Many elderly, disabled, and low-income individuals face significant challenges in accessing transportation. For example, some of these challenges are as follows: Sixteen percent of respondents over age 75 reported not having a driver’s license in 2001, and 25 percent of the respondents had not driven at least once in the last month according to an AARP survey. Elderly people are also more likely to have difficulty accessing traditional public transportation due to physical ailments. Thirty percent of respondents with disabilities reported difficulty in accessing transportation, compared to 10 percent of respondents without a disability, according to a 2000 survey by the National Organization on Disabilities. Low-income households are less likely to own a car than other households due to the prohibitive cost of purchasing, insuring, and maintaining a car, and public transportation may not provide sufficient options for their needs. Over 90 percent of public assistance recipients do not own a car. The importance of coordinating transportation services for transportation- disadvantaged populations has been evident since the 1970s. In 1977, we issued a report on transportation coordination, which concluded that the most significant hindrance to the coordination of transportation services under these programs was confusion at all levels of government as to how much coordination federally funded projects could engage in. Since 1986, responsibility for coordinating transportation programs at the federal level has rested in the Coordinating Council on Access and Mobility, which was created under a memorandum of understanding between the Department of Health and Human Services (HHS) and the Department of Transportation (DOT). This body is composed of representatives from program offices within these departments, and employees of the two departments meet its staffing needs, on a part-time basis. More recent reviews have continued to identify a need for stronger efforts in this area. In a 1999 report on transportation coordination, we found that coordination efforts of the Coordinating Council, DOT, and HHS were ongoing but still needed strengthening. This report also noted that the Congress had endorsed increased coordination as evidenced by several provisions in the Transportation Equity Act for the 21st Century (TEA- 21), and significant financial benefits had been realized through coordination. In addition, reports by advocacy groups and transportation researchers have raised concerns over continuing duplication of effort among federal programs and certain sub-populations still not being served effectively. We identified 62 federal programs that fund transportation services to populations that are transportation-disadvantaged. As shown in figure 1, the bulk of these programs are administered by four federal agencies—23 programs in HHS, 15 programs in the Department of Labor (DOL), 8 programs in the Department of Education, and 6 programs in DOT. The remaining 10 programs are administered by the Departments of Housing and Urban Development (HUD), Veterans Affairs (VA), Agriculture, and the Interior. A full listing of programs, their authorizing legislation, typical uses, types of trips provided, target populations, and spending information is found in appendix II. Many of the 62 programs are significantly involved in providing transportation services to their recipients. These include 16 programs identified by the Community Transportation Association of America (CTAA) as being routinely used to provide transportation and an additional 11 programs that we identified as spending at least $4 million for transportation services to transportation-disadvantaged populations in fiscal year 2001 on the basis of funding data or estimates that were available. The remaining programs also fund transportation services, but do so minimally, or the extent of transportation services funded is unknown, according to program officials. Table 1 shows the 16 programs identified by CTAA and how they provide transportation. These 16 programs are administered by DOT, HHS, Education, and DOL. As the table shows, transportation is not the primary purpose of most of these programs. For example, Medicaid provides payments for medical services, and the Vocational Rehabilitation Grants Program provides training and employment services to individuals with disabilities. Table 2 shows the 11 programs we identified as spending at least $4 million on transportation for the transportation-disadvantaged in fiscal year 2001. Under most of the federal programs providing transportation services, funding recipients typically purchase the services from existing sources, according to program officials. This includes contracting for services with private transportation providers or providing bus tokens, transit passes, taxi vouchers, mileage reimbursement to volunteers or program participants, or some combination of these methods. For example, recipients of funds from DOL’s Workforce Investment Act Adult Services Program typically provide bus tokens or mileage reimbursement for participants to access training, while recipients of HHS’s Grants for Supportive Services and Senior Centers most often contract with local transportation providers to provide client transportation. The funding recipients of several programs, however, typically purchase and operate vehicles, or modify existing vehicles for use by individuals with disabilities. These programs include Head Start and the Program for American Indian, Alaskan Native, and Hawaiian Elders in HHS; the Vocational Rehabilitation Grants Program in the Department of Education; and the six programs within DOT. Several of these programs have requirements for grantees to coordinate their services with other agencies providing similar services, which would include transportation, among other services. For example, Head Start grantees are required to make every reasonable effort to coordinate transportation services they provide with other human service transportation in their communities. Similarly, DOT’s Capital Assistance Program for Elderly Persons and Persons with Disabilities, Job Access and Reverse Commute, and Nonurbanized Area Formula Program have requirements for grantees to coordinate their transportation services. In addition, some programs have provisions designed to avoid duplication of effort and encourage the use of existing community resources. For example, Workforce Investment Act programs may use funds to support those who are participating in the program only if those individuals are unable to obtain services through other programs, according to program officials. Also, the Veterans’ Workforce Investment Program requires grantees to provide information on the linkages this program will have with other providers of services to benefit veterans. Available information shows that federal programs spent an estimated $2.4 billion on transportation services for transportation-disadvantaged populations in fiscal year 2001, and additional state and local spending for these populations was several hundred million dollars more. Complete spending information is not available because many federal funding recipients are not required to distinguish transportation from other spending when reporting spending information to federal agencies. Information on federal spending for transportation is available for 29 of the 62 programs we identified. These programs spent an estimated $2.4 billion on transportation services in fiscal year 2001. (Appendix II lists available spending data for each federal program.) Based on available information, HHS programs as a whole spent the most on transportation for transportation-disadvantaged populations in 2001—an estimated $1.8 billion. Table 3 shows estimated transportation spending by the eight federal agencies that fund services for the transportation-disadvantaged. More than three-quarters of our estimate is based on spending for transportation in five programs. Of the five, Medicaid and Head Start, both in HHS, spent the most on transportation in fiscal year 2001—an estimated $976.2 million and $514.5 million, respectively. The three other programs, all of which spent more than $100 million on services for the transportation-disadvantaged in fiscal year 2001, were DOT’s Capital Assistance Program for Elderly Persons and Persons with Disabilities, HHS’s Temporary Assistance for Needy Families (TANF), and VA’s Veterans Medical Care Benefits. The amount spent on transportation services by the remaining 33 federal programs is unknown, mainly because the majority of programs do not require recipients of federal funds to report transportation spending information to the federal agency. Total state and local spending for transportation services, which supplements federal spending for such programs, is likely significant—at least in the hundreds of millions of dollars—although the total is unknown because most programs do not require grantees to report these data. Matching requirements, which represent the nonfederal contributions to the program’s costs that come from state, local, or private funds, provide some information on state and local spending on transportation for the transportation-disadvantaged. About half of the 62 programs have matching requirements that generally require states and localities to contribute between 5 and 50 percent of total costs. Additionally, limited information from officials in the five states we visited indicates that total state and local spending on transportation runs into the hundreds of millions of dollars. For example: Nonfederal contributions for Medicaid nonemergency transportation ranged from 32 to 50 percent of the total spending on this service in the five states that we visited. In New York, 50 percent, or an estimated $139.4 million, of the state’s total spending on Medicaid funded transportation in 2001 was from nonfederal sources. In Florida and Wisconsin approximately 40 percent of the total amount spent on nonemergency medical transportation in the state was from nonfederal sources; state contributions in those states were $28.6 million and $13.4 million, respectively, in 2001. In Arizona and South Dakota, approximately one-third of the total amount spent on Medicaid transportation was from nonfederal sources in those states in 2001, approximately $7.0 million and $490,000, respectively. In Wisconsin nearly 38 percent, or $922,000, of the funding to provide transportation services through DOT’s Capital Assistance Program for Elderly Persons and Persons with Disabilities in 2001 was from nonfederal sources. The program requires grantees to provide 20 percent of total program funding. In New York, about 30 percent of the spending on transportation under the Department of Education’s Vocational Rehabilitation Program in 2002, or $2.6 million, was from nonfederal sources. Similarly, about 27 percent or $673,000 of Florida’s funding was from nonfederal sources in 2001. The program requires states to contribute 21.3 percent of total costs. Although some states and localities currently spend a significant amount for transportation through federal programs, many now face budget deficits that could diminish their future contribution to these programs. In a 2003 survey by the National Conference of State Legislatures, 36 states reported budget deficits midway through their fiscal year. Fifteen of these states reported deficits in excess of 5 percent of the state budget, and four states are facing deficits greater than 10 