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Developing a
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CalACT Spring Conference Presentation – April 2011
Terri Persons, Lake County/City Area Planning Council
Heather Menninger, A-M-M-A Transit Planning
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Lake County NEMT Plan
Non-Emergency Medical Transportation
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Lake County/City APC
NEMT Plan G
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Lake County NEMT Plan
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3.
1.
2.
Identify existing conditions & context
Health care conditions: primary care development, service gaps, care coordination
Public transportation: services and funding
Published studies on NEMT cost/benefit
1.
2.
3.
4.
Document NEMT need
Countywide household survey- 33,000 residences
Agency survey-200 organizations
3 Public workshops, intercept surveys
Key stakeholder interviews
Analysis and Plan Development
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Lake County NEMT Plan
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3.
1.
2.
Identify existing conditions & context
Health care conditions: primary care development, service gaps, care coordination
Public transportation: services and funding
Published studies on NEMT cost/benefit
1.
2.
3.
4.
Document NEMT need
Countywide household survey- 33,000 residences
Agency survey-200 organizations
3 Public workshops, intercept surveys
Key stakeholder interviews
Analysis and Plan Development
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Key Findings:
 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% 45% 50%
Lake County NEMT Household Survey
Individuals Responding by Age Group
N=1829 Individuals
48%
40%
30%
20%
10%
10%
50%
40%
30%
20%
10%
0%
4%
22%
26%
Ages < 15
Ages 15-64
Ages 65-74
Ages 75 +
0%
South County North Shore/East County West County/Mountains
48% of respondents age 65 and older
Lack of Transportation
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Key Findings: Household Survey
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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
Driven by relative who lives with me
Driven by a relative who lives elsewhere
Transit / bus
Walk
Dial-a-ride
3%
Bike
Taxi cab
0%
2%
1%
11%
3%
8%
20%
26%
40% 60% 80%
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Key Findings:
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
Lack of transportation
Health improved, felt better, felt worse
Forgot about appointment
Private matter / personal reasons
Could not get off of work or school
Don't know / don't remember
0%
4%
1%
1%
5%
5%
12%
20% 40% 60%
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Key Findings:
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%
- More likely originating on
North Shore
- Trips intermittent and onetime for some
- Trips continuing for others
I / we didn't miss any appointments
Lack of transportation
Health improved, felt better, felt worse
Forgot about appointment
Private matter / personal reasons
Could not get off of work or school
Don't know / don't remember
0%
4%
1%
1%
5%
5%
12%
20% 40% 60%
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Key Findings:
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%
- More likely originating on
North Shore
- Trips intermittent and onetime for some
- Trips continuing for others
I / we didn't miss any appointments
Lack of transportation
Health improved, felt better, felt worse
Forgot about appointment
Private matter / personal reasons
Could not get off of work or school
Don't know / don't remember
0%
4%
1%
1%
5%
5%
12%
20% 40% 60%
Scale of need modest – 12% of responding individuals, among representative respondents.
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Key Findings: Household Survey
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Who is missing appointments due to lack of transportation?
Lake County NEMT Household Survey
Missed Medical Appointments Due to Lake of Transportation
B y Age and By No Insurance
-Youth most likely to miss medical appointments due to transport.
30%
20%
10%
23%
16%
7% 6%
13.3%
Ages < 15
Ages 15-64
Ages 65-79
Ages 80+
No Insurance
- Seniors least likely to miss appointments due to transport.
0%
Lack of Transportation
- Responding nonsenior adults and those with no insurance more likely to miss.
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Key Findings: Household Survey
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Appointments scheduled by age group and those without insurance – past six months
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
 Youth - fewer appointments, smaller range.
90
80
84
 Seniors younger and oldest greatest range of # of appointments,
70
60
50
40
53
60
Q1
Minium
Median
Maximum
Q3
N= 1,588 Individuals reporting they received health care
N= 55 individuals reporting no heatlh insurance and receiving health care
 No insurance adults - fewer appointments, smaller range.
30
20
10
15
4
5
20
0
3
Ages <15
3
Ages 15-64 Ages 65-74 Ages 75+
3
No Insurance - All
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Ages

Key Findings: Household Survey
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Within Lake County –
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Countywide majority of trips to Doctors’ offices –
63%
Out-of-Lake County -
 25% of households report out-of-county destinations
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 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
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 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
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Key Findings:
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“.... 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
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Key Findings:
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1.
2.
3.
Alternatives to traveling – NOT make the trip
Addressing missed medical appointments due to lack of transportation
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Continued improvements to:
Lake Transit
County streets and roads/ pedestrian path of access issues
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Key Findings:
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1.
2.
3.
Alternatives to traveling – NOT make the trip
Addressing missed medical appointments due to lack of transportation
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Continued improvements to:
Lake Transit
County streets and roads/ pedestrian path of access issues
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Key Findings:
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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
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Key Findings:
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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
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Key Findings: Positive Impact on
Health Care Indicators
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“.... 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
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Recommendations:
Lake County NEMT Plan Goals
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Improve mobility
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Improve medical care access with improved
NEMT services
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Promote public safety
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pursue near and longterm funding
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Recommendations:
Lake County NEMT Plan Goals
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Existing Goals
 Improve mobility
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Improve medical care access with improved NEMT services
 Promote public safety
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Sustainable – pursue near and long-term funding
Added Goal
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Coordination commitment – before agencies consider other transportation options that they are committed to working together on Lake County NEMT program
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Recommendations:
Likely Service Pilots
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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
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Recommendations:
Likely Service Pilots
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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
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Recommendations:
Funding Challenges for NEMT
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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
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Recommendations:
Funding Challenges for NEMT
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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
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Recommendations -
 Program of Projects Approach
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Address breadth of needs
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Test individual pilot initiatives
 Brokerage-type Infrastructure
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Leverage multiple resources
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Weave into a countywide program
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Increase capacity to seek continuing funding
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Recommendations -
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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
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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 startup funding secured…..
5.
Undertake hiring of Mobility Manager/ Broker
6.
7.
8.
Determine cost-reimbursement/ pricing for human service trips
Undertake local research re Medi-Cal reimbursement
Implement pilot projects; formal evaluations 1 st and 2 nd yrs.
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Developing NEMT Program
Next Steps -
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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 persont@dow-associates.com
A-M-M-A Transit Planning
Heather Menninger (951) 784-1333 heather@ammatransitplanning.com
www.ammatransitplanning.com
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Recommendations:
Lake NEMT $ Possibilities
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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
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