998   29 U.S.C. § 774  (3)(A), 29 U.S.C. §  2912 (d)

Workforce  Investment Act  of 1998  29 U.S.C.  § 2911(d)(2)

Workforce  Investment Act  of 1998   29 U.S.C. §§  2801(46)

Funding for bus  and bus  facilities, new  fixed guideway  and  modernization,  and other  capital  expenses  $3,566,689,946(obligated)

General public in  urbanized areas  $4,849,410,834  (obligated)

General public  and federally  recognized tribes  $624,837,418(obligated)

Elderly  individuals and  persons with  disabilities  $176,237,261  (obligated)

Low-income  individuals and  reverse  commuters   $163,976,876  (obligated)

General public  and individuals  with disabilities  $544,261  (obligated)

To enhance  transportation  systems and  access to  those systems  $90,140,813  (obligated)

Mileage  reimbursement;  special mode  (ambulance,  wheelchair  van); common  carrier (air, bus,  train, boat, taxi)

To access VA  or VA-  authorized  non-VA health  care  $745,315,000(obligated)

Homeless  Veterans  Comprehensive  Service  Programs Act of  1992  38 U.S.C. §§  2011(b)(1)(B),  7721 Note   and  transportation  of homeless  veterans by  community- based  providers  (obligated)

No actual data  or estimate  available from  the federal  agency  Spending was reported by program officials, and we did not verify the information. Amounts  obligated or expended on transportation are given, depending upon the information available. When  actual information was not available, agency officials provided estimates.

Figure was amount obligated in fiscal year 2010 for 32 van grants, and grantees have 5 years to  spend these funds, according to program officials.

section_title: Appendix III: Comments from the Department of Education

section_title: Appendix IV: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact

section_title: Staff Acknowledgments
paragraphs: In addition to the individual named above, other key contributors to this  report were Heather MacLeod, Assistant Director; Rebekah Boone; Brian  Chung; Jennifer Clayborne; Jean Cook; Bert Japikse; Delwen Jones; and  Sara Ann Moessbauer.


Question-summary annotations: questions: question: How many federal programs are authorized to fund transportation services for the transportation disadvantaged?
answer: Eighty federal programs are authorized to fund transportation services for the transportation disadvantaged, but transportation is not the primary mission of most of the programs GAO identified.
child_questions: question: Of these, how many programs support public transportation?
answer: Of these, the Department of Transportation administers 7 programs that support public transportation.

question: What types of services do the other programs provide?
answer: The remaining 73 programs are administered by 7 other federal agencies and provide a variety of human services, such as job training, education, or medical care, which incorporate transportation as an eligible expense in support of program goals.

question: Why does total federal spending on transportation services for the transportation disadvantaged remain unknown?
answer: Total federal spending on transportation services for the transportation disadvantaged remains unknown because, in many cases, federal departments do not separately track spending for these services.

questions: question: What is the interagency Coordinating Council on Access and Mobility's role?
answer: The interagency Coordinating Council on Access and Mobility, which the Secretary of Transportation chairs, has led governmentwide transportation coordination efforts since 2003.

question: What is the aim of "United We Ride"?
answer: The Coordinating Council has undertaken a number of activities through its “United We Ride” initiative aimed at improving coordination at the federal level and providing assistance for state and local coordination.
child_questions: question: What are some examples of the results of this?
answer: For example, its 2005 Report to the President on Human Service Transportation Coordination outlined collective and individual department actions and recommendations to decrease duplication, enhance efficiencies, and simplify access for consumers.

question: What are some of the key challenges to federal interagency?
answer: Key challenges to federal interagency coordination efforts include a lack of activity at the leadership level of the Coordinating Council in recent years—the Coordinating Council leadership has not met since 2008—and the absence of key guidance documents for furthering agency coordination efforts.

questions: question: How do state and local officials try to help the disadvantaged when it comes to transportation?
answer: State and local officials GAO interviewed use a variety of planning and service coordination efforts to serve the transportation disadvantaged.
child_questions: question: What do these efforts include?
answer: Efforts include state coordinating councils, regional and local planning, one-call centers, mobility managers, and vehicle sharing.

question: What are some examples of the implementation of this?
answer: For example, state coordinating councils provide a forum for federal, state, and local agencies to discuss and resolve problems related to the provision of transportation services to the transportation disadvantaged.

question: What are some other examples?
answer: In other examples, one-call centers can provide clients with transportation program information and referrals for appropriate service providers and mobility managers may serve many functions—as policy coordinators, operations service brokers, and customer travel navigators.

questions: question: How do Americans struggle with transportation?
answer: Millions of Americans are unable to provide their own transportation or have difficulty accessing public transportation.
child_questions: question: Who is affected the most?
answer: Such transportation-disadvantaged individuals may include those who are elderly, have disabilities, or have low incomes.

question: Which agencies try to improve this aspect for these individuals?
answer: The Departments of Education, Health and Human Services (HHS), Labor (DOL), Transportation (DOT), Veterans Affairs (VA), and other federal agencies may provide funds to state and local entities to help these individuals access human service programs.
child_questions: question: What has GAO done as a result?
answer: As requested, GAO examined (1) federal programs that may fund transportation services for the transportation disadvantaged; (2) federal coordination efforts undertaken since 2003; and (3) coordination at the state and local levels.

questions: question: What should the Secretary of Transportation and the Coordinating Council do to promote and enhance federal, state, and local coordination activities?
answer: To promote and enhance federal, state, and local coordination activities, the Secretary of Transportation and the Coordinating Council should meet to (1) complete and publish a strategic plan; and (2) report on progress of recommendations made by the Council in its 2005 Report to the President and develop a plan to address outstanding recommendations. Education and VA agreed with GAO’s recommendations.
child_questions: question: What do HHS, DOL, DOT, and other federal agencies think of the report?
answer: HHS, DOL, DOT, and other federal agencies neither agreed nor disagreed with the report.

question: What was the general opinion on technical comments?
answer: Technical comments were incorporated as appropriate.