percent of the state budget. Because 49 states have balanced budget requirements, such large deficits could lead to a decrease in the amount of funds available to states for programmatic spending, including transportation programs. For example, according to the National Conference of State Legislatures report, 29 states have imposed across-the-board cuts in response to budget deficits. State budget deficits have affected state transportation spending differently in the five states that we visited. For example: Two of the states have cut their state programs that local grantees used to fund services for the transportation-disadvantaged, according to transportation officials in those states. In one state, the state legislature eliminated the state’s transportation assistance program to help deal with the state’s budget deficit; as a result, the state official and the director of a senior center in the state said that some of the projects funded through the program will likely be discontinued because grantees cannot find replacement funds. In the other state, the state legislature cut a state fund that grantees used to supplement federal transportation funding. According to an official, the loss of this fund, combined with the increasing costs of fuel and insurance, may lead providers to cut service to transportation-disadvantaged populations by as much as 40 percent. In another state, the Governor’s plan for closing the state’s budget gap includes reducing spending on Medicaid nonemergency medical transportation by $5 million, or 7.6 percent; however, the state’s fund dedicated to providing other services for the transportation-disadvantaged was not recommended for cuts. Transportation officials in two states told us that they had not yet experienced cuts in state funding for services for the transportation- disadvantaged. In one of the states, local grantees rely on a state transportation fund and a large set-aside of TANF funds to provide services to transportation-disadvantaged populations. Without these two funds, local grantees would have difficulty financing services for the transportation-disadvantaged, according to an official. The other state is not currently anticipating cuts in state funding for services for transportation-disadvantaged populations, however, according to an official, the full impact of the fiscal situation in that state will not be known until local governments develop program budgets for 2004 because the local governments—which are also facing budget constraints—play a key role in determining what services will be provided. While some states are not currently experiencing reductions in their transportation programs, many states are anticipating that budget deficits will continue into 2004. According to the National Conference of State Legislatures report, 36 states are anticipating budget gaps for 2004; nearly all of these states anticipate gaps greater than 5 percent of their state budget and half of these states expect gaps greater than 10 percent. Efforts to improve services and achieve cost savings through coordination of transportation activities among agencies at all levels of government vary. At the state and local levels, the extent and the type of coordination activities differ, ranging from one state body providing guidance and overseeing coordination efforts for most of its programs to two local agencies sharing vehicles. In some areas within the five states we visited, coordination among providers has resulted in significant benefits, such as improved customer service and lower unit costs. However, we also found some examples of overlapping, fragmented, or confusing services resulting from a lack of coordination. At the federal level, DOT, HHS, and—to some extent—DOL have undertaken some activities aimed at improving coordination among their programs. DOT and HHS implement many of their activities through the Coordinating Council on Access and Mobility. However, DOT and HHS make only a few mentions of coordinating services for the transportation-disadvantaged in their strategic and annual performance plans, and other agencies do not mention such activities at all. Also, several federal agencies that provide services to the transportation-disadvantaged are not involved in coordination efforts at the national level. While agencies within each state we visited were involved in some form of coordination, the extent of coordination of transportation services varies widely. For example, Florida has a state organization that oversees the coordination of most of the transportation services for the transportation- disadvantaged, while some other states we visited had no statewide coordination body. Even in states without such a coordinating body, however, some state and local agencies are engaged in coordination efforts. This variation also occurred in the nation as a whole, according to data from a preliminary report by the National Academy of Sciences’ Transportation Research Board, which found that roughly half of U.S. states have a state transportation coordinating body. (See appendix III for information on the type of coordination in the five states we visited and the state agencies involved.) Within each state, local efforts also varied. Examples of coordination activities include the following: Coordinated planning: In this type of coordination, some combination of human service and transportation agencies and providers work together to plan transportation services for their clients. For example, in northwestern Wisconsin, at the initiative of staff from a center for independent living, the Area Consortium on Transportation was formed in 2001 to improve the planning and provision of transportation for the disabled and others who are transit-dependent. The council—which consists of consumers, transit providers, county and city officials, disability organizations, and aging groups—is instituting several pilot programs to test various methods of coordination. Brokerage: In this type of coordination, one agency or provider serves as the central point of contact for providing ride and eligibility information or actually arranging transportation services for clients of multiple programs. For example, officials in several New York counties wanted to maximize residents’ mobility by coordinating transportation services offered by various federal and state programs, but lacked the expertise or start-up costs to do so. With a grant from the state Departments of Transportation and Health, the counties instituted a coordination demonstration project whereby one agency arranges an average of 2,500 daily trips for clients from a number of populations—such as the disabled, senior citizens, former welfare recipients, and others—served by different federal and state programs. Shared use of vehicles among multiple programs: In this type of coordination, one agency may provide transportation for clients of multiple programs, or each program may own its own vehicles but allow them to be used by other programs. For example, in Arizona, vans from one county’s vocational rehabilitation center travel to a neighboring county to pick up program clients. While there, they also transport clients of Jobs Administration programs. The two programs split the cost of transportation equally. Appendix IV contains a list of some informational resources available for agencies interested in coordinating. In some areas we visited, coordination among providers—through sharing vehicles, consolidating services under a single agency, or sharing information about available services—has resulted in significant benefits, such as improved customer service and lower unit costs. State and local agencies providing transportation under the 62 federal programs often serve similar client groups, provide similar services, and operate in similar geographic areas, so there can be duplication of effort and inefficiency in providing transportation when those agencies do not coordinate. In our site visits, we found several examples of overlapping, fragmented, or confusing services in places where agencies were not coordinating. Through coordination, some local agencies have realized both improved levels of service and financial benefits, such as reduced costs of providing each trip, as follows: A coordinated system in central Florida provides transportation for Medicaid, vocational rehabilitation, and other programs. According to local officials, vans used to show up late, if at all, and clients had difficulty finding out the status of their ride. Since consolidating services under a single provider and bringing scheduling and dispatch services in-house, officials report service improvement. Through collaboration, information-sharing, and cost-sharing among county agencies, the Clinton County transit system in New York serves both Medicaid and elderly populations, making it easier for those populations to access medical and community services because they only have to be familiar with one system. A federal regional official said that coordination could remove the stigma of specialized transportation because all recipients use the same service and are treated equally. Three New York counties joined in a transportation brokering service that saved an estimated $92,000 in 2001 by identifying a lower-cost alternative means of transportation, that is, moving groups of clients in buses rather than transporting individual clients in taxis. This brokerage service provides transportation to Medicaid patients, the disabled, veterans, and other client groups. In Aberdeen, South Dakota, the local transit agency consolidated the transportation services previously provided by both senior and medical centers as well as other federal, state, and local programs. This consolidation allowed the agency to increase the number of trips provided while reducing the average cost of providing each trip by about 20 percent—from about $5 to $4. The agency has also improved its services by coordinating with local taxi companies to provide night and weekend trips. Although the various programs we reviewed target specific populations, some populations are eligible to receive transportation services from multiple programs, resulting in duplication and inefficiency in some cases. In our visits with state and local transportation and human service agencies and providers, officials we interviewed identified several examples of overlapping services in areas or programs that were not coordinating. A for-profit transportation provider in one state told us that he often has two vehicles overlap on the same route at the same time, one for medical trips and one for paratransit, because it is too difficult to mix clients due to complicated fee structures and paperwork requirements imposed by the state for the two programs. An official from a workforce development program in another state told us that many programs in his county use their own vans to deliver clients to the job center, but because the programs do not coordinate, only a few people ride in each van. In another locality that state and local officials said has had difficulty coordinating, several human service providers hired a consultant to study the extent to which various agencies provide similar transportation services within a geographic region. This research showed substantial overlap in local services for the transportation-disadvantaged, as shown in figure 2. The consultant identified ways in which the number of routes could be substantially reduced through better coordination, which