    Transportation-Disadvantaged Populations: Some Coordination
    Efforts Among Programs Providing Transportation Services, but
    Obstacles Persist (30-JUN-03, GAO-03-697).

    Millions of Americans are unable to provide their own
    transportation--or even use public transportation--for Medicaid
    appointments, Head Start classes, job training, or other
    services. Such "transportation disadvantaged" persons are often
    disabled, elderly, or low income. Various federal programs are
    authorized to provide transportation services to them. GAO was
    asked to (1) identify the federal programs that fund such
    transportation services and the amount spent on them, (2) assess
    the extent of coordination among the various programs, and (3)
    identify any obstacles to coordination and potential ways to
    overcome such obstacles.
    -------------------------Indexing Terms-------------------------
    REPORTNUM:   GAO-03-697
        ACCNO:   A07400
      TITLE:     Transportation-Disadvantaged Populations: Some
    Coordination Efforts Among Programs Providing Transportation
    Services, but Obstacles Persist
         DATE:   06/30/2003
      SUBJECT:   Disadvantaged persons
    	     Federal aid for transportation
    	     Interagency relations
    	     Program evaluation
    	     Public assistance programs
    	     Strategic planning
    	     Arizona
    	     Florida
    	     New York
    	     South Dakota
    	     Wisconsin

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    GAO-03-697

    Report to Congressional Requesters

    United States General Accounting Office

    GAO

    June 2003 TRANSPORTATIONDISADVANTAGED POPULATIONS Some Coordination
    Efforts Among Programs Providing Transportation Services, but Obstacles
    Persist

    GAO- 03- 697

    Sixty- two federal programs* most of which are administered by the
    Departments of Health and Human Services, Labor, Education, and
    Transportation* fund transportation services for the
    transportationdisadvantaged. The full amount these programs spend on
    transportation is unknown because transportation is not always tracked
    separately from other spending. However, available information (i. e.,
    estimated or actual outlays or obligations) on 29 of the programs shows
    that federal agencies spent at least

    an estimated $2.4 billion on these services in fiscal year 2001.
    Additional spending by states and localities is also not fully known but
    is at least in the hundreds of millions of dollars.

    Efforts to improve services and achieve cost savings through coordination
    of transportation activities (through sharing resources or information or
    consolidating services under a single agency) among federal agencies vary.
    The Coordinating Council on Access and Mobility* a body with
    representation from the Departments of Transportation and Health and

    Human Services* has undertaken some activities to improve coordination.
    However, other agencies that administer a substantial number of programs
    for the transportation- disadvantaged, such as the Departments of Labor
    and Education, are not part of the Council. In addition, the Coordinating
    Council*s strategic plan is not linked to its action plan and contains few
    measurable performance goals. The strategic and annual performance plans
    of the Departments of Transportation and Health and Human Services contain
    few references to coordination relating to their subagencies and programs
    that fund transportation services for the transportationdisadvantaged, and
    the plans of the Departments of Labor and Education do not mention
    coordinating these services.

    Obstacles impeding coordination include concern among administrators that
    their own participants might be negatively affected, program rules that
    limit use by others, and limited guidance and information on coordination.
    To mitigate these obstacles, officials and experts suggested making
    federal standards more consistent, creating a clearinghouse or better Web
    site to facilitate interagency communication and provide better guidance
    on coordination, and providing financial incentives or instituting
    mandates to coordinate. Examples of Vehicles Used to Serve the
    Transportation- Disadvantaged

    Millions of Americans are unable to provide their own transportation* or
    even use public transportation* for Medicaid appointments, Head Start
    classes, job training, or other services. Such
    *transportationdisadvantaged* persons are often disabled, elderly, or low
    income. Various federal programs are authorized to provide transportation
    services to them. GAO was asked to (1) identify the federal programs that
    fund such

    transportation services and the amount spent on them, (2) assess the
    extent of coordination among the various programs, and (3)

    identify any obstacles to coordination and potential ways to overcome such
    obstacles.

    GAO recommends that the Departments of Labor and Education join the
    Coordinating Council on Access and Mobility. GAO also recommends that the

    Departments of Health and Human Services, Labor, Education, and
    Transportation (1) strengthen the

    Coordinating Council*s strategic plan, (2) include long- term goals and
    measures for coordination in their agencies* strategic and annual
    performance plans, and (3) develop

    and distribute additional guidance and information to encourage
    coordination. The Departments of Health and Human Services, Labor,
    Education, and Transportation generally concurred with the findings and
    recommendations in this report.

    www. gao. gov/ cgi- bin/ getrpt? GAO- 03- 697. To view the full product,
    including the scope and methodology, click on the link above. For more
    information, contact. Katherine Siggerud at (202) 512- 2834.

    Highlights of GAO- 03- 697, a report to congressional requesters

    June 2003

    TRANSPORTATION- DISADVANTAGED POPULATIONS

    Some Coordination Efforts Among Programs Providing Transportation
    Services, but Obstacles Persist

    Page i GAO- 03- 697 Transportation Coordination Letter 1 Results in Brief
    3 Background 6 Sixty- Two Federal Programs Fund Transportation Services to
    Transportation- Disadvantaged Populations 8 Extent of Spending on Services
    for the TransportationDisadvantaged

    Is Not Fully Known but Is in the Billions of Dollars 12 Coordination
    Efforts Vary, but Some Successful Efforts Show

    Promising Results 17 Officials Cited Numerous Obstacles to Successfully
    Coordinating Services and Provided Potential Options to Mitigate Them 28
    Conclusions 36 Recommendations for Executive Action 37 Agency Comments and
    Our Evaluation 38 Appendix I Scope and Methodology 40

    Appendix II Inventory of Federal Programs Providing Transportation
    Services to the TransportationDisadvantaged

    42

    Appendix III Federal and State Coordination Efforts 55 Federal
    Coordination 55 State Coordination 60 Appendix IV Informational Resources
    on Coordination 62

    Web Sites 62 Reports 62 Appendix V Comments from the Department of Health
    and Human Services 63 GAO Comments 66 Contents

    Page ii GAO- 03- 697 Transportation Coordination Appendix VI Comments from
    the Department of Education 67

    Appendix VII GAO Contacts and Staff Acknowledgments 69 GAO Contacts 69
    Staff Acknowledgments 69 Tables

    Table 1: Sixteen Programs Identified by CTAA as Regularly Providing
    Funding for Transportation 10 Table 2: Eleven Programs Spending at Least
    $4 Million in Fiscal

    Year 2001 11 Table 3: Estimated Spending on Transportation Services for
    the Transportation- Disadvantaged by Eight Federal Agencies in Fiscal Year
    2001 13 Table 4: Status of Federal Responses to GAO*s Recommendations

    to Improve Coordination 23 Table 5: Federal Actions Taken in Response to
    GAO Recommendations for Improving Coordination 55 Table 6: Examples of
    State Coordination of Services for the Transportation- Disadvantaged 60
    Figures

    Figure 1: Number of Programs Providing Transportation Services to the
    Transportation- Disadvantaged, by Agency 9 Figure 2: Overlapping Daily
    Routes of Vehicles Serving the

    Transportation- Disadvantaged in Sioux Falls, South Dakota 21

    Page iii GAO- 03- 697 Transportation Coordination Abbreviations

    ADA Americans with Disabilities Act of 1990 CTAA Community Transportation
    Association of America CTAP Community Transportation Assistance Project
    DOL U. S. Department of Labor DOT U. S. Department of Transportation FTA
    Federal Transit Administration GPRA Government Performance and Results Act
    of 1993 HHS U. S. Department of Health and Human Services HUD U. S.
    Department of Housing and Urban Development JARC Job Access and Reverse
    Commute MOE maintenance of effort P. L. public law RTAP Rural Transit
    Assistance Program TANF Temporary Assistance for Needy Families TEA- 21
    Transportation Equity Act for the 21 st Century TCRP Transit Cooperative
    Research Program U. S. C. U. S. Code VA U. S. Department of Veterans
    Affairs VR Vocational Rehabilitation WETAP Wisconsin Employment
    Transportation Assistance Program

    This is a work of the U. S. Government and is not subject to copyright
    protection in the United States. It may be reproduced and distributed in
    its entirety without further permission from GAO. It may contain
    copyrighted graphics, images or other materials. Permission from the
    copyright holder may be necessary should you wish to reproduce copyrighted
    materials separately from GAO*s product.

    Page 1 GAO- 03- 697 Transportation Coordination June 30, 2003 The
    Honorable Don Young

    Chairman The Honorable James L. Oberstar Ranking Democratic Member
    Committee on Transportation and Infrastructure House of Representatives

    The Honorable Thomas E. Petri Chairman The Honorable William O. Lipinski
    Ranking Democratic Member Subcommittee on Highways, Transit, and Pipelines
    Committee on Transportation and Infrastructure House of Representatives

    The ability to access personal or public transportation is fundamental for
    people to connect with employment opportunities, health and medical
    services, educational services, and the community at large. However,
    certain populations in the United States lack the ability to provide their
    own transportation or have difficulty accessing whatever conventional
    public transportation may be available. These
    *transportationdisadvantaged* persons may have an age- related condition,
    a disability, or income constraints. This is potentially a sizeable group.
    For example,

    according to the 2000 U. S. Census, 35.1 million people were over age 65,
    44.5 million people were over age 21 and disabled, and 33.9 million people
    were living below the poverty line. Many within these populations face
    significant problems in accessing transportation.

    Many federal programs authorize use of funds to provide transportation for
    transportation- disadvantaged people so they can access government
    programs. Programs that provide incidental transportation include health
    and medical programs, job- training programs, or programs for the aging.

