Presentation Outline

1. Coordinated Transportation RetreatFlorida Commission for the Transportation DisadvantagedApril 11, 2012Jo Ann Hutchinson, United We Ride AmbassadorNational Resource Center for Human Service Transportation Coordination

2. Presentation Outline • History & Role of the National Resource Center for Human Services Transportation Coordination • Coordination at the National Level • Trends That Will Impact Transportation Coordination • Strategies to Address Trends • Coordinated Planning • Why States Look to Florida as a Coordination Model • How the NRC Can Help

3. Thank You for Your Service to Floridians!

4. National Resource Center for Human Service Transportation Coordination • NRC was created in SAFETEA-LU (Federal Transportation Act) in 2005. Prior to the NRC, the United We Ride Initiative was created by Executive Order by President George Bush and resulted in the statutory creation of the NRC to create national emphasis on coordination. • Basic Purpose: Provide states and communities with the support they need to improve and coordinate their public and human service transportation. • Goal: To help states and communities across the country to better coordinate community transportation, making them more livable, especially for human service program customers. • How: Cooperative Agreement between Federal Transit Administration and Community Transportation Association of America

5. National Resource Center for Human Service Transportation Coordination Collaborates with the Federal Transit Administration (FTA) and the Coordinating Council on Access & Mobility (CCAM) • Provides technical assistance to CCAM • Meets with individual members of the CCAM • Provides support to CCAM meetings Research Technical Assistance (TA) & Training Strategic Partnerships with National Consortium and Other TA Centers Ambassador Program - Ten ambassadors serve all states/territories across the country and are assigned to a FTA region. Region IV includes the States of Florida, Alabama, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee and Puerto Rico.

6. Federal Interagency Coordination Council on Access and Mobility Presidential Executive Order established in 2004, under the direction of Department of Transportation, created the Interagency Transportation Coordinating Council on Access and Mobility (CCAM). The Council works to promote interagency cooperation and establishes mechanisms to minimize duplication and overlap of Federal transportation programs (estimated at 80 programs).

7. Federal Interagency Coordination Council on Access and Mobility • Secretaries of Transportation • Health and Human Services • Education • Labor • Veterans Affairs • Agriculture • Housing and Urban Development • Interior • The Attorney General • The Commissioner of Social Security • And any other department the Secretary of Transportation designates.

8. Florida Has Led Other States to Starting Their Coordination Journey Florida saw this picture long before “coordination was cool’’ !

9. Coordination Is… • The efficient & effective use of limited transportation resources for getting people to work, health care and other daily activities • Working with transit providers, veterans organizations, human service agencies, private institutions, businesses, volunteers and political leaders to broaden transportation options. • Keeping people mobile and independent in their own homes • Encouraging greater use of available transportation resources • Increasing overall health and well-being • Reducing overall costs to society (health care, unemployment, etc.) • Creating cost-sharing arrangements between human service agencies and transportation communities

10. The National Conference of State Legislatures Reports… • 44,000 levels of government are involved in providing or funding transportation. Each has its own laws and regulations to carry out their multitude of responsibilities. • In addition, thousands of non-profit agencies, private companies and individuals are involved with providing transportation services to a wide audience of customers and users. • Coordinating councils are implemented in recognition of the complex governing structures that have arisen over time to meet the needs of various populations for transportation services, which has resulted in a lack of consistency in approaches, an overlap of services in some places, and unconnected services in others. • Close to thirty states now have coordinating councils statutorily created or by a governor’s executive order or initiative. In Florida, a separate state commission implements a statewide coordination scheme.

11. Trends Impacting Transportation Coordination • Planning for the next reauthorization of SAFETEA-LU (Federal Transportation Act) continues to be debated with continued emphasis and expansion for coordination • FTA programs allow for use of human service transportation programs as local match and funding of mobility management functions as another way to improve coordination options • Veterans transportation needs are rising and new federal funds (applications due April 19) are being made available to create access for veterans and their families in a coordinated concept • Medicare for older adults is limited to emergency transportation but plans are proposed to create a non-emergency provision due to the growth in seniors, dialysis transportation and more • The Coordinating Council on Access & Mobility (CCAM) is working on major coordination policies amongst all the federal agencies to improve coordination at the State and local levels

12. Trends Impacting Transportation Coordination • The creation of the NRC managed by CTAA is expected to continue to help states and communities identify and implement ways to work together. • Unemployment is high creating the need for the unemployed and the underemployed to identify other forms of mobility. • More people are in poverty than in recent years due to the economy resulting in more mobility needs for health care, employment, training, etc. • A crisis in kidney disease and dialysis treatment has increased 900 percent. The three-weekly-for-four-hours treatment will create enormous transportation challenges especially for the return trip. Coordinated mobility is the key to solve these challenges. (New) • The nation's population of those 65 and older will double between 2000 and 2030, according to the U.S. Administration on Aging. That adds up to one out of every five Americans — 72.1 million people. • Older Americans desire to “age in place” remaining in their homes. 79% of seniors live in suburban (56%) or rural (23%) communities.