are being considered by the agencies involved. State and local officials also provided examples of fragmented services and confusion in localities without coordinated programs. One official in an uncoordinated area said that a lack of coordination results in fragmented services, placing a burden on people who receive transportation through many different programs, depending on trip purpose, because they must be familiar with multiple systems, rules, and requirements. Fragmentation also occurs when adjoining counties do not coordinate their public transportation routes, leaving riders stranded due to unconnected transit systems. In one state, local officials told us that paratransit services do not extend beyond county lines, so people have to schedule two separate trips to get from their homes in one county to medical services in an adjoining county. When the first paratransit ride is behind schedule, a passenger sometimes has to wait for hours for the connecting ride. A provider in another state has contracts to provide transportation services for clients in multiple human service programs. Because of a lack of coordination among those programs, the transportation provider said that his company has to maintain two separate dispatching and reservation systems for its vehicles to comply with differing reporting and eligibility requirements. Vehicles can only operate under one dispatching system at a time, so the drivers cannot provide rides to more than one type of client at a time. The provider also said that clients who call for rides are confused by the sheer number of programs, and the agents who make their reservations do not know for which programs the clients are eligible. Although the Coordinating Council on Access and Mobility and various federal agencies have taken a number of steps to improve coordination, these efforts have had mixed results. As shown in table 4, the Coordinating Council on Access and Mobility—a body consisting of representatives from DOT and HHS—has responded to three of the recommendations we made in our 1999 report by adopting a strategic plan, developing an action plan, and helping to ensure that planned coordination efforts reinforce one another by issuing guidelines for coordinating transportation services. Goals and objectives in the strategic plan include such things as promoting interdepartmental collaboration at the federal level through the development of a joint agenda for transportation research that is of common use to multiple federal departments. According to the most recent action plan, the Council has completed some activities, such as producing a series of “how to” publications on using intelligent transportation systems to assist in the coordination of HHS programs with local transit agencies. The Council’s responses to the other three recommendations are still ongoing. For example, Council representatives told us that they plan to issue their first annual report on coordination achievements in June 2003, although this report was originally due to be issued in October 2000, according to the Council’s strategic plan. With regard to the recommendation on regional working groups, the 10 DOT and HHS regional offices have been convening workshops with state transportation officials during 2003 to discuss obstacles to coordination and other issues. Finally, the Council’s efforts to strengthen its Web site have had mixed results. One of the tasks listed in the Council’s strategic plan is to develop and maintain a Web site that would, among other things, enhance the exchange of coordination ideas, issues, and concerns. The Council has developed a Web site—operated by DOT in conjunction with CTAA—that is reachable through a link on the Federal Transit Administration’s section of DOT’s Web site. However, there is no similar link from HHS’s Web site (or the Web sites of other federal agencies that fund transportation services for the transportation-disadvantaged), possibly making it more difficult for human service and other agencies to be aware of and access the site. In addition, the site does not yet contain specific information on obstacles to coordination or strategies for overcoming them, which we recommended in 1999, though it does contain links to some reports on the subject. There is also a page from which viewers can E-mail the Council with questions or suggestions. The Council is working with CTAA to further strengthen the site. Through the Council, DOT and HHS have sponsored a number of other efforts to enhance coordination. For example, as part of an item in the Council’s action plan, DOT and HHS helped initiate a consortium of national professional organizations and interest groups to conduct research and provide educational activities related to coordinating services for the transportation-disadvantaged. Among other tasks, the consortium has been asked to pursue several items from the Council’s action plan, such as identifying promising practices and obstacles in transportation coordination and developing strategies for addressing the obstacles. Officials from the Council said that working with the consortium provides a depth of knowledge and experience because consortium members represent local as well as national interests so that issues are pursued “from both ends.” As part of the upcoming regional workshops sponsored by the DOT and HHS regional offices, participants will discuss expanded opportunities for achieving more coordinated delivery of transportation services in medical, aging, and other assistance programs, and technical assistance resources will be shared with participants. Intended audiences include state transportation coordinating councils; state agencies that administer medical, aging, and other assistance programs; and agencies serving individuals with disabilities. According to DOT and HHS, participants will be asked to develop state transportation coordination action plans for their home state, and resources will be made available to assist states in implementing their plans following the workshop. (See appendix III for more information on federal coordination activities.) Because it is not a federal executive branch agency, the Coordinating Council is not subject to the requirements of the Government Performance and Results Act (GPRA) of 1993 and, therefore, does not have to follow the act’s guidance for producing strategic plans, annual performance plans, and annual reports. However, there are several best practices in strategic planning that could be useful guides for improving the Council’s strategic plan when it is updated at the end of 2003 and the action plan when it is next updated. For example, the current strategic plan does not contain an overall mission statement for the Council or performance measures that clearly relate to its long-term goals and objectives, both of which are considered best practices in strategic planning. In addition, there are no explicit links between the stated goals and objectives in the strategic plan and the activities in the action plan. For example, the current action plan includes seven tasks related to the use of information technology systems, but those tasks are not clearly linked to any of the Council’s long-term goals or objectives. Because the Council has no funding or full-time staff of its own, it is dependent on support from HHS and DOT. However, neither department currently highlights the coordination of services for the transportation- disadvantaged as a priority in its long-term strategic plan or annual performance plan. According to GPRA guidance, agencies are encouraged to identify programs with common purposes or crosscutting issues in their strategic plans. In addition, the agencies’ annual performance plans should identify performance goals that reflect activities being undertaken to support programs of a crosscutting nature, and show evidence of coordination among crosscutting programs. DOT’s most recent strategic plan and performance plan do not explicitly mention the Coordinating Council, although both briefly discuss coordinating special-needs transportation with other federal agencies under DOT’s Job Access and Reverse Commute (JARC) program. However, there is no mention of coordination of DOT’s Transit Capital Assistance Program for Elderly Persons and Persons with Disabilities with other programs for elderly or disabled populations. At the subagency level, the Federal Transit Administration’s strategic plan includes the Coordinating Council in an appendix on coordination of crosscutting functions, under the strategic goal of promoting economic growth and trade, and its performance plan mentions working with the Council under a different goal—that of promoting mobility and accessibility. HHS’s current strategic plan does not discuss coordination of transportation services with other agencies, but its draft plan for 2003-2008 specifically lists DOT and state and local transportation and human service agencies as important partners in providing transportation to access services in distressed communities and for health care and employment and training programs elsewhere. Education, DOL, HUD, and VA are not listed, however. The performance plans of individual HHS components vary widely in their treatment of transportation coordination. For example, the performance plan of the Centers for Medicare & Medicaid does not mention transportation at all, while the Administration on Aging’s performance plan states that the agency works closely with HHS and DOT officials on the Coordinating Council in pursuit of improved transportation services. The strategic and annual performance plans of the other federal agencies that fund transportation services for the transportation-disadvantaged generally do not mention coordination of such services. Other federal agencies are also involved in some coordination efforts outside the scope of the Council. For example, DOL is working with CTAA and DOT to implement several rounds of pilot projects testing various transportation strategies in support of local one-stop employment and training centers. Officials from DOT and DOL are also in the process of developing guidelines for using Workforce Investment Act funds (a DOL program) for Job Access purposes (a DOT program). In addition, some of DOL’s research studies and technical assistance materials provide examples of transportation coordination efforts. However, we did not find examples of involvement in transportation coordination efforts at the national level at the Departments of Education, HUD, and VA, although some of these agencies are involved in transportation working groups in some of the federal regional offices. The membership of the Coordinating Council only consists of DOT and HHS officials, representing less than half of the 62 federal programs that can be used to fund services for the transportation-disadvantaged. Although these two agencies comprise the majority of funding for transportation that we were able to identify, the Departments of Labor and Education also have a significant number of programs—more than one-third of the total—that provide services to the transportation-disadvantaged. Officials from the Council said that other agencies had expressed interest in coordination activities and had been invited to observe Council meetings in the past, but only DOL sent a representative for a short time period. Council officials said it would be very beneficial to have other agencies formally involved in their coordination efforts, which would require a renewal