    The coordination of these transportation services* through pooling
    resources, consolidating trips provided by various agencies under a single
    agency, or sharing information between programs* has been found to improve
    the quality and cost- effectiveness of service. At the federal level, the
    Coordinating Council on Access and Mobility* a body consisting of
    representatives from the Departments of Health and Human Services and
    Transportation* is charged with coordinating transportation services
    provided by federal programs and promoting the maximum feasible

    United States General Accounting Office Washington, DC 20548

    Page 2 GAO- 03- 697 Transportation Coordination coordination at the state
    and local levels. In a 1999 report, 1 we found that these coordination
    efforts needed strengthening. We have also issued

    other reports raising concerns about service coordination. 2 You asked
    that we study the extent to which government agencies and programs are
    currently providing transportation services to the transportation-
    disadvantaged and coordinating the provision of these transportation
    services and that we update you on actions taken by the Coordinating
    Council since our 1999 report. This report addresses (1) the federal
    programs that provide transportation services for
    transportationdisadvantaged populations and the types of services they
    provide; (2) federal, state, and local government spending for
    transportation services through these federal programs; 3 (3) the extent
    of coordination among state, local, and federal agencies in delivering
    transportation services for the transportation- disadvantaged, including
    actions taken by the Coordinating Council; and (4) any obstacles that may
    impede effective coordination and potential options for overcoming such
    obstacles.

    Our overall approach was to (1) review federal laws and regulations
    governing the use of federal funds for services for
    transportationdisadvantaged populations; (2) analyze spending data where
    available; (3) review federal and other governmental activities and the
    research literature related to the coordination of transportation
    services; and (4) obtain the views of more than 100 officials from
    federal, state, and local government agencies, industry and client
    advocacy groups, and other experts involved with or affected by the
    coordination process on the obstacles and options for improving
    coordination. Many of these interviews were part of case studies that we
    conducted in five states* Arizona, Florida, New York, South Dakota, and
    Wisconsin* to understand how these various federal programs were
    implemented and coordinated at the state and local level. We chose these
    states to include a cross section

    1 U. S. General Accounting Office, Transportation Coordination: Benefits
    and Barriers Exist, and Planning Efforts Progress Slowly, GAO/ RCED- 00- 1
    (Washington, D. C.: Oct. 22, 1999).

    2 U. S. General Accounting Office, Welfare Reform: Job Access Program
    Improves Local Service Coordination, but Evaluation Should Be Completed,
    GAO- 03- 204 (Washington, D. C.: Dec. 6, 2002); Hindrances to Coordinating
    Transportation of People Participating in Federally Funded Grant Programs:
    Volume I, GAO/ RCED- 77- 119 (Washington, D. C.: Oct. 17, 1977).

    3 For the purposes of this report, spending refers to estimated or actual
    outlays or obligations, depending on what information was available from
    the agency.

    Page 3 GAO- 03- 697 Transportation Coordination of characteristics
    including urban/ rural mix, geographic area of the country, and presence
    or absence of a state council or other coordinating

    body. Appendix I contains more information about our scope and
    methodology.

    We identified 62 federal programs* most of which are administered by the
    Departments of Health and Human Services, Labor, Education, and
    Transportation* that are used to fund transportation services for
    transportation- disadvantaged populations. Sixteen of these seem
    particularly relevant in that the Community Transportation Association of
    America 4 identified them as being regularly used to fund transportation
    services. In addition, based on available information, we identified 11
    other programs that are notable, in that transportation spending under
    each one was at least $4 million in fiscal year 2001. While the remaining
    programs also fund transportation services, they do so minimally, or the
    extent of transportation services funded is unknown, according to program
    officials. Most programs purchase transportation services from existing
    private or public providers. For example, several programs in the

    Department of Labor typically provide bus tokens, and Medicaid providers
    often contract with local transportation providers. 5 In contrast,
    Department of Transportation programs and several others such as Head

    Start in the Department of Health and Human Services typically purchase
    and operate vehicles or modify them for use by individuals with
    disabilities. Several of these 62 programs are required to coordinate
    services they provide with other agencies providing similar services,
    which can include transportation.

    Federal, state, and local spending for these transportation services is in
    the billions of dollars, although the full extent of spending is unknown
    because transportation spending is not always tracked separately from
    other program spending. In the 29 programs for which we could obtain

    actual spending amounts or estimates from program officials, federal 4 The
    Community Transportation Association of America is a national,
    professional membership association that conducts research and provides
    technical assistance for community transportation providers. See Community
    Transportation Association of America, Building Mobility Partnerships:
    Opportunities for Federal Investment

    (Washington, D. C.: March 2002). 5 Medicaid is a joint federal- state
    program to finance health care coverage for certain categories of low-
    income individuals, including families with children, persons with
    disabilities, and elderly individuals. Results in Brief

    Page 4 GAO- 03- 697 Transportation Coordination spending on transportation
    services for transportation- disadvantaged populations was at least $2.4
    billion in fiscal year 2001. Department of Health and Human Services
    programs spent about three- quarters of this

    amount. State and local agencies also provide funding for many of these
    programs, often to fulfill matching requirements, which generally range
    from 5 to 50 percent of total program costs for these programs. Estimates
    of state and local spending are generally not available because few
    agencies track such information at the federal or state level. However,
    based on available information, it is evident that state and local
    contributions for these services are significant* at least several hundred
    million dollars.

    Efforts to improve services and achieve cost savings through coordination
    of transportation activities among agencies at all levels of government
    vary; however, in some areas we visited, close coordination among
    providers has shown promising results. Some local agencies have realized
    substantial benefits by coordinating their transportation services through
    sharing vehicles, consolidating services under a single agency, or sharing
    information about available services. For example, a transit agency in
    South Dakota consolidated the transportation services previously provided
    by both senior and medical centers as well as other federal, state, and
    local programs. This consolidation allowed the agency to expand its

    service hours and increase the number of trips provided while reducing the
    average cost of providing each trip by about 20 percent. We found
    instances, however, in which there were overlapping, fragmented, or
    confusing services among programs that did not coordinate. For example, a
    local official said that the vans delivering clients to the local job
    center are owned by many different programs, but because the programs do
    not coordinate, only a few people ride in each van. At the federal level,
    agencies have taken some limited steps to coordinate their transportation
    programs since our 1999 report. 6 For example, the Coordinating Council on
    Access and Mobility has finalized a strategic plan and issued guidelines
    for coordinating transportation services. However, the long- term goals
    and objectives in its strategic plan are generally not measurable, and
    they are not linked to the activities in the Council*s action plan. Also,
    the strategic and annual performance plans of the Departments of
    Transportation and Health and Human Services contain few references to
    coordination of programs for the transportation- disadvantaged, and the
    plans of the Departments of Labor, Education, and the other federal
    agencies contain

    6 GAO/ RCED- 00- 1.

    Page 5 GAO- 03- 697 Transportation Coordination no such references. In
    addition, the Coordinating Council only includes officials from two
    federal departments (Transportation and Health and

    Human Services), representing less than half of the 62 federal programs
    that can be used to fund services for the transportation- disadvantaged,
    while the Departments of Labor and Education, which administer onethird of
    the programs, are not members of the Council. Furthermore, while the
    Coordinating Council is working to improve its Web site, the site is not
    linked to the Web site of the Department of Health and Human Services,
    making it more difficult for human service agencies at all government
    levels to be aware of and access the site.

    Although decision makers face numerous obstacles in trying to coordinate
    transportation services for the transportation- disadvantaged, officials
    and experts that we consulted also offered several potential options to
    mitigate these obstacles and enhance coordination among federal, state,
    and local agencies. We grouped the obstacles into three categories: (1)
    reluctance to share vehicles and fund coordination activities due to
    concerns about

    possible adverse effects on clients; (2) different eligibility
    requirements, safety standards, and other programmatic requirements that
    can limit programs* ability to share transportation resources; and (3)
    lack of leadership and commitment to coordinate, as evidenced by the
    limited guidance and information provided by federal and state agencies on
    the possible techniques for coordinating services. To mitigate these
    obstacles, officials and experts suggested three potential options. One
    option is to

    harmonize standards among federal programs* such as safety standards
    related to types of seat belts and driver training requirements* so that
    programs can serve additional populations or better share transportation
    resources. Another option is to expand interagency forums that would
    facilitate communication among agencies involved in coordination efforts
    and to share additional technical guidance and information on coordination
    among federal and state agencies through a central clearinghouse or
    improved Web site. The third option is to provide financial incentives or
    mandates that would give priority in federal funding to those grant
    applicants that show a strong commitment to coordinate or

    require specific coordination efforts among grant recipients as a
    condition of receiving federal funding. We did not assess the costs and
    benefits of these options; however, some would require extensive statutory
    or regulatory changes and could cause agencies to incur significant costs.

    Given the multiplicity of federal programs that can fund transportation
    services for the transportation- disadvantaged, and the significant
    amounts spent on those services, effective coordination efforts are needed
    to ensure that transportation services reach the greatest number of

    Page 6 GAO- 03- 697 Transportation Coordination recipients. Accordingly,
    our report contains several recommendations designed to strengthen and
    enhance coordination activities in the four

    federal departments that administer most of the programs that fund
    transportation services* Health and Human Services, Labor, Education, and
    Transportation. In commenting on the draft of this report, those four

    departments generally concurred with the findings and recommendations. In
    addition, we provided the draft report to two other departments that
    provide services to the transportation- disadvantaged* Housing and Urban
    Development and Veterans Affairs* and those departments also agreed

    with the findings. In some cases, these departments also provided
    technical clarifications, which were incorporated as appropriate to ensure
    accuracy.

    Many elderly, disabled, and low- income individuals face significant
    challenges in accessing transportation. For example, some of these
    challenges are as follows:

     Sixteen percent of respondents over age 75 reported not having a
    driver*s license in 2001, and 25 percent of the respondents had not driven
    at least once in the last month according to an AARP survey. 7 Elderly
    people are also more likely to have difficulty accessing traditional
    public transportation due to physical ailments.

