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Center for Advancing Research in Transportation Emissions, Energy, and Health (CARTEEH)

A USDOT University Transportation Center

Lower Transit Fares

Lowering transit fares, such as through vouchers and reimbursements, can result in greater access to healthy destinations and improve connectivity. In poor neighborhoods dependent on transit, people can experience isolation from other parts of their community or much-needed goods and services if those amenities are too far away to walk to, or if transit is too expensive.1 This can include providing vouchers to a specific population which allows them to take public or private transportation for free or at a reduced cost.2 The strategy also offers mileage reimbursements to support participating members who drive their own vehicle or are unable to find friends or family to take them to their various medical emergency or non-emergency appointments.3 The target population includes those who could not access transportation due to physical disabilities, old age, a medical condition, or financial constraints. With the voucher, participants either pay less or or take a ride for free while the transportation provider gets reimbursed by the funding sponsor. A voucher system allows users to chose transportation service to match their needs. It allows them to chose the type of vehicle, time and day, type of service (e.g. door-to-door, public buses, taxis, etc.), thereby mitigating traditional transportation barriers.

Considering this strategy will help achieve the goal of the following objectives

  • Less Contamination
  • Less Emissions
  • Less Traffic Noise
  • Connectivity and Inclusion
  • Healthy Destinations
  • Less Traffic Violence
  • Active Transportation
  • Green Space

Transportation lifecycle phases

This strategy is associated with the following transportation lifecycle phases:

  • Construction
  • End of Life
  • Maintenance
  • Material Selection
  • Operations
  • Policy and Planning
  • Project Development

Who's involved

  • Healthcare providers
  • NGOs
  • Policymakers
  • Transit agencies
  • Vulnerable road users
Lowering transit fares, such as through vouchers and reimbursements, can result in greater access to healthy destinations and improve connectivity. In poor neighborhoods dependent on transit, people can experience isolation from other parts of their community or much-needed goods and services if those amenities are too far away to walk to, or if transit is too expensive.2 The strategy also offers mileage reimbursements to support participating members who drive their own vehicle or are unable to find friends or family to take them to their various medical emergency or non-emergency appointments.3 The target population includes those who could not access transportation due to physical disabilities, old age, a medical condition, or financial constraints. With the voucher, participants either pay less or or take a ride for free while the transportation provider gets reimbursed by the funding sponsor. A voucher system allows users to chose transportation service to match their needs. It allows them to chose the type of vehicle, time and day, type of service (e.g. door-to-door, public buses, taxis, etc.), thereby mitigating traditional transportation barriers.

How it Helps

Vouchers and reimbursements will reduce the total cost on transportation to healthcare facilities and improve healthcare access, especially in vulnerable populations. There will be substantial reduction in the number of missed medical appointment which will enhance the patient’s quality of life. Lower transit fares can improve connectivity by allowing access to jobs, health care, education and other activities that support health. This strategy will also create partnerships between transportation providers and health institutes, thereby expanding revenue for the participating agencies.3 In addition, this can decrease traffic congestion by encouraging more community members to utilize public transit, thus reducing vehicle emissions and urban noise levels.

Implementing

Education:

Both users and transportation providers need to be educated on how to use the vouchers and made aware of other available options.4 This is will improve usability and reduce potential friction between the two parties.

Funding:

Funding is essential for the success of this program, as it makes subsidizing prices for users feasible. One of the ways to obtain funding is through sponsorship from interested stakeholders or partnerships between the affected community or health providers with transportation institutes. This partnership will yield more commuters for transit agencies while reducing prices for users. Additionally, funds can be obtained through government grants, loans, or donations.

Transportation Mode:

The success of voucher strategy depends on the available transportation mode in the community where it is meant to be implemented. While advanced transportation systems like subways are available in cities, many rural areas depend on less sophisticated private vehicles for transportation. The available transportation mode should be identified, as well as the methods for expansion and forming partnerships with providers.

Verification and Approval:

The socio-demographic profile (such as age, disability status, income level, disease condition, etc.) of all beneficiaries need to be verified and approved before participating in the program. All drivers and transportation agencies also need to be equally verified.

Technology:

Technology like mobile/desktop apps or websites that will allow users to register and easily claim reimbursements will hugely usher this strategy to success.

Challenges:

Potential challenges of this strategy may include tracking mileage for reimbursements, as there might be over- or under-estimation of mileage. Additionally, there is a possibility of fraud reimbursement claims from transportation providers and agencies from the sponsoring stakeholders.5 The strategy also requires established systems and programs for execution, maintenance, monitoring, and evaluation.

Examples

1) Center for Independent Living for Western Wisconsin

Wisconsin’s New Freedom Transportation Program allows people with disabilities and older adults to have access to transportation to medical appointments, shopping, and recreation trips. This program makes use of volunteer drivers who get mileage reimbursements or vouchers for individual participants in all of the 18 counties it covers.

https://www.ruralhealthinfo.org/toolkits/transportation/3/western-wisconsin

2) Living Independence Network Corporation

Twin Falls, Idaho’s voucher program helps reduce the transportation burden of the residents of rural Idaho. It provides reduced-cost transportation to and from health appointments, shopping and recreational activities, and other purposes.

https://www.ruralhealthinfo.org/toolkits/transportation/3/living-independence

3) Wyoming Independent Living

The Transportation Check Program provides an all-encompassing transportation solution including voucher and reimbursement to increase community access and reduce transportation barriers.

https://www.wilr.org/programs/transportation-check-program

4) Medicaid’s Medical Transportation Program

Voucher and reimbursement is one of Medicaid’s transportation programs to increase access to medical care for eligible individuals who are current beneficiaries of Medicaid.

https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/downloads/nemt-booklet.pdf

1. Bocarejo, J. P., et al. (2012). Transport accessibility and social inequities: a tool for identification of mobility needs and evaluation of transport investments. Journal of Transport Geography, 24, 142-154. https://doi.org/10.1016/j.jtrangeo.2011.12.004
2. RHIhub. Voucher Models. https://www.ruralhealthinfo.org/toolkits/transportation/2/models-to-improve-access/voucher-models
3. AAA 1-B. Mobility Management Service Literature Review. http://www.aaa1b.org/wp-content/uploads/2011/02/RFP-Literature-Review.pdf
4. Menotti, E. P., et al. (2016). Vouchers: A Hot Ticket for Reaching the Poor and Other Special Groups With Voluntary Family Planning Services. Glob Health Sci Pract, 43, 384-393. https://doi.org/10.9745/GHSP-D-16-00084
5. CMS. (2016). Medicaid Non-Emergency Medical Transportation Booklet for Providers. https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/downloads/nemt-booklet.pdf