of the Council’s charter and memorandums of understanding among all agencies involved as well as other formal mechanisms to ensure that the proper people are engaged in the effort. Although some federal, state, and local agencies encourage the coordination of services for the transportation-disadvantaged and some coordination efforts have been established, federal, state, and local officials, as well as representatives of national advocacy and industry organizations with whom we spoke, identified numerous obstacles that impede effective coordination. We clustered the wide range of identified obstacles into three categories related to (1) sharing vehicles and the low priority given to funding coordination activities; (2) programmatic differences; and (3) limited federal, state, and local leadership and commitment to undertake and sustain coordination efforts. To mitigate these obstacles, these officials and other experts suggested three potential options: harmonizing standards and requirements among federal programs with a transportation component, providing and disseminating additional guidance and information on coordination, and providing financial incentives or mandates to coordinate. One set of obstacles was related to officials’ reluctance to share vehicles or their tendency to give low priority to funding coordination activities. In addition, some areas have limited transportation services available, thus limiting any opportunities to benefit from coordination. In interviews in every state we visited, as well as with national advocacy and industry organizations, the unwillingness or inability to share vehicles was identified as a major obstacle. Administrators of some federal programs may be apprehensive about sharing vehicles for coordination due, in part, to their belief that only they understand their clients’ needs and can provide the necessary personalized services. For example, program administrators reported being concerned about a loss of control over the quality and convenience of transportation services for their clients and wanted to maintain their discretion over how to serve their clients and which transportation resources to purchase. Program administrators also expressed concern over mixing vulnerable populations, such as the developmentally disabled and children, or frail, sick, and healthy populations, in one coordinated system. According to a report on coordinated transportation systems, this reluctance among providers to cooperate can lead to an underutilization of vehicles. Likewise, some human service clients may be apprehensive about using coordinated transportation because they may be uncomfortable mixing with members of other populations with whom they are unfamiliar or they may fear a loss of accommodation or convenience, such as having to switch from door-to-door service to curb-to-curb service or public transit. The overall costs of coordination, which can include additional staff members and staff time needed for maintaining and overseeing coordination efforts, can be significant. For example, a transportation brokerage firm in one state faced substantial added costs when it began coordinating transportation for human services programs due to requirements to meet more stringent state and federal safety standards. However, some officials stated that the low priority given to funding coordination activities could impede coordination efforts. For example, according to officials in one state, although recipients of funds from DOT’s Capital Assistance Program for Elderly Persons and Persons with Disabilities are required to coordinate with other local transportation services provided from federal sources, the program’s current allotment for administrative expenses would not support any staff to work on coordination activities. In addition, some states invest in coordination, while others do not allocate funds specifically for coordination, and efforts to coordinate often become ancillary activities for those involved. Guidelines issued by the Coordinating Council state that coordination will not solve all transportation problems in all communities. Coordination may not be an effective strategy in those communities that have limited transportation services available, particularly in those communities that are not served by public transportation. For example, in some remote areas—such as the northwestern part of South Dakota where services available to many communities are 40 to 60 miles away—there are few transportation services available to transport individuals to hospitals or other services. In these areas, coordination may not be a workable or cost- effective option. Coordinating multiple programs administered at various levels of government is complicated because the programs have different requirements with respect to eligibility, funding, reporting, and safety; and they differ in their programmatic goals and missions. Federal program rules that specify the eligible populations that each program can serve may limit opportunities for collaboration. For example, DOT officials in one region stated that they were unable to combine DOL and DOT funds for a DOT transportation program for migrant farm workers because DOL funds are designated for U.S. citizens, while there is no such restriction on the use of DOT funds. In addition, some liability insurance policies specify that a program’s vehicles may serve only a certain population, thus those programs face additional insurance costs to transport individuals other than program clients. Such restrictions may lead to inefficient transportation services within a community. For example, an official in one state we visited commented that one agency’s vehicle provided medically related trips three times per week to that agency’s clients, but would not transport other individuals seeking similar medical services provided under other federal programs due, in part, to liability insurance restrictions. Safety requirements may also vary by program and jurisdiction, thus complicating efforts to transport multiple client groups. Some programs, such as Head Start, have specific vehicle standards that are often more stringent than those of other programs, making it difficult to share vehicles. For instance, different standards for roof strength, types of seat belts, and driver qualifications pose problems for schools, human service agencies, and public transit providers interested in sharing vehicles. Some areas have been able to overcome specific program rules to share vehicles. For example, a Head Start grantee in one state we visited was able to transport students using vehicles supplied by the local public transit provider because these vehicles met the same safety standards as school buses. Funding streams and cycles vary across federal programs, making coordination more difficult. For example, DOT funds generally flow from the state to counties or cities, while DOL funds flow through the state to local designees. In addition, funding for programs such as Head Start flow directly to grantees rather than through states, making it more difficult for the states to directly manage the coordination activities of local grantees, according to an official in one state. There is also complexity in working with different funding time frames and cycles under multiple federal programs. For example, although DOT’s JARC program allows grantees to use other federal funds to provide the local “match” required to obtain JARC funds, the funding time frames and cycles of these other funding sources are different, complicating efforts to combine financial resources. Different reporting requirements among programs can create excessive paperwork in a coordinated system and may make it difficult for agencies to determine their true transportation costs and the benefits that may be realized from coordination. For example, one report commented that a transit provider was required to give each of several human service agencies a separate bill for services provided, which reflected the unique requirements imposed by each of those agencies. Furthermore, according to officials, Medicaid requires the state Medicaid agency to demonstrate that individuals receiving transportation under Medicaid are not receiving transportation from any other source and that the transportation is medically necessary, complicating the determination of how to fund transportation services for each Medicaid recipient in a coordinated system in which costs are shared among agencies. In addition, human service agencies and providers may not be required or accustomed to collecting complete and uniform transportation data for their programs. A recent report concluded that such information was beneficial because it enabled administrators to re-evaluate how best to provide transportation services and the savings they could achieve through coordination. For example, when Florida’s statewide coordination program was established, state and local agencies in Florida reported their total estimated annual transportation-related expenditures at $8 million. However, once reporting requirements were in place for all agencies providing services for the transportation-disadvantaged, actual expenditures were estimated to total $224.9 million statewide—much higher than the initial estimate. Such information has helped agencies in Florida understand the true costs of providing transportation and has encouraged some agencies to become more interested in coordination as they realize the potential for cost savings. Unlike transportation agencies, human service agencies provide transportation as a secondary service so that their clients may access primary human services. Therefore, while DOT-funded transportation agencies have specific and relatively uniform federal requirements for transportation planning, human service agencies do not typically conduct transportation planning or collect transportation-related data for their programs, making the planning of coordinated transportation between transit and human service agencies challenging. In addition, human service, transportation, medical, and workforce agencies all have distinct technical languages and cultures, which may inhibit collaboration among these agencies. In one state we visited, the labor and transportation departments experienced difficulty collaborating because some common terms have completely different meanings within each agency. For example, transportation officials interpreted the term “cost-allocation” as an accounting methodology to estimate the overall cost of operating transportation services in order to determine the appropriate rate to charge for these services, while state labor officials interpreted the term as a way to determine what proportion of overall costs will be funded by each agency. Although some federal and state agencies have recognized the potential offered by coordination and provided some assistance toward this end, officials we interviewed expressed concerns about the amount and effectiveness of the guidance they have received on coordination. In addition, the absence of interagency forums or other mechanisms to develop and share information about coordination initiatives limits the support that local providers receive to effectively coordinate. Officials in some states we visited said that they receive little federal guidance on potential strategies to coordinate services. As a result, they develop their own approaches without the benefit of guidance on the most effective way to coordinate services. We