     Thirty percent of respondents with disabilities reported difficulty in
    accessing transportation, compared to 10 percent of respondents without a
    disability, according to a 2000 survey by the National Organization on
    Disabilities.

     Low- income households are less likely to own a car than other
    households due to the prohibitive cost of purchasing, insuring, and
    maintaining a car, and public transportation may not provide sufficient
    options for their needs. Over 90 percent of public assistance recipients
    do not own a car. 8 7 Anita Stowell Ritter, Audrey Straight, Ed Evans,
    Understanding Senior Transportation:

    Report and Analysis of a Survey of Consumers Age 50+ (Washington, D. C.:
    AARP Public Policy Institute, 2002).

    8 U. S. Federal Highway Administration and U. S. Federal Transit
    Administration, 2002 Status of the Nation*s Highways, Bridges, and
    Transit: Conditions and Performance

    (Washington, D. C.: Department of Transportation, 2003). Background

    Page 7 GAO- 03- 697 Transportation Coordination The importance of
    coordinating transportation services for transportationdisadvantaged
    populations has been evident since the 1970s. In 1977, we

    issued a report on transportation coordination, 9 which concluded that the
    most significant hindrance to the coordination of transportation services
    under these programs was confusion at all levels of government as to how
    much coordination federally funded projects could engage in. Since 1986,
    responsibility for coordinating transportation programs at the federal
    level has rested in the Coordinating Council on Access and Mobility, which
    was created under a memorandum of understanding between the Department of
    Health and Human Services (HHS) and the Department of Transportation
    (DOT). This body is composed of representatives from program offices
    within these departments, and employees of the two departments meet its
    staffing needs, on a part- time basis.

    More recent reviews have continued to identify a need for stronger efforts
    in this area. In a 1999 report on transportation coordination, 10 we found
    that coordination efforts of the Coordinating Council, DOT, and HHS were
    ongoing but still needed strengthening. This report also noted that the
    Congress had endorsed increased coordination as evidenced by several
    provisions in the Transportation Equity Act for the 21st Century (TEA21),
    11 and significant financial benefits had been realized through

    coordination. In addition, reports by advocacy groups and transportation
    researchers have raised concerns over continuing duplication of effort
    among federal programs and certain sub- populations still not being served
    effectively. 12 9 GAO/ RCED- 77- 119. 10 GAO/ RCED- 00- 1.

    11 P. L. 105- 178. 12 For example, a report prepared for AARP found that
    transportation resources for the elderly, disabled, and other groups were
    often not coordinated, leading to duplication of services. The services
    were also found to vary in quality and to fail to address the needs of
    individuals who did not meet specific agency or program eligibility
    requirements. See Jon E. Burkhardt, Coordinated Transportation Systems
    (Washington, D. C.: AARP, September 2000).

    Page 8 GAO- 03- 697 Transportation Coordination We identified 62 federal
    programs that fund transportation services to populations that are
    transportation- disadvantaged. 13 As shown in figure 1, the bulk of these
    programs are administered by four federal agencies* 23 programs in HHS, 15
    programs in the Department of Labor (DOL), 8

    programs in the Department of Education, and 6 programs in DOT. 14 The
    remaining 10 programs are administered by the Departments of Housing and
    Urban Development (HUD), Veterans Affairs (VA), Agriculture, and the
    Interior. A full listing of programs, their authorizing legislation,
    typical uses, types of trips provided, target populations, and spending
    information is found in appendix II.

    13 In addition to these 62 programs, it is likely that there other federal
    programs that could be used to fund transportation improvements or other
    transportation services. Our scope included programs that provide
    nonemergency, nonmilitary, surface transportation services, targeted to
    transportation- disadvantaged populations. We excluded most programs that
    were strictly for research or demonstration activities or provided
    strictly cash assistance with no restrictions on use, as well as some
    economic development programs that benefit the general public and are not
    targeted to transportationdisadvantaged

    populations. Efforts by other researchers to inventory all federal
    programs that could conceivably provide transportation yielded additional
    programs not found in our inventory due to differing selection criteria.
    See Building Mobility Partnerships: Opportunities for Federal Investment.

    14 Two DOT programs that are included here, the Urbanized Area and
    Nonurbanized Area Formula Programs, are used to support mass transit
    intended for the general public, many of whom could conceivably provide
    their own transportation. We include them because the Americans with
    Disabilities Act (ADA) of 1990 (42 U. S. C. 126) requires that transit
    operators provide accessible paratransit service that is comparable to
    their regular service for disabled individuals who are unable to provide
    their own transportation or access the regular transit system, and TEA- 21
    allows a portion of these transit formula grants to be used to offset
    paratransit operating costs. Sixty- Two Federal

    Programs Fund Transportation Services to TransportationDisadvantaged

    Populations

    Page 9 GAO- 03- 697 Transportation Coordination Figure 1: Number of
    Programs Providing Transportation Services to the Transportation-
    Disadvantaged, by Agency

    Many of the 62 programs are significantly involved in providing
    transportation services to their recipients. These include 16 programs
    identified by the Community Transportation Association of America

    (CTAA) 15 as being routinely used to provide transportation and an
    additional 11 programs that we identified as spending at least $4 million
    for transportation services to transportation- disadvantaged populations
    in fiscal year 2001 on the basis of funding data or estimates that were

    available. The remaining programs also fund transportation services, but
    do so minimally, or the extent of transportation services funded is
    unknown, according to program officials. Table 1 shows the 16 programs
    identified by CTAA and how they provide transportation. These 16 programs
    are administered by DOT, HHS, Education, and DOL. As the table shows,
    transportation is not the primary purpose of most of these programs. For
    example, Medicaid provides payments for medical services, and the
    Vocational Rehabilitation Grants Program provides training and employment
    services to individuals with disabilities. 15 Building Mobility
    Partnerships: Opportunities for Federal Investment.

    Page 10 GAO- 03- 697 Transportation Coordination Table 1: Sixteen Programs
    Identified by CTAA as Regularly Providing Funding for Transportation
    Agency Program Description

    Department of Education Vocational

    Rehabilitation Grants Assists states in operating programs that provide
    vocational rehabilitation services

    for individuals with disabilities. Services include counseling, training,
    job placement, and other supportive services, including transportation.
    Grants for Supportive Services and Senior Centers

    Assists states in developing a community- based system of services for
    older individuals. Services provided include nutrition services, caregiver
    support services, senior centers, and transportation services. Program for
    American Indian, Alaskan Native, and Native Hawaiian Elders

    Assists tribal organizations in the delivery of supportive services to
    older Native Americans. Services provided include nutrition services,
    caregiver support services, senior centers, and transportation services.

    Head Start Assists local grantees in providing a program of comprehensive
    health, educational, and other services to promote school readiness for
    low- income children. Transportation to and from program services is
    generally provided. Medicaid Assists states in payments for medical
    assistance to populations that meet categorical eligibility (such as
    families with children or persons who are elderly or

    disabled) as well as income and resource requirements. States are required
    to assure transportation to medical services. Department of

    Health and Human Services

    Temporary Assistance for Needy Families Provides grants to states or
    tribes to assist needy families with children. Grantees

    have the flexibility to use funds in any manner that meets the purposes of
    the program, which can include transportation to services. Senior
    Community Service Employment Program

    Assists states and other grantees in providing work opportunities in
    community service activities for low- income individuals 55 years of age
    and older. Transportation to training and job placements can be provided.

    Workforce Investment Act Adult Services Program

    Assists states in providing workforce investment activities. *Intensive*
    services provided to low- income participants include occupational and
    basic skills training, and transportation can be provided to access such
    services. Workforce Investment Act Dislocated Worker Program

    Assists states in providing workforce investment activities. *Intensive*
    services provided to low- income participants include occupational and
    basic skills training, and transportation can be provided to access such
    services. Department of

    Labor Workforce Investment Act Youth Activities Assists states in
    providing workforce investment activities that will help low- income

    youth acquire the skills, training, and support needed to achieve
    employment success. Transportation can be provided to access services.
    Capital Investment

    Grants Assists states in financing facilities for use in mass public
    transportation service. Projects can include those that are designed to
    meet the special needs of elderly or

    disabled individuals. Urbanized Area Formula Program Assists urbanized
    areas in financing capital projects for use in mass transportation
    service. Ten percent of funds may be used to pay for ADA paratransit
    operating

    costs. a Nonurbanized Area Formula Program Assists nonurbanized areas with
    capital and operating expenses needed to provide

    public transportation service. Ten percent of funds may be used to pay for
    ADA paratransit operating costs. Job Access and Reverse Commute Provides
    grants to develop transportation services to connect low- income persons
    to

    employment and support services. Funds can be used for capital and
    operating costs associated with new or expanded service. Department of

    Transportation Capital and Training Assistance for Overthe- Road Bus
    Accessibility

    Assists private operators of over- the- road buses with financing capital
    and training costs associated with making buses accessible to individuals
    with disabilities.

    Page 11 GAO- 03- 697 Transportation Coordination Agency Program
    Description

    Capital Assistance Program for Elderly Persons and Persons with
    Disabilities

    Provides financial assistance to nonprofit organizations in meeting the
    transportation needs of elderly persons and persons with disabilities
    where public transportation services are unavailable, insufficient, or
    inappropriate. Funds may be used for eligible capital expenses, such as
    purchasing vehicles, or to contract for service. Sources: CTAA and Catalog
    of Federal Domestic Assistance.

    a The ADA required that all fixed route transportation services and
    facilities be accessible to individuals with disabilities, including
    wheelchair users. While the ADA gave priority to providing such
    transportation in the same vehicles used by the general riding public, it
    also required complimentary paratransit systems as a *safety net* for
    individuals whose disabilities prevent them from using accessible fixed-
    route services.

