____
___________________________________________________________________________________________________________________
Developing a
NON-EMERGENCY
MEDICAL TRANSPORTATION PLAN
FOR LAKE COUNTY
_______________________________________________________________________________________________________________________
CalACT Spring Conference Presentation – April 2011
Terri Persons, Lake County/City Area Planning Council
Heather Menninger, A-M-M-A Transit Planning
1
Lake County NEMT Plan
Non-Emergency Medical Transportation
_______________________________________________________________________________________________________________________
What we did and why
 Defining the case for coordinated NEMT
program
 Recommended program elements
 Current initiatives

2
3
Lake County/City APC
NEMT Plan Goals
________________________________________________________________________________________________________________________
For Lake County residents –
 Improve mobility
 Improve access to medical care
by improved NEMT services
 Promote public safety
 Be sustainable
4
Lake County NEMT Plan
Approach
_______________________________________________________________________________________________________________________
Identify existing conditions & context

1.
Health care conditions: primary care development, service gaps, care
coordination
2.
3.
Document NEMT need

1.
2.
3.
4.

Public transportation: services and funding
Published studies on NEMT cost/benefit
Countywide household survey- 33,000 residences
Agency survey-200 organizations
3 Public workshops, intercept surveys
Key stakeholder interviews
Analysis and Plan Development
5
Lake County NEMT Plan
Approach
_______________________________________________________________________________________________________________________
Identify existing conditions & context

1.
Health care conditions: primary care development, service gaps, care
coordination
2.
3.
Document NEMT need

1.
2.
3.
4.

Public transportation: services and funding
Published studies on NEMT cost/benefit
Countywide household survey- 33,000 residences
Agency survey-200 organizations
3 Public workshops, intercept surveys
Key stakeholder interviews
Analysis and Plan Development
6
Key Findings:
Countywide Household Survey
 3%
well-distributed response – 1,052
households; 1,890 persons
Lake County NEMT Household Survey
In What Town or Community Do You Live, Is Closest to You?
N=1583 Individuals
45%
50%
45%
40%
30%
Lake County NEMT Household Survey
Individuals Responding by Age Group
20%
10%
N=1829 Individuals
10%
48%
Ages < 15
50%
40%
22%
30%
20%
26%
Ages 15-64
0%
South County
North Shore/East County
West County/Mountains
Ages 65-74
Ages 75 +
4%
10%
0%
Lack of Transportation
48% of respondents age 65 and older
7
Key Findings: Household Survey
Accessing Health Care
_________________________________________________________________________________________________________
How do people report getting to health care?
Lake County NEMT Household Survey
How Do Family Members Travel to Medical Appointments?
N=1890 Individuals
67%
Drove self
26%
Driven by relative who lives with me
11%
Driven by a relative who lives elsewhere
8%
Transit / bus
Walk
Dial-a-ride
3%
3%
Bike
2%
Taxi cab
1%
0%
20%
40%
60%
80%
8
Key Findings:
Accessing Health Care
Missing medical appointments…
Lake County NEMT Household Survey
Why Did You or Family Members Miss Medical Appointments in the Past Six Months?
N= 1890 Individuals
60%
I / we didn't miss any appointments
12%
Lack of transportation
Health improved, felt better, felt worse
5%
Forgot about appointment
5%
Private matter / personal reasons
Could not get off of work or school
Don't know / don't remember
0%
4%
1%
1%
20%
40%
60%
9
Key Findings:
Accessing Health Care
Missing medical appointments…
Lake County NEMT Household Survey
Why Did You or Family Members Miss Medical Appointments in the Past Six Months?
N= 1890 Individuals
60%
I / we didn't miss any appointments
- More likely originating on
North Shore
- Trips intermittent and onetime for some
- Trips continuing for others
12%
Lack of transportation
Health improved, felt better, felt worse
5%
Forgot about appointment
5%
Private matter / personal reasons
Could not get off of work or school
Don't know / don't remember
0%
4%
1%
1%
20%
40%
60%
10
Key Findings:
Accessing Health Care
Missing medical appointments…
Lake County NEMT Household Survey
Why Did You or Family Members Miss Medical Appointments in the Past Six Months?
N= 1890 Individuals
60%
I / we didn't miss any appointments
- More likely originating on
North Shore
- Trips intermittent and onetime for some
- Trips continuing for others
12%
Lack of transportation
Health improved, felt better, felt worse
5%
Forgot about appointment
5%
Private matter / personal reasons
Could not get off of work or school
Don't know / don't remember
0%
4%
1%
1%
20%
40%
60%
Scale of need modest – 12% of responding individuals, among
representative respondents.
11
Key Findings: Household Survey
Accessing Health Care
_________________________________________________________________________________________________________
Who is missing appointments due to lack of
transportation?
-Youth most likely
Lake County NEMT Household Survey
Missed Medical Appointments Due to Lake of Transportation
By Age and By No Insurance
30%
23%
Ages < 15
16%
Ages 15-64
20%
10%
13.3%
7%
0%
Lack of Transportation
6%
Ages 65-79
Ages 80+
No Insurance
to miss medical
appointments due
to transport.
- Seniors least
likely to miss
appointments due
to transport.
- Responding nonsenior adults and
those with no
insurance more
likely to miss.
12
Key Findings: Household Survey
Accessing Health Care
_________________________________________________________________________________________________________
Appointments scheduled by age group and
those without insurance – past six months
Youth
- fewer
appointments,
smaller range.
Lake County NEMT Household Survey
Quartile Distributions of Number of Medical Appointments Made In Past Six Months,
by Age Group and by Reporting No Insurance
90
84
80
Q1
70
Seniors younger
and oldest greatest range of #
of appointments,
Minium

