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1 in 5 Adults Derailed Care Access Amid Transportation Barriers

Boosting public transit investment and offering Medicaid-supported nonemergency medical transportation can kickstart care access stalled by transportation barriers, RWJF researchers said.

Over 20 percent of US adults, mainly low-income individuals, experience transportation barriers that hinder care access, leading to at least one missed medical appointment in the past year, revealed an Urban Institute and Robert Wood Johnson Foundation study.

When it comes to healthcare access barriers, transportation takes the driver's seat as a key social determinant of health. Without adequate transportation, issues such as hunger, loneliness, and unemployment can accelerate at a faster pace.

Since the COVID-19 pandemic, the boom of telehealth helped steer care access around transportation barriers for some individuals, as per the Urban Institute researchers. Although telehealth has successfully reduced transportation obstacles for certain types of healthcare, such as mental health and primary care services, it can't replace in-person care for all health needs.

Using information from the June 2022 round of the Urban Institute's Health Reform Monitoring Survey of adults aged 18 to 64, the study focused on adults who do not have access to a privately owned vehicle.

Although transportation challenges, such as high gas prices and vehicle maintenance costs, can affect individuals with access to a vehicle, those without a privately owned vehicle experience transportation barriers at a higher rate. This is particularly true for those who rely on public transportation.

Transportation barriers such as lack of access to a vehicle or public transit impacted 21 percent of adults as they forwent care, according to the 2022 poll.

However, the rate was lower for those with good public transportation access who did not own a personal vehicle, as only 9 percent of them reported skipping medical appointments, according to the poll.

The study found that 91 percent of adults had access to a vehicle, but Black adults, those with low family incomes, individuals with a disability, and those with public health insurance or without any coverage had significantly lower access rates. Anywhere from 78 to 83 percent of people in those groups had access to a vehicle.

While private motorized vehicles are the primary mode of transportation in the US, many people, especially those residing in urban areas, with low incomes, or identifying as Black or Hispanic/Latinx rely on public transit to get around.

Approximately 5 percent of all nonelderly adults reported skipping necessary medical care in the past year due to transportation issues. This problem was more common among people from low-income families, individuals with disabilities, and those on public health programs.

The poll revealed that transportation-related barriers to healthcare were experienced by 14 percent of people from low-income families, 17 percent of adults with disabilities, 12 percent of adults covered by public health insurance, and 13 percent of adults without household access to a vehicle.

“This analysis provides new evidence on transportation barriers to health care, highlighting the importance of public transit accessibility in promoting equitable access to health care for states, local governments, and other stakeholders to consider when weighing investments in public transit,” the Urban Institute researchers stated.

Gaps in healthcare access due to transportation-related issues could be filled by either expanding public transit investment or through Medicaid coverage of non-emergency medical transportation. However, NEMT benefits can differ from state to state due to Medicaid’s flexibility.

“Policymakers may also consider expanding transportation benefits in health insurance plans—such as the Non-Emergency Medical Transportation benefit in Medicaid, which varies considerably across and within states to include coverage of public transit fares,” the researchers continued.

Although Medicaid plans must provide their members with access to non-emergency medical transportation, only 29 percent of Medicaid beneficiaries are aware of this benefit, as a past survey showed.

Moreover, out of those aware of NEMT or rideshare benefits, only 37 percent utilized them. Furthermore, ridesharing services have become increasingly popular in recent years as an attempt to eliminate transportation as a barrier to care, particularly for individuals who don't have access to public transit.

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