    Table 2 shows the 11 programs we identified as spending at least $4
    million on transportation for the transportation- disadvantaged in fiscal
    year 2001.

    Table 2: Eleven Programs Spending at Least $4 Million in Fiscal Year 2001
    Agency Program

    Department of Agriculture Food Stamp Employment and Training Program
    Department of Education 21st- Century Community Learning Centers
    Department of Labor Job Corps

    Community Health Centers HIV Care Grants Social Services Block Grants
    Department of Health and

    Human Services State Children*s Health Insurance Program Community
    Development Block Grant Department of Housing and Urban Development
    Supportive Housing Program Automobiles and Adaptive Equipment for Certain

    Disabled Veterans Department of Veterans Affairs Veterans Medical Care
    Source: GAO. Under most of the federal programs providing transportation
    services,

    funding recipients typically purchase the services from existing sources,
    according to program officials. This includes contracting for services
    with private transportation providers or providing bus tokens, transit
    passes, taxi vouchers, mileage reimbursement to volunteers or program
    participants, or some combination of these methods. For example,

    recipients of funds from DOL*s Workforce Investment Act Adult Services
    Program typically provide bus tokens or mileage reimbursement for
    participants to access training, while recipients of HHS*s Grants for
    Supportive Services and Senior Centers most often contract with local
    transportation providers to provide client transportation. The funding
    recipients of several programs, however, typically purchase and operate

    Page 12 GAO- 03- 697 Transportation Coordination vehicles, or modify
    existing vehicles for use by individuals with disabilities. These programs
    include Head Start and the Program for

    American Indian, Alaskan Native, and Hawaiian Elders in HHS; the
    Vocational Rehabilitation Grants Program in the Department of Education;
    and the six programs within DOT.

    Several of these programs have requirements for grantees to coordinate
    their services with other agencies providing similar services, which would
    include transportation, among other services. For example, Head Start
    grantees are required to make every reasonable effort to coordinate
    transportation services they provide with other human service
    transportation in their communities. Similarly, DOT*s Capital Assistance
    Program for Elderly Persons and Persons with Disabilities, Job Access and
    Reverse Commute, and Nonurbanized Area Formula Program have requirements
    for grantees to coordinate their transportation services. In addition,
    some programs have provisions designed to avoid duplication of effort and
    encourage the use of existing community resources. For example, Workforce
    Investment Act programs may use funds to support those who are
    participating in the program only if those individuals are unable to
    obtain services through other programs, according to program officials.
    Also, the Veterans* Workforce Investment Program requires

    grantees to provide information on the linkages this program will have
    with other providers of services to benefit veterans.

    Available information shows that federal programs spent an estimated $2.4
    billion on transportation services for transportation- disadvantaged
    populations in fiscal year 2001, and additional state and local spending
    for these populations was several hundred million dollars more. Complete
    spending information is not available because many federal funding
    recipients are not required to distinguish transportation from other
    spending when reporting spending information to federal agencies. Extent
    of Spending on

    Services for the TransportationDisadvantaged Is Not Fully Known but Is in
    the Billions of Dollars

    Page 13 GAO- 03- 697 Transportation Coordination Information on federal
    spending for transportation is available for 29 of the 62 programs we
    identified. 16 These programs spent an estimated $2.4 billion on
    transportation services in fiscal year 2001. (Appendix II lists

    available spending data for each federal program.) Based on available
    information, HHS programs as a whole spent the most on transportation for
    transportation- disadvantaged populations in 2001* an estimated $1.8
    billion. Table 3 shows estimated transportation spending by the eight

    federal agencies that fund services for the transportation- disadvantaged.

    Table 3: Estimated Spending on Transportation Services for the
    Transportation- Disadvantaged by Eight Federal Agencies in Fiscal Year
    2001

    Agency Amount spent on

    transportation for transportationdisadvantaged

    (in millions) Percent of total estimate Number of programs

    included in estimate Total number of

    programs that provide transportation

    Department of Health and Human Services $1,771.0 72.4% 10 23

    Department of Transportation $317.3 13.0% 6 6

    Department of Veterans Affairs $160.8 6.6% 3 3

    Department of Education $135.3 5.5% 2 8

    Department of Labor $26.4 1.1% 3 15

    Department of Housing and Urban Development $21.7 0.9% 4 4

    Department of Agriculture $13.0 0.5% 1 1

    Department of the Interior Not available 0.0% 0 2 Total (for 8 agencies)
    $2,445.5 100.0% 29 62

    Sources: GAO summary of HHS, DOT, VA, Education, DOL, Agriculture, HUD,
    and Interior data and estimates. More than three- quarters of our estimate
    is based on spending for transportation in five programs. Of the five,
    Medicaid and Head Start, both in HHS, spent the most on transportation in
    fiscal year 2001* an estimated $976.2 million and $514.5 million,
    respectively. The three other programs, all of which spent more than $100
    million on services for the

    transportation- disadvantaged in fiscal year 2001, were DOT*s Capital
    Assistance Program for Elderly Persons and Persons with Disabilities,

    16 Of these 29 programs, 17 provided actual spending data for fiscal year
    2001. Program officials for the remaining 12 programs provided an estimate
    of transportation spending for 2001. Spending by 29 Federal

    Programs Is Estimated at $2.4 billion in Fiscal Year 2001

    Page 14 GAO- 03- 697 Transportation Coordination HHS*s Temporary
    Assistance for Needy Families (TANF), and VA*s Veterans Medical Care
    Benefits.

    The amount spent on transportation services by the remaining 33 federal
    programs is unknown, mainly because the majority of programs do not
    require recipients of federal funds to report transportation spending
    information to the federal agency. 17 Total state and local spending for
    transportation services, which

    supplements federal spending for such programs, is likely significant* at
    least in the hundreds of millions of dollars* although the total is
    unknown because most programs do not require grantees to report these
    data. Matching requirements, which represent the nonfederal contributions
    to the program*s costs that come from state, local, or private funds,
    provide some information on state and local spending on transportation for
    the transportation- disadvantaged. About half of the 62 programs have
    matching requirements that generally require states and localities to
    contribute between 5 and 50 percent of total costs. 18 Additionally,
    limited information from officials in the five states we visited indicates
    that total

    17 Total program obligations for these 33 programs were about $14.8
    billion in fiscal year 2001. While information was not available on the
    portion of the $14.8 billion devoted to providing transportation services,
    we were able to analyze data on other human services programs which
    indicate that, on average, about 3 percent of total spending on those

    programs was devoted to transportation. We do not know whether this 3
    percent is an appropriate estimate of transportation spending for these 33
    programs because grantees are not required to report transportation
    spending information to the federal agency. Furthermore, several officials
    who administer programs that had no spending data told us that
    transportation services probably represented less than 1 percent of their
    total program spending. 18 It is difficult to determine the amount of
    nonfederal contributions to transportation services on the basis of
    matching requirements because grantees are generally required to

    match total program spending rather than spending for a particular
    service, such as transportation. To illustrate, Head Start grantees are
    required to contribute 20 percent of total program costs, not necessarily
    20 percent of transportation costs. Transportation under the program could
    be entirely funded from federal dollars while the local share is used to
    fund teachers or other program costs. The issue is further complicated
    because

    some of these programs have maintenance of effort (MOE) requirements
    (which require states and localities to maintain their contributions to a
    program at some pre- determined level) rather than matching requirements.
    Under the TANF program, for example, the state*s MOE requirement is
    determined through an index against the amount the state spent

    for fiscal year 1994 under the Aid to Families with Dependent Children
    program. MOE funds will, therefore, constitute a different percentage of
    total program spending for each state in each year. State and Local

    Transportation Spending Is Unknown, but Is Likely Significant

    Page 15 GAO- 03- 697 Transportation Coordination state and local spending
    on transportation runs into the hundreds of millions of dollars. For
    example:

     Nonfederal contributions for Medicaid nonemergency transportation ranged
    from 32 to 50 percent of the total spending on this service in the five
    states that we visited. 19 In New York, 50 percent, or an estimated $139.4
    million, of the state*s total spending on Medicaid funded transportation
    in 2001 was from nonfederal sources. In Florida and Wisconsin
    approximately 40 percent of the total amount spent on nonemergency medical
    transportation in the state was from nonfederal sources; state
    contributions in those states were $28.6 million and $13.4 million,
    respectively, in 2001. In Arizona and South Dakota, approximately one-
    third of the total amount spent on Medicaid transportation was from
    nonfederal sources in those states in 2001, approximately $7.0 million and
    $490, 000, respectively.  In Wisconsin nearly 38 percent, or $922,000, of
    the funding to provide

    transportation services through DOT*s Capital Assistance Program for
    Elderly Persons and Persons with Disabilities in 2001 was from nonfederal
    sources. The program requires grantees to provide 20 percent of total
    program funding.

     In New York, about 30 percent of the spending on transportation under
    the Department of Education*s Vocational Rehabilitation Program in 2002,
    or $2.6 million, was from nonfederal sources. 20 Similarly, about 27
    percent or

    $673,000 of Florida*s funding was from nonfederal sources in 2001. The
    program requires states to contribute 21.3 percent of total costs.

    Although some states and localities currently spend a significant amount
    for transportation through federal programs, many now face budget deficits
    that could diminish their future contribution to these programs. In a 2003
    survey by the National Conference of State Legislatures, 21 36 states

    19 The amount that states are required to contribute depends on how states
    claim transportation under Medicaid. If states claim Medicaid as an
    optional medical expense, the state or local portion ranges from 17 to 50
    percent of total costs, based on a measure known as the Federal Medical
    Assistance Percentage. If states claim transportation as an administrative
    expense, the state or local portion is 50 percent of total costs. 20 Data
    for state fiscal year 2001 were not available. Program officials indicate
    that there should not be significant differences in 2001 and 2002 spending
    information. 21 National Conference of State Legislatures, State Budget
    Update: February 2003

    (Washington, D. C.: February 2003).