found the following examples of this in our work: Officials in one state said that the guidance on how to share costs among programs for projects funded jointly by DOT’s JARC grants, HHS’s TANF Program, and DOL’s Welfare-to-Work Program funds did not indicate how such sharing could or should be done. Instead, the officials had to seek advice from other states. While FTA disseminated coordination guidelines for FTA and HHS programs to transportation officials, some HHS and transportation officials said these guidelines were not widely disseminated to human services officials or programs. According to state Medicaid offices and a national organization of individuals and agencies concerned with human services, the Centers for Medicare & Medicaid Services have not provided sufficient guidance on how to coordinate Medicaid transportation with existing public transit or other transportation resources. The Coordinating Council on Access and Mobility has limited visibility for agencies actually involved in implementing coordination efforts. In several states, human service program administrators with whom we spoke were not aware of the Council or its Web site. In the five states we visited—even in those states with a coordinating body—there was limited state guidance to help local areas implement coordination, and some officials stated that the lack of leadership and commitment at the state level was a major obstacle to local coordination. In addition, while some states have established coordinating councils or bodies or have designated a lead agency for coordination, nearly half of the states have no coordinating body, according to one report. Officials in one state explained that the lack of a coordinating body that requires various agencies to discuss and resolve transportation issues is the main obstacle toward a more coordinated system. Even in states with a coordinating council or a lead state agency, there may be a lack of local leadership or commitment to coordination efforts. For example, one city we visited was unsuccessful in achieving a coordinated system despite state encouragement to coordinate and some state-provided technical assistance. Stakeholders there described a lack of local commitment and leadership in maintaining lines of communication among those involved in coordination efforts as a factor leading to the failure. In addition, program administrators may not have data on the extent of existing transportation services that may be available to their clients within a geographic region and, therefore, may fail to realize the extent of overlapping and complementary services within their local area. Such data can produce improvements. For example, in response to a lack of data on local services, an agency in one state we visited took the lead in conducting a study that showed the extent to which various agencies provide similar transportation services within a geographic region. An agency official was hopeful that once other agencies saw the extent of overlap, they would be more willing to coordinate. Federal, state, and local officials, as well as experts in the area, have suggested three potential options to improve coordination of transportation services among federal programs: (1) harmonizing standards and requirements among federal programs, (2) expanding interagency forums and providing and disseminating additional guidance and information on coordination, and (3) providing financial incentives or coordination mandates. Officials and experts expressed a need to harmonize requirements among federal programs, such as providing more flexible regulatory language that would allow providers to serve additional client groups, creating consistent cost accounting methods, and adopting common safety standards. For example, one official commented that federal program regulations could include language permitting other client groups to make use of available transportation options. Also, some officials believed that adopting standard accounting procedures among all federal human service programs could provide a consistent measure for comparing services, allowing administrators to evaluate how best to provide transportation services and determine the savings they could achieve through coordination. Likewise, making standards for safety (e.g., types of seat belts), driver training, and liability insurance provisions uniform among federal human service programs, as appropriate, may facilitate the shared use of vehicles and drivers in one coordinated system, according to some officials. Finally, some officials suggested that federal grant programs that allow the use of funds from multiple sources should be under the same funding cycle or time frame so that these funds may be combined more easily. These officials also commented that harmonizing the time frames under which federal funding is allocated could possibly aid collaborative planning. However, differing program standards exist to ensure that the distinct needs of specific target populations are adequately served and that agencies maintain accountability for providing these services. Thus, the benefits from any change in standards or requirements would need to be balanced against continuing to properly meet client needs and sufficiently control funds distributed to grantees. In addition, harmonizing program standards and requirements among 62 federal programs authorized by more than 20 pieces of legislation would necessitate extensive legislative changes and could impose additional costs for agencies to meet new requirements. Some officials advocated expanding the number of agencies involved in coordination, establishing interagency forums, and improving central clearinghouses as ways to better develop and disseminate guidance on coordination. To enhance coordination efforts at the federal level, some officials suggested expanding the membership of the Coordinating Council on Access and Mobility to include additional federal agencies, so that a broader array of agencies that serve the transportation-disadvantaged are represented. This could include agencies such as DOL and the Department of Education that we identified as being significant because a large number of their programs authorize funding of transportation services for the transportation-disadvantaged. In addition, establishing state-level forums may also facilitate communication among agencies involved in coordination and can lead to benefits. For example, one state has established an interagency task force on transportation coordination, which has resulted in a number of benefits—including the pooling of vehicles and the expansion of services—in some areas of the state. Some officials and experts suggested that federal agencies provide additional guidance and other information that result from forums or other sources to clearly define the allowable uses of funds, assist agencies in developing cost-sharing arrangements for transporting common clientele, and encourage the establishment and participation in interagency forums. This additional guidance and information could be better disseminated through a central clearinghouse, such as the Coordinating Council’s Web site. Some officials and experts believed that incentives or mandates could help improve coordination, although others expressed concerns that such actions would have negative effects on the ability of local agencies to respond to community needs. Officials provided several examples, including the following: Federal grant applications could contain provisions giving priority in funding to those grantees committed to coordination efforts. With legislative changes, current funds allotted by multiple federal sources could be combined into one federal, state, or local fund for transportation services for the transportation-disadvantaged. Funding opportunities could be tied to federal or state coordination mandates so that there are financial consequences for a failure to coordinate. However, officials pointed out that these options also had some potential downsides that would need to be carefully considered. For example, combining funds into a single source could result in some populations being unfairly overlooked because smaller agencies at the state or local level would be at a disadvantage in competing for funding with larger agencies serving more clients. Several officials also raised concerns about mandates to coordinate. For example, some officials said that mandates might reduce the flexibility of agencies to design and deliver transportation services that specifically address their communities’ needs. In addition, some officials noted that state efforts or mandates might not guarantee successful local coordination. For example, a city in one state we visited was unsuccessful in coordinating its multiple transportation services despite state encouragement to do so and despite losing some federal funding as a result. Successful coordination among programs for the transportation- disadvantaged is not a simple matter. One clear need, given the sheer number of programs involved, is active and sustained leadership at the federal level. While the Coordinating Council on Access and Mobility is positioned to supply that leadership, its efforts are constrained in two main ways. The first is limited membership: only two departments—DOT and HHS—are members. While these departments administer nearly 30 programs that can be used for transportation, the Departments of Education and Labor administer almost as many. The absence of Education and Labor lessens the ability to muster a collective effort for greater coordination. The second constraint is a limited ability to translate a strategic vision into a set of actions. At present, there are no clear links between the long-term goals in the Council’s strategic plan and the individual tasks in its action plan. Without such links, the Council risks judging its progress on the basis of activities undertaken rather than on the outcomes of those activities and their contribution toward achieving long-term goals. Linking these goals and actions to the strategic and annual performance plans of participating departments—because the Council relies heavily on support from its member agencies—would provide an additional incentive to pursue coordination activities in the departments’ activities. There is great diversity in the specific suggestions we received about how to overcome obstacles to greater coordination. Two of the three main options raised by various officials we interviewed—making federal program standards more uniform and creating some type of requirement or financial incentive for coordination—would require substantial statutory or regulatory changes and include potential costs. The third option, expanding forums and disseminating guidance, can be done in the context of existing laws, regulations, and procedures, and may, therefore, be the most expeditious starting point. In this regard, clarification from federal agencies about how funds can be used for coordination could help state and local agencies overcome some of the obstacles identified. Similarly, state and local agencies may be in a better position to coordinate efforts if they have more knowledge about what has worked elsewhere. Although the Council has a Web site with information about coordinating transportation services, some state and local officials were unaware of it. State and local officials’ point of contact is more likely to be the Web site of the department administering the program at the