No insurance
adults - fewer
appointments,
smaller range.

Median
Maximum
60
60
Q3
53
50
N= 1,588 Individuals
reporting they received
health care
N= 55 individuals reporting
no heatlh insurance and
receiving health care
40
30
20
20
15
10
3
3
4
5
3
0
Ages <15
Ages 15-64
Ages 65-74
Ages 75+
No Insurance - All
Ages
13
Key Findings: Household Survey
Accessing Health Care
_________________________________________________________________________________________________________
Within Lake County –

Countywide majority of trips to Doctors’ offices –
63%
Out-of-Lake County 
25% of households report out-of-county
destinations
14
Key Findings: Categorizing NEMT Needs
Individual/ Consumer-Based
_________________________________________________________________________________________________________







Able-bodied seniors
Frail elderly, chronically ill, severely ill persons
Persons with disabilities with stable health
Veterans
Individuals without insurance/ low income
persons
Families with young children
Non-English speaking individuals
15
Key Findings: Categorizing NEMT Needs
Institutional
_________________________________________________________________________________________________________






Public transit - availability, service levels, reliability
Public transit and NEMT- information needs
Pedestrian access
Vehicles - replacement, expansion, coordination (brokerage)
Out-of-county transportation NEMT
Coordination opportunities - emergency personnel; no
single information #; funding changes
16
Key Findings:
Positive Impact on Health Care Indicators
_________________________________________________________________________________________________________
“.... A strong case is made that improved access to
NEMT for transportation-disadvantaged persons is
cost effective in terms of better health care. In some
cases…”
- decreases health care costs
- longer life expectancy or improved quality of life
Transit Cooperative Research Program
Cost Benefit Analysis of Providing Non-Emergency Medical Transportation, 2005
17
Key Findings:
NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________
1.
2.
3.
Alternatives to traveling – NOT make the trip
Addressing missed medical appointments due
to lack of transportation
Continued improvements to:


Lake Transit
County streets and roads/ pedestrian path of access issues
18
Key Findings:
NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________
1.
2.
3.
Alternatives to traveling – NOT make the trip
Addressing missed medical appointments due
to lack of transportation
Continued improvements to:


Lake Transit
County streets and roads/ pedestrian path of access issues
19
Key Findings:
NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________
4.
5.
6.
7.
Expanded public transit info & travel training
Transit fare subsidies for lowest income
individuals
Accessible vehicles - capital replacement
Emergency Vehicles/ Personnel Use for Interfacility Transfers and “5150” Transport
20
Key Findings:
NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________
4.
5.
6.
7.
Expanded public transit info & travel training
Transit fare subsidies for lowest income
individuals
Accessible vehicles - capital replacement
Emergency Vehicles/ Personnel Use for Interfacility Transfers and “5150” Transport
21
Key Findings: Positive Impact on
Health Care Indicators
_________________________________________________________________________________________________________
“.... A strong case is made that improved access to
NEMT for transportation-disadvantaged persons is
cost effective in terms of better health care. In some
cases…”
- decreases health care costs
- longer life expectancy or improved quality of life
Transit Cooperative Research Program
Cost Benefit Analysis of Providing Non-Emergency Medical Transportation, 2005
22
Recommendations:
Lake County NEMT Plan Goals
________________________________________________________________________________________________________________________
Existing Goals
 Improve mobility
 Improve medical care access with improved
NEMT services
 Promote public safety
 Sustainable – pursue near and longterm funding
23
Recommendations:
Lake County NEMT Plan Goals
________________________________________________________________________________________________________________________
Existing Goals