    Page 16 GAO- 03- 697 Transportation Coordination reported budget deficits
    midway through their fiscal year. Fifteen of these states reported
    deficits in excess of 5 percent of the state budget, and four

    states are facing deficits greater than 10 percent of the state budget.
    Because 49 states have balanced budget requirements, such large deficits
    could lead to a decrease in the amount of funds available to states for

    programmatic spending, including transportation programs. For example,
    according to the National Conference of State Legislatures report, 29
    states have imposed across- the- board cuts in response to budget
    deficits.

    State budget deficits have affected state transportation spending
    differently in the five states that we visited. For example:

     Two of the states have cut their state programs that local grantees used
    to fund services for the transportation- disadvantaged, according to
    transportation officials in those states. In one state, the state
    legislature eliminated the state*s transportation assistance program to
    help deal with the state*s budget deficit; as a result, the state official
    and the director of a senior center in the state said that some of the
    projects funded through the

    program will likely be discontinued because grantees cannot find
    replacement funds. In the other state, the state legislature cut a state
    fund that grantees used to supplement federal transportation funding.

    According to an official, the loss of this fund, combined with the
    increasing costs of fuel and insurance, may lead providers to cut service
    to transportation- disadvantaged populations by as much as 40 percent.

     In another state, the Governor*s plan for closing the state*s budget gap
    includes reducing spending on Medicaid nonemergency medical transportation
    by $5 million, or 7.6 percent; however, the state*s fund dedicated to
    providing other services for the transportation- disadvantaged was not
    recommended for cuts.

     Transportation officials in two states told us that they had not yet
    experienced cuts in state funding for services for the
    transportationdisadvantaged. In one of the states, local grantees rely on
    a state transportation fund and a large set- aside of TANF funds to
    provide services to transportation- disadvantaged populations. Without
    these two funds, local grantees would have difficulty financing services
    for the transportation- disadvantaged, according to an official. The other
    state is not currently anticipating cuts in state funding for services for
    transportation- disadvantaged populations, however, according to an
    official, the full impact of the fiscal situation in that state will not
    be known until local governments develop program budgets for 2004 because
    the local governments* which are also facing budget constraints* play a
    key role in determining what services will be provided.

    Page 17 GAO- 03- 697 Transportation Coordination While some states are not
    currently experiencing reductions in their transportation programs, many
    states are anticipating that budget deficits

    will continue into 2004. According to the National Conference of State
    Legislatures report, 36 states are anticipating budget gaps for 2004;
    nearly all of these states anticipate gaps greater than 5 percent of their
    state

    budget and half of these states expect gaps greater than 10 percent. 22
    Efforts to improve services and achieve cost savings through coordination
    of transportation activities among agencies at all levels of government
    vary. At the state and local levels, the extent and the type of
    coordination activities differ, ranging from one state body providing
    guidance and overseeing coordination efforts for most of its programs to
    two local agencies sharing vehicles. In some areas within the five states
    we visited, coordination among providers has resulted in significant
    benefits, such as improved customer service and lower unit costs. However,
    we also found some examples of overlapping, fragmented, or confusing
    services resulting

    from a lack of coordination. At the federal level, DOT, HHS, and* to some
    extent* DOL have undertaken some activities aimed at improving
    coordination among their programs. DOT and HHS implement many of their
    activities through the Coordinating Council on Access and Mobility.
    However, DOT and HHS make only a few mentions of coordinating services for
    the transportation- disadvantaged in their strategic and annual
    performance plans, and other agencies do not mention such activities at
    all. Also, several federal agencies that provide services to the
    transportation- disadvantaged are not involved in coordination efforts at

    the national level. While agencies within each state we visited were
    involved in some form of coordination, the extent of coordination of
    transportation services varies widely. For example, Florida has a state
    organization that oversees the

    coordination of most of the transportation services for the
    transportationdisadvantaged, while some other states we visited had no
    statewide coordination body. Even in states without such a coordinating
    body, however, some state and local agencies are engaged in coordination
    efforts. This variation also occurred in the nation as a whole, according
    to data from a preliminary report by the National Academy of Sciences*
    Transportation Research Board, which found that roughly half of U. S.

    22 Eleven states and the District of Columbia did not report 2004 budget
    deficit information. Coordination Efforts

    Vary, but Some Successful Efforts Show Promising Results

    Extent of State and Local Transportation Coordination Varies

    Page 18 GAO- 03- 697 Transportation Coordination states have a state
    transportation coordinating body. 23 (See appendix III for information on
    the type of coordination in the five states we visited

    and the state agencies involved.) Within each state, local efforts also
    varied. Examples of coordination activities include the following:

    Coordinated planning: In this type of coordination, some combination of
    human service and transportation agencies and providers work together to
    plan transportation services for their clients. For example, in
    northwestern

    Wisconsin, at the initiative of staff from a center for independent
    living, the Area Consortium on Transportation was formed in 2001 to
    improve the planning and provision of transportation for the disabled and
    others who

    are transit- dependent. The council* which consists of consumers, transit
    providers, county and city officials, disability organizations, and aging
    groups* is instituting several pilot programs to test various methods of

    coordination.

    Brokerage: 24 In this type of coordination, one agency or provider serves
    as the central point of contact for providing ride and eligibility
    information or actually arranging transportation services for clients of
    multiple programs. For example, officials in several New York counties
    wanted to maximize residents* mobility by coordinating transportation
    services offered by various federal and state programs, but lacked the
    expertise or start- up costs to do so. With a grant from the state
    Departments of Transportation and Health, the counties instituted a
    coordination demonstration project whereby one agency arranges an average
    of 2, 500 daily trips for clients from a number of populations* such as
    the disabled, senior citizens, former welfare recipients, and others*
    served by different federal and state programs.

    23 Westat, Toolkit for Rural Community Coordinated Transportation
    Services, Transit Cooperative Research Project of the Transportation
    Research Board, Project B- 24, Interim Report (Rockville, MD: March 2002).

    24 The Community Transportation Association of America defines brokerage
    as a method of providing transportation where riders are matched with
    appropriate transportation providers through a central trip- request and
    administration facility. The transportation

    broker may centralize vehicle dispatch, record keeping, vehicle
    maintenance, and other functions under contractual arrangements with
    agencies, municipalities, and other organizations. Actual trips are
    provided by a number of different vendors.

    Page 19 GAO- 03- 697 Transportation Coordination Shared use of vehicles
    among multiple programs: In this type of coordination, one agency may
    provide transportation for clients of

    multiple programs, or each program may own its own vehicles but allow them
    to be used by other programs. For example, in Arizona, vans from one
    county*s vocational rehabilitation center travel to a neighboring county
    to pick up program clients. While there, they also transport clients of
    Jobs Administration programs. The two programs split the cost of
    transportation equally.

    Appendix IV contains a list of some informational resources available for
    agencies interested in coordinating. In some areas we visited,
    coordination among providers* through sharing

    vehicles, consolidating services under a single agency, or sharing
    information about available services* has resulted in significant
    benefits, such as improved customer service and lower unit costs. State
    and local

    agencies providing transportation under the 62 federal programs often
    serve similar client groups, provide similar services, and operate in
    similar geographic areas, so there can be duplication of effort and
    inefficiency in providing transportation when those agencies do not
    coordinate. In our

    site visits, we found several examples of overlapping, fragmented, or
    confusing services in places where agencies were not coordinating.

    Through coordination, some local agencies have realized both improved
    levels of service and financial benefits, such as reduced costs of
    providing each trip, as follows:

    Improved customer service:

     A coordinated system in central Florida provides transportation for
    Medicaid, vocational rehabilitation, and other programs. According to
    local officials, vans used to show up late, if at all, and clients had
    difficulty finding out the status of their ride. Since consolidating
    services under a single provider and bringing scheduling and dispatch
    services in- house, officials report service improvement.

     Through collaboration, information- sharing, and cost- sharing among
    county agencies, the Clinton County transit system in New York serves both
    Medicaid and elderly populations, making it easier for those populations
    to access medical and community services because they only have to be
    familiar with one system. Coordination Has Led to

    Improvements, While Lack of Coordination Can Result in Overlap

    Benefits of Coordination

    Page 20 GAO- 03- 697 Transportation Coordination  A federal regional
    official said that coordination could remove the stigma of specialized
    transportation because all recipients use the same service

    and are treated equally.

    Financial benefits:

     Three New York counties joined in a transportation brokering service
    that saved an estimated $92,000 in 2001 by identifying a lower- cost
    alternative means of transportation, that is, moving groups of clients in
    buses rather than transporting individual clients in taxis. This brokerage
    service provides transportation to Medicaid patients, the disabled,
    veterans, and other client groups.

     In Aberdeen, South Dakota, the local transit agency consolidated the
    transportation services previously provided by both senior and medical
    centers as well as other federal, state, and local programs. This
    consolidation allowed the agency to increase the number of trips provided
    while reducing the average cost of providing each trip by about 20

    percent* from about $5 to $4. The agency has also improved its services by
    coordinating with local taxi companies to provide night and weekend trips.