federal level. Establishing better links between the Council’s Web site and the sites of the departments could help connect grantees with information that may help them coordinate with other programs, better serve clients, and use funds more efficiently. To increase communication and collaboration among the major agencies involved in providing transportation services for the transportation- disadvantaged, we recommend that the Secretaries of the Departments of Labor and Education join the Coordinating Council on Access and Mobility. To promote and enhance federal, state, and local transportation coordination activities, we recommend that the Secretaries of the Departments of Health and Human Services, Labor, Education, and Transportation take the following actions: As member agencies of the Coordinating Council on Access and Mobility, ensure that the long-term goals in the Council’s strategic plan have clear links to the individual tasks in its action plan and that these actions are tied to measurable annual performance goals. Ensure that strategic and annual performance plans discuss their departments’ transportation coordination efforts and incorporate long- term goals and performance measures that address the need for coordination among programs for the transportation-disadvantaged. Develop and distribute additional guidance to states and other grantees that encourages coordinated transportation by clearly defining the allowable uses of funds, explaining how to develop cost-sharing arrangements for transporting common clientele, and clarifying whether funds can be used to serve individuals other than the program’s target population. Link the Web sites of their agencies involved in providing services for the transportation-disadvantaged to the Coordinating Council’s Web site and advertise the site in agency correspondence and during conferences or other outreach opportunities. We provided the Departments of Health and Human Services, Labor, Education, Transportation, Housing and Urban Development, and Veterans Affairs with draft copies of this report for their review and comment. We requested verification of key facts from the Departments of Agriculture and the Interior, but we did not seek comments from these departments because they did not administer significant numbers of programs that benefit the transportation-disadvantaged. All six departments generally agreed with the findings and conclusions in the report and provided technical clarifications, which were incorporated as appropriate. The four departments to whom we made recommendations—Health and Human Services, Labor, Education, and Transportation—also generally concurred with those recommendations. In particular: The Department of Health and Human Services provided written comments on the draft of this report which are presented and evaluated in appendix V. The department noted that it has initiated actions to implement our recommendations, including (1) strengthening the linkage between the Coordinating Council’s strategic and action plans, (2) reviewing the department-wide strategic plan for opportunities to reflect its transportation coordination efforts, (3) developing coordination guidance, and (4) linking the Coordinating Council’s Web site to the Department of Health and Human Services’ Web site. The department also suggested that we consider incorporating other researchers’ estimates of transportation spending by health and human service programs. However, we estimated program expenditures only for those programs where there was sufficient evidence to support an estimate. Department of Labor officials stated that the department looks forward to joining the Coordinating Council on Access and Mobility to improve the transportation services provided by federal human service programs. In addition, department officials commented that the reauthorization of some human service and surface transportation legislation was forthcoming during the preparation of this report and that these legislative changes may impact the future directions of the federal programs included in this report. The Department of Education provided written comments on the draft of this report, which are presented in appendix VI. The department said that it would look favorably on an opportunity to join the Coordinating Council on Access and Mobility and it would consider developing coordination guidance for state and other grantees and instituting methods of linking Web-based information resources about transportation. Department of Transportation officials said that the Federal Transit Administration is committed to accomplishing effective transportation coordination and noted that the list of the agency’s activities and accomplishments in appendix III of this report demonstrate its commitment and support for coordination. It also stated that the administration’s proposal for the reauthorization of surface transportation legislation, introduced in May 2003, includes provisions that would encourage further coordination efforts. We are sending copies of this report to the appropriate congressional committees and to the Secretaries and other appropriate officials of the Departments of Transportation, Health and Human Services, Labor, Education, Housing and Urban Development, Veterans Affairs, Agriculture, and the Interior. We also will make copies available to others upon request. In addition, the report will be available at no charge on the GAO Web site at http://www.gao.gov. If you have any questions about this report, please contact me at siggerudk@gao.gov or at (202) 512-2834. Additional GAO contacts and acknowledgments are listed in appendix VII. Our scope of work included federal programs that provide transportation services to the transportation-disadvantaged. To provide information on the purposes and types of such federal programs, we first determined the universe of programs by reviewing an existing inventory produced by the Community Transportation Association of America and a report prepared for the Coordinating Council on Access and Mobility. We then supplemented and modified this inventory of programs on the basis of interviews with agency officials and searches of the Catalog of Federal Domestic Assistance. We included only those programs that provide nonemergency, nonmilitary, surface transportation services of any kind, targeted to transportation-disadvantaged populations. We interviewed program administrators to identify the general target population and the types of transportation services and trips that are typically provided under each program. To address the issues related to program funding, effects of coordination, and coordination obstacles and options, we (1) conducted interviews and document reviews in the pertinent eight federal agencies that administer the 62 federal programs that fund transportation services for the transportation-disadvantaged; (2) conducted five case studies in Arizona, Florida, New York, South Dakota, and Wisconsin; (3) reviewed the literature on the challenges encountered in coordinating services for the transportation-disadvantaged; and (4) interviewed industry representatives and advocacy groups representing elderly and disabled populations. We did not verify spending data or estimates received from federal agencies for accuracy. At the federal level, we interviewed officials from the headquarters of the Federal Transit Administration in the Department of Transportation; the Administration on Aging, the Administration for Children and Families, the Centers for Medicare & Medicaid Services, the Health Resources Services Administration, the Office of Intergovernmental Affairs, and the Substance Abuse and Mental Health Services Administration in the Department of Health and Human Services; the Employment and Training Administration in the Department of Labor; the Department of Agriculture; the Department of Education; the Department of Housing and Urban Development; the Department of the Interior; and the Department of Veterans Affairs. We also interviewed federal officials from the 10 regional offices of the Federal Transit Administration and some regional officials in the Departments of Health and Human Services and Labor. The federal officials we met with included representatives of the Coordinating Council on Access and Mobility from the Federal Transit Administration and the Department of Health and Human Services. In conducting our case studies in the five states, we reviewed documentation and interviewed more than 100 officials from state and local transportation and human service agencies and service providers, as well as consumers of transportation services. We judgmentally chose the states to include three states without a state mandate or state coordinating body and two states with such conditions. We also chose states on the basis of relative concentrations of elderly, disabled, and low-income populations, and for some, geographic dispersion. Within each state, we spoke with state officials responsible for coordinating transportation services for the transportation-disadvantaged and/or overseeing funds from the 62 federal programs we identified. We also asked some of these state officials for recommendations of local officials and transportation providers to interview in a range of urban, suburban, and rural areas and coordinated and uncoordinated programs within the state. Finally, we interviewed representatives of professional, industry, and advocacy organizations that are part of the National Consortium on the Coordination of Human Services Transportation, a group that represents a broad spectrum of stakeholders involved with coordination of transportation for the disadvantaged. We conducted our work from July 2002 through June 2003 in accordance with generally accepted government auditing standards. Food Stamp Act of 1977, as amended 7 U.S.C. § 2015(d)(4)(I)(i) (I) Department of Education, Office of Elementary and Secondary Education 21st-Century Community Learning Centers Department of Education, Office of Innovation and Improvement 20 U.S.C. § 7173(a)(10) $84,600,000 (estimate) 20 U.S.C. § 7225a(a) Department of Education, Office of Special Education and Rehabilitative Services Individuals with Disabilities Education Act 20 U.S.C. §§ 1401(a)(22), 1411(a)(1) Workforce Investment Act of 1998 29 U.S.C. §§ 796f-4(b)(3) and 705(18)(xi) U.S. Code provisions authorizing funds for transportation 29 U.S.C. § 796k(e)(5) Workforce Investment Act of 1998 29 U.S.C. §§ 796e-2(1) and 705(18)(xi) Workforce Investment Act of 1998 29 U.S.C. §§ 795g and 705(36) Rehabilitation Act of 1973, as amended 29 U.S.C. § 723(a)(8) Persons with physical or mental impairments $50,700,000 (estimate) To access child care services $0 (estimate) U.S. Code provisions authorizing funds for transportation 42 U.S.C. §§ 15002, 15081(2)(D) Target population as defined by program officials Persons with developmental disabilities 42 USCA § 9835(a)(3)(C) (ii) Fiscal year 2001 federal spending on transportation No actual data or estimate available from the federal agency $514,500,000 (estimate) Refugee Act of 1980, as amended 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) Refugee Act of 1980, as amended 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) Refugee Act of 1980, as amended 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) Refugee Act of 1980, as amended 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) Social Security Act, as amended 42 U.S.C. § 1397a(a)(2)(A) Fiscal year 2001 federal spending on