Mobility is Key for Older Adults, But How to Pay for It?

Access to transportation is especially important to older adults, caregivers and the communities where they live. By 2040, almost one in five Americans will be older than age 65. Many of these people live active lives, are able to drive and to take public transportation. They want and need to connect with their families, get to health appointments, and enjoy social, recreational and entertainment activities, living the independent lives they desire—now and into the future.

However, should they have to give up their independent mobility due to illness or disability, their lives can be severely hampered without viable alternative transportation options. Giving up the car keys almost doubles the symptoms of depression in older adults.

Many alternatives exist for older adults, although availability varies by community. Alternatives include volunteer driver programs coordinated by nonprofits and faith-based organizations; on-demand paratransit services (small buses and/or minivans that provide curb-to-curb service); taxi services; and personal door-to-door services that use drivers to help riders get to public transit. Public transportation is an option as well, and agencies often provide discounts or vouchers for older riders.

‘Giving up the car keys almost doubles the symptoms of depression in older adults.’

These transportation modes are available to many older adults through government agencies, faith-based and nonprofit organizations. But, there is a significant and disruptive transformation in transportation technology happening right now. Across the last decade, the United States has seen the introduction of emerging technologies such as micromobility (personal mobility solutions for short rides such as electric bikes, etc.), ridesharing, electric vehicles and potentially self-driving cars.

But the questions remain, who will and how to pay for these new transportation options as the population ages?

Current State of Transportation Funding for Older Adults

For now, Medicaid covers the cost of emergency medical transportation for eligible individuals. An emergency is when one’s medical needs are immediate. Medicaid also covers rides for eligible individuals to and from the doctor’s office, the hospital or another medical office for Medicaid-approved care, which is called “non-emergency medical transportation,” because it does not involve a medical emergency. Medicaid may provide rides for individuals with no working car or driver’s license, who have a physical or mental disability or who are unable to travel or wait for a ride alone, but this provision would need approval from the state Medicaid agency.

In short, Medicaid only covers non-emergency rides if specifically to attend Medicaid-approved care. Therefore, the question is how to pay for the day-to-day movement for older adults that will help to keep them physically and socially engaged?

To provide for non-emergency transportation funding, the Federal Transit Administration (FTA) created the Section 5310 program, also called Enhanced Mobility of Seniors & Individuals with Disabilities. The program provides funding to states to help private nonprofit groups meet the transportation needs of older adults and people with disabilities. This program supports transportation services planned, designed and carried out to meet these needs in all areas of the country, and can include traditional services (support for buying buses and vans, wheelchair lifts, ramps, and securement devices, and mobility management programs) or nontraditional services (travel training for older adults, volunteer driving programs, helping with costs of providing same day service or door-to-door service).

Funds are allocated among the states by a formula based upon the number of older adults and people with disabilities in each state, according to the latest available U.S. Census data. The federal share for capital projects is 80 percent and for operating costs is 50 percent, so states and localities are required to make up the funding difference. Programs under Section 5310 include the National Aging and Disability Transportation Center and the National Center for Mobility Management.

Furthermore, within the last transportation bill (the FAST Act), a discretionary pilot program called Section 3006(b) was formed for innovative coordinated access and mobility. The program assists in financing innovative projects for people in need of transportation that improve coordination of transportation services and non-emergency medical transportation services.

‘Companies like Waymo, Cruise, Lyft and Uber can and should support investments to bring new transportation technology into the mainstream.’

To better coordinate agencies that provide funding for transportation for older adults and those with disabilities, in 2004 an interagency partnership with representatives from USDOT (U.S. Department of Transportation) and 10 other federal agencies, Coordinating Council on Access and Mobility (CCAM), was formed to improve the quality, efficiency and availability of transportation services for targeted populations.

Innovating to Pay for the Next Iteration of Transportation Technology for Older Adults

Federal grant programs under sections 5310 and 3006(b), with coordinating assistance from CCAM, can help organizations secure funding to assist transportation for older adults. It is likely that these same programs can and will be extended to support new transportation technologies on the horizon, although funding at today’s levels will not be enough.

Existing gaps could be funded by private organizations (via public/private partnerships), revenue from advertisements and in-kind contributions, among other sources. Companies like Waymo, Cruise, Lyft and Uber can and should support investments to bring new transportation technology into the mainstream and support initiatives targeted to older adults.

On the government side, there is much to be excited about in the recently released fiscal year 2022 USDOT budget. This budget calls for $110 million for a new Thriving Communities program that will establish a new office to support communities in eliminating persistent transportation barriers and increasing access to jobs, school and businesses; a $50 million increase for Vehicle Safety Programs, to advance the equitable development and implementation of safe vehicle technologies, keep pace with the rapid innovation in vehicle electronics and automated driving systems, and ensure the safety of alternative-fuel vehicles—all of interest to older adults; and $13.5 billion for transit, including $550 million for Transit Infrastructure Grants.

As transportation groups continue to innovate, leaders from across the spectrum—government, nonprofit and the private sector—can and must commit to ensuring that these new technologies will support older adults’ ability to be mobile. Developing new and innovative payment structures will be key to this effort. Let’s ensure all people are as mobile as possible today and in the future.

Richard Ezike, PhD, is an expert on transportation equity, environmental sustainability and STEM education outreach. He has advised on transportation issues for federal agencies such as the departments of Energy and Transportation, and the Environmental Protection Agency; and for organizations such as the Transportation Research Board, Smart Growth America, the Greenlining Institute, Securing America’s Future Energy and the State Innovation Exchange. Dr. Ezike holds memberships with the Conference of Minority Transportation Officials, the Young Professionals in Transportation, and the National Urban League Young Professionals Network.