    Although the various programs we reviewed target specific populations,
    some populations are eligible to receive transportation services from
    multiple programs, resulting in duplication and inefficiency in some
    cases. In our visits with state and local transportation and human service
    agencies and providers, officials we interviewed identified several
    examples of overlapping services in areas or programs that were not
    coordinating. A for- profit transportation provider in one state told us
    that he often has two vehicles overlap on the same route at the same time,
    one for medical trips and one for paratransit, 25 because it is too
    difficult to mix clients due to complicated fee structures and paperwork
    requirements imposed by the state for the two programs. An official from a
    workforce development program in another state told us that many programs
    in his county use their own vans to deliver clients to the job center, but
    because the programs do not coordinate, only a few people ride in each
    van. In another locality that state and local officials said has had
    difficulty

    coordinating, several human service providers hired a consultant to study
    25 Paratransit most often refers to wheelchair- accessible, demand-
    response van service, according to the Community Transportation
    Association of America, and is more flexible than fixed route transit but
    more structured than the use of a private automobile. Effects of a Lack of

    Coordination

    Page 21 GAO- 03- 697 Transportation Coordination the extent to which
    various agencies provide similar transportation services within a
    geographic region. This research showed substantial

    overlap in local services for the transportation- disadvantaged, as shown
    in figure 2. The consultant identified ways in which the number of routes
    could be substantially reduced through better coordination, which are
    being considered by the agencies involved.

    Figure 2: Overlapping Daily Routes of Vehicles Serving the
    TransportationDisadvantaged in Sioux Falls, South Dakota

    Note: This picture shows the daily routes of vehicles operated by seven
    different agencies in the same region of Sioux Falls, South Dakota.
    Overlap occurs when routes have the same or nearby starting and ending
    points and are transporting similar clients at similar times. This graphic
    illustrates that many of these agencies have similar starting and ending
    points. Among the agencies shown in

    this graphic are two vocational rehabilitation agencies (serving the same
    general population) as well as agencies that serve low- income clients or
    clients with disabilities. While the graphic cannot show the time element,
    many of these routes represent trips occurring within 30 minutes of each
    other in the morning and afternoon.

    Page 22 GAO- 03- 697 Transportation Coordination State and local officials
    also provided examples of fragmented services and confusion in localities
    without coordinated programs. One official in an uncoordinated area said
    that a lack of coordination results in

    fragmented services, placing a burden on people who receive transportation
    through many different programs, depending on trip purpose, because they
    must be familiar with multiple systems, rules, and requirements.
    Fragmentation also occurs when adjoining counties do not coordinate their
    public transportation routes, leaving riders stranded due to unconnected
    transit systems. In one state, local officials told us that paratransit
    services do not extend beyond county lines, so people have to schedule two
    separate trips to get from their homes in one county to

    medical services in an adjoining county. When the first paratransit ride
    is behind schedule, a passenger sometimes has to wait for hours for the
    connecting ride. A provider in another state has contracts to provide
    transportation services for clients in multiple human service programs.
    Because of a lack of coordination among those programs, the transportation
    provider said that his company has to maintain two separate dispatching
    and reservation systems for its vehicles to comply with differing
    reporting and eligibility requirements. Vehicles can only operate under
    one dispatching system at a time, so the drivers cannot provide rides to
    more than one type of client at a time. The provider also said that
    clients who call for rides are confused by the sheer number of programs,
    and the agents who make their reservations do not know for which programs
    the clients are eligible.

    Although the Coordinating Council on Access and Mobility and various
    federal agencies have taken a number of steps to improve coordination,
    these efforts have had mixed results.

    As shown in table 4, the Coordinating Council on Access and Mobility* a
    body consisting of representatives from DOT and HHS* has responded to
    three of the recommendations we made in our 1999 report 26 by adopting a

    strategic plan, developing an action plan, and helping to ensure that
    planned coordination efforts reinforce one another by issuing guidelines
    for coordinating transportation services. Goals and objectives in the
    strategic plan include such things as promoting interdepartmental
    collaboration at the federal level through the development of a joint
    agenda for transportation research that is of common use to multiple

    26 GAO/ RCED- 00- 1. Federal Progress toward

    Improved Coordination Varies Some Prior Recommendations

    to the Coordinating Council Have Been Implemented

    Page 23 GAO- 03- 697 Transportation Coordination federal departments.
    According to the most recent action plan, the Council has completed some
    activities, such as producing a series of *how to*

    publications on using intelligent transportation systems to assist in the
    coordination of HHS programs with local transit agencies.

    Table 4: Status of Federal Responses to GAO*s Recommendations to Improve
    Coordination Recommendations from 1999 GAO report Completed Under way

    The DOT/ HHS Coordinating Council on Access and Mobility should adopt a
    prioritized strategic plan. X The Coordinating Council should develop an
    action plan with specific responsibilities. X The Coordinating Council
    should issue an annual report on its major initiatives and accomplishments
    to the Secretaries of DOT and HHS. X DOT and HHS should ensure that
    planned coordination efforts reinforce one another. X DOT and HHS should
    direct their regional working groups to assess obstacles to transportation
    coordination.

    X The Coordinating Council should strengthen its Web site and make
    information available on obstacles to coordination and strategies to
    overcome them.

    X Source: GAO. The Council*s responses to the other three recommendations
    are still

    ongoing. For example, Council representatives told us that they plan to
    issue their first annual report on coordination achievements in June 2003,
    although this report was originally due to be issued in October 2000,
    according to the Council*s strategic plan. With regard to the

    recommendation on regional working groups, the 10 DOT and HHS regional
    offices have been convening workshops with state transportation officials
    during 2003 to discuss obstacles to coordination and other issues.

    Finally, the Council*s efforts to strengthen its Web site have had mixed
    results. One of the tasks listed in the Council*s strategic plan is to
    develop and maintain a Web site that would, among other things, enhance
    the exchange of coordination ideas, issues, and concerns. The Council has
    developed a Web site 27 *operated by DOT in conjunction with CTAA* that is
    reachable through a link on the Federal Transit Administration*s section

    of DOT*s Web site. However, there is no similar link from HHS*s Web site
    27 www. fta. dot. gov/ CCAM/ www. index. html.

    Page 24 GAO- 03- 697 Transportation Coordination (or the Web sites of
    other federal agencies that fund transportation services for the
    transportation- disadvantaged), possibly making it more

    difficult for human service and other agencies to be aware of and access
    the site. In addition, the site does not yet contain specific information
    on obstacles to coordination or strategies for overcoming them, which we
    recommended in 1999, though it does contain links to some reports on the
    subject. There is also a page from which viewers can E- mail the Council
    with questions or suggestions. The Council is working with CTAA to further
    strengthen the site.

    Through the Council, DOT and HHS have sponsored a number of other efforts
    to enhance coordination. For example, as part of an item in the Council*s
    action plan, DOT and HHS helped initiate a consortium of national
    professional organizations and interest groups 28 to conduct research and
    provide educational activities related to coordinating services for the
    transportation- disadvantaged. Among other tasks, the consortium has been
    asked to pursue several items from the Council*s action plan, such as
    identifying promising practices and obstacles in transportation
    coordination and developing strategies for addressing the obstacles.
    Officials from the Council said that working with the consortium provides
    a depth of knowledge and experience because consortium members represent
    local as well as national interests so that issues are pursued *from both
    ends.*

    As part of the upcoming regional workshops sponsored by the DOT and HHS
    regional offices, participants will discuss expanded opportunities for
    achieving more coordinated delivery of transportation services in medical,
    aging, and other assistance programs, and technical assistance resources
    will be shared with participants. Intended audiences include state
    transportation coordinating councils; state agencies that administer
    medical, aging, and other assistance programs; and agencies serving
    individuals with disabilities. According to DOT and HHS, participants will
    be asked to develop state transportation coordination action plans for
    their home state, and resources will be made available to assist states in

    28 To date, the consortium consists of the AARP, Amalgamated Transit
    Union, American Association of State Highway and Transportation Officials,
    American Public Transportation Association, American Public Human Services
    Association, American Public Works Association, American Red Cross,
    Association of Metropolitan Planning Organizations, Children*s Health
    Fund, Community Transportation Association of America, Easter Seals
    Project Action, National Association of Area Agencies on Aging, National
    Conference of State Legislatures, National Governor*s Association, and the
    Taxicab, Limousine, and

    Paratransit Association. DOT and HHS Have Sponsored

    Other Coordination Activities

    Page 25 GAO- 03- 697 Transportation Coordination implementing their plans
    following the workshop. (See appendix III for more information on federal
    coordination activities.)

    Because it is not a federal executive branch agency, the Coordinating
    Council is not subject to the requirements of the Government Performance
    and Results Act (GPRA) of 1993 29 and, therefore, does not have to follow
    the act*s guidance for producing strategic plans, annual performance
    plans, and annual reports. However, there are several best practices in
    strategic planning that could be useful guides for improving the Council*s
    strategic plan when it is updated at the end of 2003 and the action plan

    when it is next updated. For example, the current strategic plan does not
    contain an overall mission statement for the Council or performance
    measures that clearly relate to its long- term goals and objectives, both
    of which are considered best practices in strategic planning. 30 In
    addition, there are no explicit links between the stated goals and
    objectives in the strategic plan and the activities in the action plan.
    For example, the current action plan includes seven tasks related to the
    use of information technology systems, but those tasks are not clearly
    linked to any of the Council*s long- term goals or objectives.

    Because the Council has no funding or full- time staff of its own, it is
    dependent on support from HHS and DOT. However, neither department
    currently highlights the coordination of services for the
    transportationdisadvantaged as a priority in its long- term strategic plan
    or annual performance plan. According to GPRA guidance, agencies are
    encouraged to identify programs with common purposes or crosscutting
    issues in their strategic plans. In addition, the agencies* annual
    performance plans should identify performance goals that reflect
    activities being undertaken to support programs of a crosscutting nature,
    and show evidence of coordination among crosscutting programs. 31 DOT*s
    most recent strategic plan and performance plan do not explicitly mention
    the Coordinating

    Council, although both briefly discuss coordinating special- needs
    transportation with other federal agencies under DOT*s Job Access and
    Reverse Commute (JARC) program. However, there is no mention of
    coordination of DOT*s Transit Capital Assistance Program for Elderly

    29 P. L. 103- 62. 30 U. S. General Accounting Office, Agencies* Strategic
    Plans Under GPRA: Key Questions to Facilitate Congressional Review, GAO/
    GGD- 10.1.16 (Washington, D. C.: May 1, 1997).