transportation $786,605 (partial outlay) Personal Responsibility and Work Opportunity Reconciliation Act of 1996, as amended 42 U.S.C. §§ 604(a), (k) No assistance is provided to families without a minor child, but states determine specific eligibility $160,462,214 (partial outlay) Older Americans Act of 1965, as amended 42 U.S.C. §§ 3057, 3030d(a)(2) Social Security Act, as amended 42 U.S.C. §§ 1396a, 1396n(e)(1)(A) To access health care services $976,200,000 (estimate) Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 42 U.S.C. §§ 1397jj(a)(26), (27) Department of Health and Human Services, Health Resources and Services Administration Public Health Service Act, as amended 42 U.S.C. § 254b(b)(1)(A) (iv) Public Health Service Act, as amended 42 U.S.C. § 256(e)(1)(B)(iii) To access health care services $4,200,000 (estimate) Service Act, as amended 42 U.S.C. § 254c-8(e)(1) Ryan White Comprehensive AIDS Resources Emergency Act of 1990 42 U.S.C. §§ 300ff-21(a), 23(a)(2)(B) No actual data or estimate available from the federal agency No actual data or estimate available from the federal agency $19,500,000 (estimate) Social Security Act, as amended 42 U.S.C. § 701(a)(1)(A) ADAMHA Reorganization Act, as amended 42 U.S.C. § 300x-1(b)(1) ADAMHA Reorganization Act, as amended 42 U.S.C. § 300x-32(b) Department of Housing and Urban Development, Office of Community Planning and Development Housing and Community Development Act of 1974 42 U.S.C. § 5305(a)(8) $6,761,486 (partial outlay) 42 U.S.C. § 12907(a)(3) To access health care and other services $190,252 (partial outlay) Program must serve a majority of low- income persons Low-income persons with HIV or AIDS and their families Homeless persons and families with children $14,000,000 (estimate) Department of Housing and Urban Development, Office of Public and Indian Housing Housing and Community Development Act of 1992, as amended 42 U.S.C. § 1437v(l)(3) Residents of the severely distressed housing and residents of the revitalized units $700,000 (estimate) Workforce Investment Act of 1998 29 U.S.C. §§ 2801(46), 2912(d) Workforce Investment Act of 1998 29 U.S.C. § 2911(d)(2) Older Americans Act of 1965 42 U.S.C. § 3056(c)(6)(A) (iv) Low-income persons aged 55 or over $4,400,000 (estimate) U.S. Code provisions authorizing funds for transportation 19 U.S.C. § 2296(b) Personal Responsibility and Work Opportunity Reconciliation Act of 1996 42 U.S.C. § 612(a)(3)(C) Personal Responsibility and Work Opportunity Reconciliation Act of 1996 42 U.S.C. § 603(a)(5)(C) Investment Act of 1998, as amended 29 U.S.C. §§ 2801(46), 2864(d)(2) Workforce Investment Act of 1998, as amended 29 U.S.C. §§ 2801(46), 2864(e)(2) Workforce Investment Act of 1998, as amended 29 U.S.C. §§ 2801(46), 2864(e)(2) U.S. Code provisions authorizing funds for transportation 29 U.S.C. §§ 2801(46), 2854(a)(4) Workforce Investment Act of 1998, as amended 29 U.S.C. §§ 2801(46), 2914(b) Fiscal year 2001 federal spending on transportation No actual data or estimate available from the federal agency $415,000 (estimate) Fiscal year 2001 federal spending on transportation $17,500,000 (estimate) $0 (partial obligation) General public, although paratransit services are for the special needs of persons with disabilities $36,949,680 (partial obligation) Fiscal year 2001 federal spending on transportation $126,594,591 Grantees report total expenditures and unliquidated obligations made by the state Vocational Rehabilitation (VR) Agency for transportation services provided to individuals served under the State VR Services Program for a fiscal year. Total obligations include both federal and nonfederal funds under the State VR Services Program, the supplemental federal funds awarded to the State VR Agency for the cost of supported employment services under the Supported Employment Program, and funds from other rehabilitation sources. The Department of Education does not collect data on the specific sources of funds used for transportation obligations under the program. However, based on information available from total annual obligations on a national aggregate basis, a program official estimated that of the total amount reported for transportation, about 96 percent would be from the State VR Services Program, and of that amount approximately 76 percent would be federal funds. Similar estimates could not be made for the Supported Employment Program. Public Law 102-477 is applied to allow tribal governments to consolidate funding from several federal programs. These include: the Department of Health and Human Services’s Temporary Assistance for Needy Families, and Child Care and Development Fund programs; the Department of Labor’s Native American Employment and Training, and Welfare-to-Work Grants for Federally Recognized Tribes programs; and the Bureau of Indian Affairs’ Employment Assistance, Indian Social Service and Welfare Assistance, Adult Basic Education, and Higher Education programs. The Indian Social Services and Welfare Assistance Program is not used for transportation outside 102-477. The Adult Basic Education and Higher Education programs do not target transportation-disadvantaged populations as defined in this study outside of 102-477. The Employment Assistance program and the HHS and DOL programs provide transportation assistance separately from 102-477. Program funding from fiscal year 1998 and 1999 may still be spent, but the program no longer receives funding. Federal and state efforts to coordinate the services for the transportation- disadvantaged provided through their programs vary widely. This appendix offers some examples of those efforts. In 1999, we reviewed the coordination efforts of the Coordinating Council on Access and Mobility, a body of representatives from the U.S. Department of Transportation (DOT) and the U.S. Department of Health and Human Services (HHS). We made several recommendations for improving coordination between these two agencies. Table 5 shows the recommendations and actions taken in response. As a result of items in the Coordinating Council’s strategic plan and action plan, FTA and HHS have undertaken multiple efforts to coordinate transportation services provided through their programs. Other federal agencies are also involved in coordination activities. Examples of federal coordination efforts include the following: The FTA and HHS’s Administration on Aging have entered into a memorandum of understanding to increase coordination of transportation for older adults. For example, the agreement says that FTA and the Administration on Aging will work together to better coordinate the provision of funding opportunities to the aging services and transportation networks for the purpose of fostering coordination of transportation services and developing innovative service delivery models. FTA and HHS’s Centers for Medicare & Medicaid Services are developing an action plan between them to address the coordination of Medicaid funded transportation. Department of Labor (DOL) and DOT officials are developing guidelines about using Workforce Investment Act funds for programs funded under DOT’s Job Access and Reverse Commute Program. Some federal regional offices have interagency working groups to discuss transportation and other areas of mutual concern. Four of the 10 regions have formal working groups that meet regularly to discuss ways to use federal funds more efficiently, including for transportation services. These groups include officials from FTA, HHS and, in some regions, the Departments of Labor, Education, Housing and Urban Development, Veterans Affairs, and others. In 4 other regions, FTA and some components of HHS work together informally. One of the regions also has a formal working group that meets quarterly to discuss Workforce Investment Act programs. A study undertaken on behalf of DOT and HHS examined seven specific planning strategies that can be used as part of a flexible regional planning process for coordinating transportation services of health and human service and transit agencies. The report is available on the Coordinating Council’s Web site. The Community Transportation Association of America (CTAA) is an organization consisting primarily of rural and small community transportation providers, and it serves the dual role of transportation industry representative and mobility advocate. It also has responsibility for updating and maintaining the Coordinating Council’s Web site. CTAA sponsored a National Summit on Coordination in May 2003 to encourage federal, state, and local coordination. The participants—who came from federal departments, human service agencies, state associations, and transit providers—discussed, among other things, obstacles to coordination and strategies for addressing them. CTAA established a Web site for the National Transit Resource Center, an information clearinghouse funded by DOT and HHS. The site contains links to the Coordinating Council as well as to the Community Transportation Assistance Project (CTAP) and the Rural Transit Assistance Program (RTAP). CTAP, funded by HHS, provides information about transportation issues, such as accessibility, coordination, funding opportunities, training, management, and legislation and regulations. CTAP also compiled a comprehensive list of federal funding resources for community transportation providers. The purpose of RTAP, funded by FTA, is to provide training and technical assistance for rural public transportation operators, improve professionalism and safety of rural public transit services, promote efficiency and effectiveness of rural transit services, and support coordination with human service transportation. HHS and CTAA have developed and distributed an Employment Transportation Toolkit designed to help communities improve access to transportation for employment purposes. DOL is working with CTAA and DOT to implement several rounds of pilot projects testing various transportation strategies in support of local one- stop employment and training centers. According to DOL officials, these strategies can include referral services, transportation information, transportation services coordination, mobility management, and other transportation strategies. DOL also provides funding to CTAA to convene regional workshops among workforce development, human services, transportation, and business communities, and to update a technical assistance toolkit for employment transportation. The toolkit includes promising practices from the state and local levels, as well as information on how businesses can be employment transportation partners. According to agency officials, DOL’s Employment and Training Administration sponsored a “Promising Practices” project that includes transportation coordination efforts. The National Consortium on the Coordination of Human Services Transportation—an initiative of FTA and HHS, under the direction of CTAA—plans to design and conduct a survey of state Medicaid directors to compile data on the Medicaid transit pass program, brokerages, and other transportation funding mechanisms within Medicaid; develop a new brochure outlining the benefits of the Medicaid pass program; develop case studies of successful brokerage programs and design a brochure describing them; identify promising practices and obstacles in human service transportation coordination and develop strategies for addressing these obstacles; and provide outreach on coordination efforts and resources. The federally-funded Transportation Research Board, an arm of the National Academy of