13. Trends Impacting Transportation Coordination • By 2015, more than 15.5 million Americans 65 and older will live in communities where public transportation service is poor or non-existent. That number will grow rapidly as the baby boom generation “ages in place” in suburbs and exurbs with few mobility options for those who do not drive. • Many older adults are returning to work either as paid employees or volunteers and many will need mobility options. Since the start of the recession in 2007, employment for people over 55 has grown by 3.9 million even though payrolls have fallen by 4.2 million. (New) • More than one-third (36 percent) of the 915,000 grandparents ages 60 and older who are caring for their grandchildren, were in the labor force in 2010 (2011 analysis of American Community Survey). • Without access to affordable travel options, seniors who no longer drive make 15 percent fewer trips to the doctor, 59 percent fewer trips to shop or eat out and 65 percent fewer trips to visit friends and family, than drivers of the same age. As the cost of owning and fueling a vehicle rises, many older Americans who can still drive nonetheless will be looking for lower-cost options

14. Trends Impacting Transportation Coordination • AARP reports that older adults predominantly travel in their personal vehicles, but transit use by people age 65+, as a share of all trips they take, has increased by a remarkable 40% between 2001 and 2009. In 2009, older adults took more than 1 billion trips on public transportation. • Most Americans are going to live for a number of years after they cease driving, so the challenge to meet the special transportation needs of these frail older people (85+) continues. • Specialized transportation is the only feasible mode for frail older persons, other than getting rides from others. They will often need travel escorts and door-to-door and door-through door assistance so that they can continue to live independently in their own homes and connected to their communities. • Lost mobility jeopardizes not only the physical and emotional health of the individual who may feel a sense of loss and dependency but also the quality of their community.

15. Trends Impacting Transportation Coordination • As the Baby Boom Generation turns 65 that began in 2011, this generation continues to age and grow, it will demand a level of mobility and an active lifestyle that far outpaces any of America’s previous generations. This aging population will both create and face significant transportation challenges, including a transportation system that lacks many features that would accommodate the level of mobility and safety older Americans desire and expect. • Transportation innovations are needed to accommodate the Baby Boom Generation’s need for improved safety and mobility will benefit users of all ages. • For older Americans, as well as the population in general, the ability to travel represents freedom, activity and choice. Older Americans prize their mobility and active lifestyles and want to maintain them as long as possible. • Few communities have started to think long term about how to plan and redesign services for aging Baby Boomers as they move out of the workforce and into retirement.

16. Trends Impacting Transportation Coordination • Dwindling budgets in a tight economy have pushed communities to cut spending on delivering meals to the homebound and shuttling folks who can no longer drive to grocery stores and doctor's offices. • Six years ago, the National Association of Area Agencies on Aging said less than half of cities it surveyed were preparing to deal with the needs of older folks. It said the results "should serve as a wake-up call for communities to begin planning now.“ Five years later, a survey was done and found little had changed. There was still an identified need for transportation. • Over 50 million people in the U.S. have some type of disability often limiting their mobility – The unemployment rate is 30% or higher with 79% of this population citing transportation as a major barrier. (New) • Veterans who serve our country in the past, present or in the future need access to health care, employment, training and other activities.

17. Trends Impacting Transportation Coordination • By 2014, at least 1.2 million riders will be eligible for Medicaid Non-emergency transportation in Florida • States are moving toward managed care models • Some states without a statewide coordinated network are choosing to hire brokers (usually on a regional level) to manage their NEMT transportation programs • State budgets are expected to continue to see the adverse effects of the recession with severely depressed state revenues and higher demand for human services • States are having to do more with less and State staffing is not increasing • More persons are unemployed qualifying for Medicaid

18. Trends Impacting Transportation Coordination • The 2014 Affordable Health Care Act will bring on new members never before eligible for Medicaid • The new Medicaid population will be mainly adults who have not had insurance: • No preventative care • Chronic untreated conditions • High utilization in the first years • States are turning to Managed Care Organizations (MCO) to manage transportation as well as the medical care • Managed Care Organizations often utilize brokers to manage their transportation needs • States have been using alternative delivery systems to provide health care through HMO’s and Managed Care

19. Strategies to Address Trends • Leadership is the key to success and including all the partners in the TD program is critical for successful outcomes (Nothing About Us Without Us) • Strengthen the coordinated transportation infrastructure by implementing new, cost effective and creative ways to provide these needed services, including, but not limited to: • Expanded bus routes, flex routes, accessible taxis, purchasing more energy efficient vehicles, installing stops or facilities that better accommodate older or physically challenged passengers; and additional non-traditional and private sector approaches to transit, including formal and informal ridesharing, donated vehicle programs, volunteer programs and taxi services. • Partner with others to offer training to help older people drive more safely, installing more road signs that are easier to read and other ways to allow older people the ability to continue driving

20. Strategies to Address Trends • Emphasize cost-effectiveness in everything you do – we all can do better! • Continue documenting your performance relating to trips and purposes and educate elected officials and others with results • Advocate in a united way at all levels with partners at the local, state and federal levels • Reach out to nontraditional partners: health maintenance organizations, local and national foundations, veteran’s organizations, faith based community, volunteer programs, local business leaders and anyone who has a desire to improve mobility • Assist industry leaders like CTAA and other partners to educate Congress to create a Medicare transportation provision (other than ambulances) • Assist CTAA and other partners to create mobility options for America’s veterans and their families • SPREAD THE WORD: Transportation investments lead to decreased costs for healthcare, unemployment related costs and higher emergency transportation costs.