Improve mobility
Improve medical care access with improved NEMT services
Promote public safety
 Sustainable – pursue near and long-term funding
Added Goal
 Coordination commitment – before agencies
consider other transportation options that they are
committed to working together on Lake County NEMT
program
24
Recommendations:
Likely Service Pilots
_________________________________________________________________________________________________________
Potential Projects -1.
2.
3.
4.
5.
6.
7.
TRIP-Type Mileage Reimbursement
Taxi User-Side Subsidy/ Trips of Last Resort
Purchase-of-Service on Existing Human Service
Agency Transportation
Travel Training Workshops
Lake Transit Authority Service Enhancements
Mobility Management/ Brokerage Capabilities
One Number/ One Call Information Service
25
Recommendations:
Likely Service Pilots
_________________________________________________________________________________________________________
Potential Projects -1.
2.
3.
4.
5.
6.
7.
TRIP-Type Mileage Reimbursement
Taxi User-Side Subsidy/ Trips of Last Resort
Purchase-of-Service on Existing Human Service
Agency Transportation
Travel Training Workshops
Lake Transit Authority Service Enhancements
Mobility Management/ Brokerage Capabilities
One Number/ One Call Information Service
26
Recommendations:
Funding Challenges for NEMT
_________________________________________________________________________________________________________




Twelve NEMT-related funding sources
None have any “extra” for expansion
Using funds in a consolidated manner,
could “buy” more NEMT trips
Small NEMT contributions could
leverage additional/ new funds
27
Recommendations:
Funding Challenges for NEMT
_________________________________________________________________________________________________________




Twelve NEMT-related funding sources
None have any “extra” for expansion
Using funds in a consolidated manner,
could “buy” more NEMT trips
Small NEMT contributions could
leverage additional/ new funds
28
Recommendations NEMT Program Design Rationale
 Program


of Projects Approach
Address breadth of needs
Test individual pilot initiatives
 Brokerage-type



Infrastructure
Leverage multiple resources
Weave into a countywide program
Increase capacity to seek continuing funding
29
Recommendations NEMT Program Design

Program of Projects

NEMT project cost range
•
•
•
•
•
$ 9,000 – travel training – 4 annual workshops + passes
$48,600 – human service trip purchase – 8,575 trips
$52,000 – taxi trips of last resort – 6,557 trips
$98,880 – mileage reimbursement – 23,760 trips
Lake Transit enhancements – range of projects
 Brokerage-type
Infrastructure
• $122,900 – 1.5 FTEs first year
30
Developing NEMT Program
Action Steps To begin….
1.
2.
3.
4.
Determine interest, willingness, ability
Identify, develop “suite of projects”
Develop grant applications – near-term and longer-term
Determine optimal organizational structure and agreements –
for Lake County NEMT Pilot Brokerage
With start-up funding secured…..
5.
6.
7.
8.
Undertake hiring of Mobility Manager/ Broker
Determine cost-reimbursement/ pricing for human service trips
Undertake local research re Medi-Cal reimbursement
Implement pilot projects; formal evaluations 1st and 2nd yrs.
31
Developing NEMT Program
Next Steps White Paper on Brokerage Opportunity
CTSA 5310 Application on Behalf of
Seniors Centers
32
Growing NEMT options for
Lake County residents…
Final NEMT report available at: www.lakeapc.org
Documents tab
Lake County/City Area Planning Council
Terri Persons and Lisa Davey Bates (707) 263-7799
[email protected]
A-M-M-A Transit Planning
Heather Menninger (951) 784-1333
[email protected]
www.ammatransitplanning.com
33
Recommendations:
Lake NEMT $ Possibilities
_________________________________________________________________________________________________________
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Transportation Development Act, LTF – up to 5%,
Existing Lake County Human Service Agency funding – County Public
Health; County Mental Health
Mental Health Services Act funding
First Five Lake grants
Veteran’s Administration national transportation pilots
Tribal Transit grant opportunities
Redwood Coast Regional Center, transportation authorizations
Caltrans Mobility Action Plan Pilot NEMT funding opportunity
Caltrans Statewide Competitive Rural grants, 5316, 5317
Caltrans Statewide Competitive 5310
Health Care initiatives sponsored by Sutter and St. Helena Hospitals
Medi-Cal fee-for-service resources; potential managed-care structure
34
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Lake County Planning Agency Non-Med Transportation