Access to reliable and affordable transportation is crucial to attaining quality health care. Patients of lesser means, including those with disabilities, are susceptible to transportation challenges that can disrupt timely health care. Services that cannot be provided remotely through telemedicine are especially difficult for this population to navigate. For many of our patients, their challenges are exacerbated by pandemic-imposed constraints, such as budgetary cuts to local transportation systems across the U.S.
At our practice, we encounter patients from all walks of life who face transportation challenges for a variety of reasons, including physical disabilities, difficulties with housing, or living in a remote area with limited public transportation. From our perspective as clinicians, it can be understandably frustrating when a patient is late to an appointment or does not present at all, which can delay care for other patients. Also, patients who repeatedly miss their appointments at certain clinics are often barred from being seen there, which affects their ability to receive future care. As clinicians, we often find ourselves at a loss on how best to help patients who repeatedly miss their medical appointments. However, it is important to understand that reliable transportation to the clinic may not always be under the patient’s control. It may be helpful to explore a patient’s reasons for tardiness or absence, as this could unearth issues with transportation.
There are several services that we can offer to our patients regardless of our area of practice:
First, as a clinician, you can request nonemergency medical transportation (NEMT) on behalf of your patients by submitting medical documentation describing their specific circumstance to their health insurer. The federal law requires that Medicaid provide NEMT if the patient, 1) has extenuating medical and/or physically disabling conditions, or 2) is unable to get to a health-related appointment by traditional modes of transportation (e.g., car, bus, taxi). Under the second criteria, patients who live in remote areas with limited public transportation could be eligible for NEMT. For patients with an insurer other than Medicaid, check with the insurer to determine if the patient’s insurance provides NEMT.
Second, paratransit can be helpful to patients experiencing transportation challenges. Paratransit is an extension of public transportation. Interested users go through an evaluation to demonstrate needs unmet by regular public transportation. Paratransit is typically used by those with disabilities for door-to-door wheelchair accessible transportation at a very low cost. Every city in the U.S. is required to have its own paratransit system by federal law. Clinicians can help patients who may qualify by submitting medical documentation to the local paratransit authority and directing patients to the authority for scheduling evaluation appointments.
Third, if NEMT and paratransit are not viable options for the patient, then consider referring patients to other resources such as various private- and government-funded organizations. NeedyMeds has a search engine that provides all organizations that help with travel expenses within each state, by diagnosis. Applicable diagnoses include AIDS, amputation, blood disorders, breast cancer, cardiac disease, chronic renal insufficiency, COVID-19, diabetes, dementia, liver disease, physical disability, seizure disorder, and “all diseases,” to name a few. These programs offer direct financial assistance, reimbursement services, and vouchers to help pay for trips to scheduled medical appointments, return trips from hospital ERs, transfers between hospitals, state-to-state travel expenses, pharmacy trips, and so on. Another option is the local public transportation system, which may have a travel voucher program for low-income riders. This can be explored at your local public transit authority’s website. Lastly, patients who receive care through Veterans Affairs may be eligible for reimbursement through the Beneficiary Travel Program. This program reimburses patients for travel expenses to and from approved health care appointments.
So the next time you encounter a patient experiencing transportation challenges, you will have some resources to offer them so that they can improve their overall access to health care.
In what additional ways can clinicians support patients with transportation challenges? Share your ideas in the comment section.
Demelio A. Urbano is an MD/MPH candidate enrolled at the UCLA David Geffen School of Medicine, Charles R. Drew University of Medicine and Science, and the UCLA Fielding School of Public Health. He has a special interest in health policy analysis and eliminating health disparities.
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