Sciences, has several completed and ongoing projects on transportation coordination, including the following: In June 2000 the board issued “Welfare-to-Work: Integration and Coordination of Transportation and Social Services.” This report identifies obstacles former welfare recipients face in making the transition to work and suggests practical strategies to improve access to job opportunities. A draft report of TCRP Project B-24, “Toolkit for Rural Community Coordinated Transportation Services,” is expected in June 2003. The objective of this research is to develop a practical toolkit for use by local communities, state agencies, and tribal governments in planning and implementing coordinated community transportation services in rural areas. The final report of TCRP Project H-26, “Economic Benefits of Coordinating Human Service Transportation and Transit Services,” is expected in late 2003. The executive summary has been made available for distribution. In this project, the researchers are examining the economic benefits associated with various strategies and practices for coordinating health and human services and transit providers, as well as additional benefits (beyond costs) that might be obtained through further coordination efforts. TCRP Project H-30, “Strategies to Increase Coordination of Transportation Services for the Transportation Disadvantaged,” has an expected completion date of January 2004. The objective of this research project is to develop strategies for initiating or improving coordination of local and regional publicly funded transportation services for the transportation-disadvantaged. Coordination of transportation services at the state level varies. We visited two states with formal coordinating bodies, one state with a formal arrangement between two agencies, and two states with no formal coordination. Table 6 identifies the states’ coordination arrangements and the agencies involved in formal coordination efforts. Arizona does not have formal transportation coordination efforts at the state level, though some state agencies work together informally, and some localities have similar arrangements. For example, an official from the Jobs Administration in the Department of Economic Security said that the Administration works with the Department of Transportation to try to avoid duplication of services in rural areas. Florida has a state coordinating body that oversees local coordination efforts among most programs. This body is called the Commission for the Transportation-Disadvantaged and was created in 1989 by the Florida Legislature to oversee the implementation of coordinated transportation disadvantaged services. The commission appoints local Community Transportation Coordinators who are responsible for the arrangement or delivery of transportation services for transportation-disadvantaged persons, either by brokering services or by providing transportation directly. Agencies are required to purchase transportation through the coordinated system, unless the services offered do not meet the needs of the client or the agency can find a lower cost alternative that meets the same safety standards. New York does not have a formal coordinating body, but some state agencies work together informally and many local agencies have entered into brokerage agreements. Officials from the Departments of Labor and Transportation say they have been working together to identify needs and initiate transportation projects for employment programs. In addition, five state agencies review and comment on applications for FTA’s Transit Capital Assistance Program for Elderly Persons and Persons with Disabilities. South Dakota has a state coordination task force that provides guidance to local coordination efforts, but not all localities or programs have developed coordinated systems. South Dakota established its Transportation Planning and Coordinating Task Force in 1998 at the initiative of the governor’s office. Additionally, the Departments of Human Services and Transportation require all of their programs or applicants to coordinate with other resources in the community. Wisconsin does not have a single body in state government that coordinates all of Wisconsin’s services for the transportation- disadvantaged, but some state and local programs do coordinate. The state Departments of Transportation and Workforce Development jointly administer the Wisconsin Employment Transportation Assistance Program (WETAP), which uses a combination of federal, state, and local funds to provide transportation for low-income residents to get to jobs and employment services. WETAP applicants are required to demonstrate coordination, and only one grant application is accepted per county. Other agencies are also working to improve coordination. The Departments of Transportation and Health and Family Services are trying to coordinate Medicaid transportation. In addition, the Department of Health and Family Services convened a conference in August 2002 to discuss ways to improve coordination of transportation for people with disabilities. Community Transportation Association of America. 2002. Building Mobility Partnerships: Opportunities for Federal Investment. Washington, D.C.: Community Transportation Association of America. Coordinating Council on Access and Mobility. 2000. Planning Guidelines for State and Local Coordination. Washington, D.C.: Coordinating Council on Access and Mobility. Creative Action, Inc. 2001. Coordinating Transportation Services: Local Collaboration and Decision-Making. Prepared for Project Action. Akron, OH: Creative Action, Inc. National Governor’s Association. 2002. Improving Public Transportation Services through Effective Statewide Coordination. Washington, D.C.: U.S. Department of Health and Human Services and U.S. Department of Transportation. Volpe National Transportation Systems Center. 2002. Innovative State and Local Planning for Coordinated Transportation. Washington, D.C.: U.S. Department of Transportation. Westat. Economic Benefits of Coordinating Human Service Transportation and Transit Services. Transit Cooperative Research Project of the Transportation Research Board. Forthcoming. Westat. Toolkit for Rural Community Coordinated Transportation Services. Transit Cooperative Research Project of the Transportation Research Board. Forthcoming. National Transportation Consortium of States, Ecosometrics, Inc., and the American Public Works Association for the Coordinating Council on Access and Mobility. 2000. Working Together: A Directory of State Coordination Programs, Policies, and Contacts: 1999-2000. Washington, D.C. The following are GAO’s comments on HHS’s letter dated May 30, 2003. 1. HHS suggested that we consider incorporating other estimates of transportation spending by health and human service programs, particularly one estimate that assumed transportation spending accounted for 5 percent of total program spending. In developing our estimate of transportation spending, we only included actual or estimated figures for which the agencies could provide supporting evidence. For those programs that had actual or estimated spending information, on average, about 3 percent of total spending for those programs was devoted to transportation. We do not know whether this 3 percent is an appropriate estimate of transportation spending for other programs because grantees are generally not required to report transportation spending information to the federal agency administering the program. Furthermore, several officials who administer programs that had no spending data told us that transportation services probably represented less than 1 percent of their total program spending. 2. HHS proposed that we identify the levels, sectors, and affiliations of officials and others we interviewed. In all agencies and locations we talked with key human service and transportation officials responsible for the delivery and coordination of human and transportation services. We interviewed more than 100 officials in numerous federal, state, and local transportation and human service agencies as well as individuals representing service providers, consumers, and professional and industry advocacy organizations. In our scope and methodology section (see app. I), we generally describe the responsibilities and affiliations of those we interviewed. In addition to the individuals above, Christine Bonham, Bradley Hunt, Bert Japikse, Jessica Lucas-Judy, Sara Ann Moessbauer, Hilary Murrish, Ryan Petitte, Stanley Stenersen, and Andrew Von Ah made key contributions to this report.

Summary: Millions of Americans are unable to provide their own transportation--or even use public transportation--for Medicaid appointments, Head Start classes, job training, or other services. Such "transportation disadvantaged" persons are often disabled, elderly, or low income. Various federal programs are authorized to provide transportation services to them. GAO was asked to (1) identify the federal programs that fund such transportation services and the amount spent on them, (2) assess the extent of coordination among the various programs, and (3) identify any obstacles to coordination and potential ways to overcome such obstacles. Sixty-two federal programs--most of which are administered by the Departments of Health and Human Services, Labor, Education, and Transportation--fund transportation services for the transportation disadvantaged. The full amount these programs spend on transportation is unknown because transportation is not always tracked separately from other spending. However, available information (i.e., estimated or actual outlays or obligations) on 29 of the programs shows that federal agencies spent at least an estimated $2.4 billion on these services in fiscal year 2001. Additional spending by states and localities is also not fully known but is at least in the hundreds of millions of dollars. Efforts to improve services and achieve cost savings through coordination of transportation activities (through sharing resources or information or consolidating services under a single agency) among federal agencies vary. The Coordinating Council on Access and Mobility--a body with representation from the Departments of Transportation and Health and Human Services--has undertaken some activities to improve coordination. However, other agencies that administer a substantial number of programs for the transportation-disadvantaged, such as the Departments of Labor and Education, are not part of the Council. In addition, the Coordinating Council's strategic plan is not linked to its action plan and contains few measurable performance goals. The strategic and annual performance plans of the Departments of Transportation and Health and Human Services contain few references to coordination relating to their subagencies and programs that fund transportation services for the transportation disadvantaged, and the plans of the Departments of Labor and Education do not mention coordinating these services. Obstacles impeding coordination include concern among administrators that their own participants might be negatively affected, program rules that limit use by others, and limited guidance and information on coordination. To mitigate these obstacles, officials and experts suggested making federal standards more consistent, creating a clearinghouse or better Web site to facilitate interagency communication and provide better guidance on coordination, and providing financial incentives or instituting mandates to coordinate.