The Children's Health Fund recognizes that in spite of the nation's significant progress in providing health care to children, millions continue to face substantial barriers that go beyond insurance coverage. Specifically, insufficient transportation infrastructure and inadequate public transportation services have emerged as critical factors and determinants of child health access in medically underserved communities. By bringing care to isolated and underserved rural and urban through mobile medical units, CHF's National Network programs overcome a large part of transportation barriers. Beyond CHF's clinical programs, addressing transportation barriers to health care is an integral part of CHFs policy agenda.
In 1998, CHF sponsored the National Child Health Caravan, an eight-day journey from New York to Mississippi and Arkansas. The Caravan initiated a grassroots dialogue about barriers to children accessing health care. Some of the barriers cited included lack of insurance coverage and the impact that the recently enacted State Child Health Insurance Program (SCHIP) would have on children's health. The lack of adequate transportation resources was given as the single greatest reason why children did not receive the pediatric care they needed on a timely basis. The Children's Health Fund disseminated the data gathered during the National Child Health Caravan in a report entitled Getting There, Getting Care: Transportation and Workforce Barriers to Child Health Care in America in 2000.
In both urban and rural areas, transportation is an important factor in health care decisions. In poor urban areas public transportation was deemed unreliable, inconvenient and poorly funded. In many rural areas, public transportation was non-existent or severely limited in scope. It was apparent that for millions of children, health insurance did not automatically mean access to health care. Inadequate or non-existent transportation prohibits these children from receiving the health care they desperately need.
In February 2004, President Bush signed Executive Order 13330 , in which he directed ten Federal agencies to improve the coordination of federally supported transportation services to transportation-disadvantaged populations. Persons deemed disabled, low income or elderly qualify for federally conducted or federally assisted transportation-related programs. The EO acknowledges that despite numerous, federally funded transportation programs, transportation services to transportation-disadvantaged populations are often fragmented, under utilized and, in some cases, unavailable.
The EO established the Interagency Transportation Coordinating Council on Access and Mobility within the Department of Transportation to promote more coordination between Federal programs that administer transportation services.
Separately, the General Accounting Office examined the 62 federal programs that provide funding for transportation-disadvantaged populations. With funding topping $2.4 billion in fiscal year 2001, the Department of Health and Human Services shoulders the bulk of the costs, followed by the Department of Labor, Department of Education and Department of Transportation. CHF supports both the GAO and the Federal government in examining the benefits of increased coordination among federal agencies to reduce barriers to care in medically underserved areas.
CHF supports continued funding for transportation initiatives. The Department of Health and Human Services administers 23 transportation service programs. DHHS spent $1.77 billion on transportation for transportation-disadvantaged populations in FY 2001. The Community Transportation of America identified five of the 23 programs as regularly providing funding for transportation. Of the five, Medicaid spent the most dollars, an estimated $976.2 million in 2001. This funding is critical. CHF calls on Congress and the administration to continue funding this essential program.
CHF advocates for increase utilization of Medicaid transportation funds. Greater efforts must be made to educate and inform Medicaid-eligible families and their health care providers about the availability of non-emergency medical transportation assistance. Best practices in contracting for transportation assistance services should be monitored to maximize transportation resources and their efficiency. In addition, states should be strongly encouraged to include transportation services as part of the SCHIP benefits package.
CHF supports federal and state efforts to promote and fund improved state coordination of available transportation resources. Improved coordination will make additional transportation resources available for medically underserved children and families.