    31 U. S. General Accounting Office, The Results Act: An Evaluator*s Guide
    to Assessing Agency Annual Performance Plans, GAO/ GGD- 10.1.20
    (Washington, D. C.: Apr. 1, 1998). Coordination Remains Largely

    Unaddressed in Strategic Planning Efforts

    Page 26 GAO- 03- 697 Transportation Coordination Persons and Persons with
    Disabilities with other programs for elderly or disabled populations. 32
    At the subagency level, the Federal Transit

    Administration*s strategic plan includes the Coordinating Council in an
    appendix on coordination of crosscutting functions, under the strategic
    goal of promoting economic growth and trade, and its performance plan
    mentions working with the Council under a different goal* that of
    promoting mobility and accessibility. 33 HHS*s current strategic plan does
    not discuss coordination of transportation services with other agencies,
    but its draft plan for 2003- 2008

    specifically lists DOT and state and local transportation and human
    service agencies as important partners in providing transportation to
    access services in distressed communities and for health care and
    employment and training programs elsewhere. Education, DOL, HUD, and VA
    are not listed, however. 34 The performance plans of individual HHS
    components vary widely in their treatment of transportation coordination.
    For example, the performance plan of the Centers for Medicare & Medicaid
    does not mention transportation at all, while the Administration on
    Aging*s performance plan states that the agency works closely with HHS and
    DOT officials on the Coordinating Council in pursuit of improved
    transportation services.

    The strategic and annual performance plans of the other federal agencies
    that fund transportation services for the transportation- disadvantaged
    generally do not mention coordination of such services.

    Other federal agencies are also involved in some coordination efforts
    outside the scope of the Council. For example, DOL is working with CTAA
    and DOT to implement several rounds of pilot projects testing various
    transportation strategies in support of local one- stop employment and

    32 U. S. Department of Transportation, Strategic Plan 2000- 2005
    (September 2000) and U. S. Department of Transportation, Performance Plan-
    FY 2004 (Washington, D. C.: February 2003).

    33 U. S. Department of Transportation Federal Transit Administration,
    Strategic Plan 1998- 2002 (Washington, D. C.: March 1998) and U. S.
    Department of Transportation Federal Transit Administration FY 2002
    Performance Plan.

    34 U. S. Department of Health and Human Services, draft of Strategic Plan
    Fiscal Years 2003- 2008, Appendix A (Washington, D. C.: July 2002). Other
    Federal Agencies Are

    Involved in Some Coordination Efforts

    Page 27 GAO- 03- 697 Transportation Coordination training centers. 35
    Officials from DOT and DOL are also in the process of developing
    guidelines for using Workforce Investment Act funds (a DOL

    program) for Job Access purposes (a DOT program). In addition, some of
    DOL*s research studies and technical assistance materials provide examples
    of transportation coordination efforts. 36 However, we did not find
    examples of involvement in transportation coordination efforts at the
    national level at the Departments of Education, HUD, and VA, although some
    of these agencies are involved in transportation working groups in some of
    the federal regional offices. The membership of the Coordinating Council
    only consists of DOT and HHS officials, representing less than half of the
    62 federal programs that can be used to fund services for the
    transportation- disadvantaged. Although these two agencies comprise the
    majority of funding for transportation that we were able to identify, the
    Departments of Labor and Education also have a significant number of
    programs* more than one- third of the total* that provide services to the
    transportation- disadvantaged. Officials from the Council said that other
    agencies had expressed interest in coordination activities and had been
    invited to observe Council meetings in the past, but only DOL sent a
    representative for a short time period. 37 Council officials said it would
    be very beneficial to have other agencies formally involved in their
    coordination efforts, which would require a renewal of the Council*s
    charter and memorandums of understanding among all agencies involved as
    well as other formal mechanisms to ensure that the proper people are
    engaged in the effort.

    35 In an effort to coordinate service delivery for employment and training
    programs, the Workforce Investment Act established one- stop centers in
    all states. Individuals seeking employment opportunities and training can
    receive services from more than a dozen federal programs that are required
    to offer their services through these one- stop centers.

    36 See *One- Stop Innovations: Leading Change under the WIA One- Stop
    System,* a report prepared for the U. S. Department of Labor by the John
    H. Heldrich Center for Workforce Development at Rutgers, the State
    University of New Jersey (Mar. 12, 2002). 37 In addition, one of DOL*s
    divisions in 2001 had a liaison to the Council*s Technical Committee*
    which focused on coordinating employment programs for low- income
    individuals. However, the DOL liaison indicated that little activity
    ensued after the liaison briefed the committee on the one- stop centers,
    and the committee later went dormant with the change in administration.

    Page 28 GAO- 03- 697 Transportation Coordination Although some federal,
    state, and local agencies encourage the coordination of services for the
    transportation- disadvantaged and some

    coordination efforts have been established, federal, state, and local
    officials, as well as representatives of national advocacy and industry
    organizations with whom we spoke, identified numerous obstacles that
    impede effective coordination. We clustered the wide range of identified
    obstacles into three categories related to (1) sharing vehicles and the
    low priority given to funding coordination activities; (2) programmatic
    differences; and (3) limited federal, state, and local leadership and
    commitment to undertake and sustain coordination efforts. To mitigate
    these obstacles, these officials and other experts suggested three
    potential options: harmonizing standards and requirements among federal
    programs

    with a transportation component, providing and disseminating additional
    guidance and information on coordination, and providing financial
    incentives or mandates to coordinate.

    One set of obstacles was related to officials* reluctance to share
    vehicles or their tendency to give low priority to funding coordination
    activities. In addition, some areas have limited transportation services
    available, thus

    limiting any opportunities to benefit from coordination. In interviews in
    every state we visited, as well as with national advocacy and industry
    organizations, the unwillingness or inability to share vehicles was
    identified as a major obstacle. Administrators of some federal programs
    may be apprehensive about sharing vehicles for coordination due, in part,
    to their belief that only they understand their clients* needs and can
    provide the necessary personalized services. For example, program
    administrators reported being concerned about a loss of control over the
    quality and convenience of transportation services for their clients and
    wanted to maintain their discretion over how to serve their clients and
    which transportation resources to purchase. Program administrators also
    expressed concern over mixing vulnerable populations, such as the
    developmentally disabled and children, or frail,

    sick, and healthy populations, in one coordinated system. According to a
    report on coordinated transportation systems, this reluctance among
    providers to cooperate can lead to an underutilization of vehicles. 38 38
    Moss Adams, LLP, Community Transportation Association of America, The
    Coordination

    Challenge (Seattle, WA: June 2000). Officials Cited

    Numerous Obstacles to Successfully Coordinating Services and Provided
    Potential Options to Mitigate Them

    Officials May Be Reluctant to Share Vehicles and Provide Financial
    Resources for Coordination

    Apprehension about Sharing Vehicles

    Page 29 GAO- 03- 697 Transportation Coordination Likewise, some human
    service clients may be apprehensive about using coordinated transportation
    because they may be uncomfortable mixing

    with members of other populations with whom they are unfamiliar or they
    may fear a loss of accommodation or convenience, such as having to switch
    from door- to- door service to curb- to- curb service or public transit.
    The overall costs of coordination, which can include additional staff

    members and staff time needed for maintaining and overseeing coordination
    efforts, can be significant. For example, a transportation brokerage firm
    in one state faced substantial added costs when it began coordinating
    transportation for human services programs due to

    requirements to meet more stringent state and federal safety standards.
    However, some officials stated that the low priority given to funding
    coordination activities could impede coordination efforts. For example,
    according to officials in one state, although recipients of funds from
    DOT*s Capital Assistance Program for Elderly Persons and Persons with
    Disabilities are required to coordinate with other local transportation
    services provided from federal sources, the program*s current allotment
    for administrative expenses would not support any staff to work on
    coordination activities. In addition, some states invest in coordination,
    while others do not allocate funds specifically for coordination, and
    efforts to coordinate often become ancillary activities for those
    involved.

    Guidelines issued by the Coordinating Council state that coordination will
    not solve all transportation problems in all communities. 39 Coordination
    may not be an effective strategy in those communities that have limited
    transportation services available, particularly in those communities that

    are not served by public transportation. For example, in some remote
    areas* such as the northwestern part of South Dakota where services
    available to many communities are 40 to 60 miles away* there are few
    transportation services available to transport individuals to hospitals or
    other services. In these areas, coordination may not be a workable or
    costeffective option.

    39 Coordinating Council on Access and Mobility, Planning Guidelines for
    Coordinated State and Local Specialized Transportation Services
    (Washington, D. C.: Dec. 20, 2000). Low Priority Given to Funding

    Coordination Activities Limited Transportation Services Available to
    Realize Benefits from Coordination

    Page 30 GAO- 03- 697 Transportation Coordination Coordinating multiple
    programs administered at various levels of government is complicated
    because the programs have different

    requirements with respect to eligibility, funding, reporting, and safety;
    and they differ in their programmatic goals and missions. Federal program
    rules that specify the eligible populations that each program can serve
    may limit opportunities for collaboration. For example, DOT officials in
    one region stated that they were unable to combine DOL and DOT funds for a
    DOT transportation program for migrant farm workers because DOL funds are
    designated for U. S. citizens, while there is no such restriction on the
    use of DOT funds. In addition, some liability

    insurance policies specify that a program*s vehicles may serve only a
    certain population, thus those programs face additional insurance costs to
    transport individuals other than program clients. Such restrictions may
    lead to inefficient transportation services within a community. For
    example, an official in one state we visited commented that one agency*s
    vehicle provided medically related trips three times per week to that
    agency*s clients, but would not transport other individuals seeking
    similar medical services provided under other federal programs due, in
    part, to liability insurance restrictions. Safety requirements may also
    vary by program and jurisdiction, thus complicating efforts to transport
    multiple client groups. Some programs, such as Head Start, have specific
    vehicle standards that are often more stringent than those of other
    programs, making it difficult to share vehicles. For instance, different
    standards for roof strength, types of seat belts, and driver
    qualifications pose problems for schools, human service agencies, and
    public transit providers interested in sharing vehicles. Some areas have
    been able to overcome specific program rules to share vehicles. For
    example, a Head Start

    grantee in one state we visited was able to transport students using
    vehicles supplied by the local public transit provider because these
    vehicles met the same safety standards as school buses.