21. Strategies to Address Trends • Increase funding support to address the growing needs (TD Trust Fund, Voluntary Donations to the TD Trust Fund, Public Transit Trust Fund, etc.) • Consider funding and incentives for coordinators and operators who engage in innovative coordination practices • Ensuring that state departments of transportation retain their authority to “flex” a portion of highway funds for transit projects and programs; • Including a “complete streets” policy to ensure that streets and intersections around transit stops are safe and inviting for seniors & other passengers • Promote regional coordination initiatives at both the delivery level and the planning level. Partnerships among the CTC’s could be enhanced as well as Local Coordinating Boards and Planning agencies

22. Strategies to Address Trends Consider FTA Funding that is available to implement mobility management activities. Such activities can include: • Support for short term management activities to plan and implement coordinated services (Development of Coordinated Plans) • The operation of transportation brokerages to coordinate providers, funding agencies and customers (Mobility Managers) • Customer-oriented travel navigator systems and neighborhood travel coordination activities such as coordinating individualized travel training and trip planning activities for customers; (Travel Training) • The development and operation of one-stop transportation traveler call centers to coordinate transportation information on all travel modes • Operational planning for the acquisition of intelligent transportation technologies to help plan and operate coordinated systems • The support of State and local coordination policy bodies and councils • Match requirements vary from 50/50 (operating programs) or 80/20 (capital program funds) Among other sources, match can be used from non-transportation contracts (i.e. Medicaid, Aging, TANF, etc) to stretch available dollars

23. Coordination is Required for FTA Funding • Requirements under SAFETEA-LU (Transportation Bill) in order to receive FTA Section 5310, 5316 and 5317 funds • Section 5310 – Elderly and Individuals with Disabilities Program: Provides for the purchase of vehicles to transport elderly persons or persons with disabilities. • Section 5316 – Job Access and Reverse Commute: Designed to transport welfare recipients and low income individuals to and from jobs and reverse commute activities • Section 5317 – New Freedom Program: Provides improved public transportation services, and alternatives to public transportation, for people with disabilities, beyond those required by the Americans with Disabilities Act of 1990 (ADA)

24. Why Other States Look to Florida • It’s working and you have a track record • You have had a continued commitment for coordination since 1979 • There is a coordinated transportation infrastructure in place in all 67 counties that serves as the gatekeeper for limited tax dollars • There is dedicated funding with the TD Trust Fund • Legislative support continues • Local elected official continue to provide financial and other support • Local Coordinating Boards continue to oversee CTC operations and perform other needed tasks at the local level • Planning agencies continue to provide needed support including developing the required coordinated human service transportation plan in order to receive available FTA funds • The Medicaid agency continues to support coordination and is committed to ensure those funds are used in the most cost effective manner • Medicaid agency works with the Commission to eliminate barriers

25. The Message That Began in 1979 Is The Same But Is More Important Than Ever: • Coordination Brings People Together: Resulting in Increased Mobility, Cost Savings in Other Social Services and Improved Lives • Coordination Maximizes Limited Resources • Coordination Ensures Accountability for Millions of Tax Dollars • Coordination Improves Efficiencies for Participating Human Service Agencies • Coordination Provides a Return on the Investment • And More Important – Coordination Improves the Quality of Life for Floridians

26. Closing Thoughts: • Coordination is not a “one time” event or process • Coordination can be best achieved through the continued efforts of elected officials, experienced transportation and planning entities, health care organizations, veterans organizations, transportation and human service agencies, advocates and others • Coordination is more achievable today due to available technical assistance resources and flexibility in program funding • Coordination is not always easy but it is achievable through trust, teamwork and cooperation • Coordination is a journey - not necessarily a destination

27. Ambassador Assistance is Available • A Clearinghouse of Information on Coordination and Available Resources • A Facilitator at the State, Regional or Local Level • A Mediator • A Problem Solver • Someone Who Cares!

28. Ambassador Contact Information Jo Ann Hutchinson, United We Ride Ambassador-Region 4National Resource Center for Human Service Transportation Coordination (NRC) Toll Free: 800.891.0590, Ext. 730Email: hutchinson@ctaa.org Blog: www.nrctransportation.org Twitter: @4Coordination

29. Any Questions

30. Thank You & United We Ride!