    Funding streams and cycles vary across federal programs, making
    coordination more difficult. For example, DOT funds generally flow from
    the state to counties or cities, while DOL funds flow through the state to
    local designees. In addition, funding for programs such as Head Start flow
    directly to grantees rather than through states, making it more difficult
    for

    the states to directly manage the coordination activities of local
    grantees, according to an official in one state. There is also complexity
    in working with different funding time frames and cycles under multiple
    federal programs. For example, although DOT*s JARC program allows grantees
    to use other federal funds to provide the local *match* required to obtain
    Differing Program

    Requirements Can Impede Coordination

    Different Eligibility Requirements

    Varying Funding Streams and Cycles

    Page 31 GAO- 03- 697 Transportation Coordination JARC funds, the funding
    time frames and cycles of these other funding sources are different,
    complicating efforts to combine financial resources.

    Different reporting requirements among programs can create excessive
    paperwork in a coordinated system and may make it difficult for agencies
    to determine their true transportation costs and the benefits that may be
    realized from coordination. For example, one report commented that a
    transit provider was required to give each of several human service
    agencies a separate bill for services provided, which reflected the unique
    requirements imposed by each of those agencies. 40 Furthermore, according

    to officials, Medicaid requires the state Medicaid agency to demonstrate
    that individuals receiving transportation under Medicaid are not receiving
    transportation from any other source and that the transportation is

    medically necessary, complicating the determination of how to fund
    transportation services for each Medicaid recipient in a coordinated
    system in which costs are shared among agencies. In addition, human
    service agencies and providers may not be required or accustomed to
    collecting complete and uniform transportation data for their programs. A
    recent report concluded that such information was beneficial because it
    enabled administrators to re- evaluate how best to provide transportation
    services and the savings they could achieve through coordination. 41 For
    example, when Florida*s statewide coordination program was established,
    state and local agencies in Florida reported their total estimated annual
    transportation- related expenditures at $8 million. However, once
    reporting requirements were in place for all agencies providing services
    for the

    transportation- disadvantaged, actual expenditures were estimated to total
    $224.9 million statewide* much higher than the initial estimate. Such
    information has helped agencies in Florida understand the true costs of
    providing transportation and has encouraged some agencies to become more
    interested in coordination as they realize the potential for cost

    savings. Unlike transportation agencies, human service agencies provide
    transportation as a secondary service so that their clients may access
    primary human services. Therefore, while DOT- funded transportation
    agencies have specific and relatively uniform federal requirements for

    40 Ecosometrics, Inc., Recommended Framework for Developing State and
    Local Human Services Transportation Planning Guidance (Bethesda, MD: Sept.
    22, 1998). 41 Volpe National Transportation Systems Center, Innovative
    State and Local Planning for Coordinated Transportation (U. S. Department
    of Transportation, February 2002). Lack of Uniform Data

    Collection and Reporting Requirements among Programs

    Distinct Purposes and Goals among Agencies

    Page 32 GAO- 03- 697 Transportation Coordination transportation planning,
    human service agencies do not typically conduct transportation planning or
    collect transportation- related data for their programs, making the
    planning of coordinated transportation between

    transit and human service agencies challenging. 42 In addition, human
    service, transportation, medical, and workforce agencies all have distinct
    technical languages and cultures, which may inhibit collaboration among
    these agencies. In one state we visited, the labor and transportation
    departments experienced difficulty collaborating because some common terms
    have completely different meanings within each agency. For example,
    transportation officials interpreted the term *cost- allocation* as an
    accounting methodology to estimate the overall cost of operating
    transportation services in order to determine the appropriate rate to
    charge for these services, while state labor officials interpreted the
    term as a way to determine what proportion of overall costs will be funded
    by each agency.

    Although some federal and state agencies have recognized the potential
    offered by coordination and provided some assistance toward this end,
    officials we interviewed expressed concerns about the amount and
    effectiveness of the guidance they have received on coordination. In
    addition, the absence of interagency forums or other mechanisms to develop
    and share information about coordination initiatives limits the support
    that local providers receive to effectively coordinate. Officials in some
    states we visited said that they receive little federal

    guidance on potential strategies to coordinate services. As a result, they
    develop their own approaches without the benefit of guidance on the most
    effective way to coordinate services. We found the following examples of
    this in our work:

     Officials in one state said that the guidance on how to share costs
    among programs for projects funded jointly by DOT*s JARC grants, HHS*s
    TANF Program, and DOL*s Welfare- to- Work Program funds did not indicate
    how such sharing could or should be done. Instead, the officials had to
    seek

    advice from other states. 42 Volpe National Transportation Systems Center,
    Innovative State and Local Planning for Coordinated Transportation.

    Program Officials May Not Know How to Coordinate Effectively

    Limited Federal Guidance and Information on Coordination

    Page 33 GAO- 03- 697 Transportation Coordination  While FTA disseminated
    coordination guidelines for FTA and HHS programs to transportation
    officials, some HHS and transportation

    officials said these guidelines were not widely disseminated to human
    services officials or programs.

     According to state Medicaid offices and a national organization of
    individuals and agencies concerned with human services, the Centers for
    Medicare & Medicaid Services have not provided sufficient guidance on how
    to coordinate Medicaid transportation with existing public transit or
    other transportation resources.

     The Coordinating Council on Access and Mobility has limited visibility
    for agencies actually involved in implementing coordination efforts. In
    several states, human service program administrators with whom we spoke
    were

    not aware of the Council or its Web site. In the five states we visited*
    even in those states with a coordinating body* there was limited state
    guidance to help local areas implement coordination, and some officials
    stated that the lack of leadership and commitment at the state level was a
    major obstacle to local coordination. In addition, while some states have
    established coordinating councils or

    bodies or have designated a lead agency for coordination, nearly half of
    the states have no coordinating body, according to one report. 43
    Officials in one state explained that the lack of a coordinating body that
    requires various agencies to discuss and resolve transportation issues is
    the main obstacle toward a more coordinated system.

    Even in states with a coordinating council or a lead state agency, there
    may be a lack of local leadership or commitment to coordination efforts.
    For example, one city we visited was unsuccessful in achieving a
    coordinated system despite state encouragement to coordinate and some
    state- provided technical assistance. Stakeholders there described a lack
    of local commitment and leadership in maintaining lines of communication

    among those involved in coordination efforts as a factor leading to the
    failure. In addition, program administrators may not have data on the
    extent of existing transportation services that may be available to their
    clients within a geographic region and, therefore, may fail to realize the
    extent of overlapping and complementary services within their local area.
    Such data can produce improvements. For example, in response to a lack 43
    Westat, Toolkit for Rural Community Coordinated Transportation Services.

    Limited State Guidance and Leadership on Coordination

    Limited Local Leadership and Commitment to Coordinate

    Page 34 GAO- 03- 697 Transportation Coordination of data on local
    services, an agency in one state we visited took the lead in conducting a
    study that showed the extent to which various agencies provide similar
    transportation services within a geographic region. An

    agency official was hopeful that once other agencies saw the extent of
    overlap, they would be more willing to coordinate.

    Federal, state, and local officials, as well as experts in the area, have
    suggested three potential options to improve coordination of
    transportation services among federal programs: (1) harmonizing standards
    and requirements among federal programs, (2) expanding interagency forums
    and providing and disseminating additional guidance and information on
    coordination, and (3) providing financial incentives or coordination
    mandates.

    Officials and experts expressed a need to harmonize requirements among
    federal programs, such as providing more flexible regulatory language that
    would allow providers to serve additional client groups, creating
    consistent cost accounting methods, and adopting common safety standards.
    For example, one official commented that federal program regulations could
    include language permitting other client groups to make use of available
    transportation options. Also, some officials believed that adopting
    standard accounting procedures among all federal human service

    programs could provide a consistent measure for comparing services,
    allowing administrators to evaluate how best to provide transportation
    services and determine the savings they could achieve through
    coordination. Likewise, making standards for safety (e. g., types of seat
    belts), driver training, and liability insurance provisions uniform among
    federal human service programs, as appropriate, may facilitate the shared
    use of vehicles and drivers in one coordinated system, according to some
    officials. Finally, some officials suggested that federal grant programs
    that

    allow the use of funds from multiple sources should be under the same
    funding cycle or time frame so that these funds may be combined more
    easily. These officials also commented that harmonizing the time frames
    under which federal funding is allocated could possibly aid collaborative
    planning. However, differing program standards exist to ensure that the
    distinct needs of specific target populations are adequately served and
    that

    agencies maintain accountability for providing these services. Thus, the
    benefits from any change in standards or requirements would need to be
    balanced against continuing to properly meet client needs and sufficiently

    control funds distributed to grantees. In addition, harmonizing program
    standards and requirements among 62 federal programs authorized by more
    than 20 pieces of legislation would necessitate extensive legislative
    Potential Options to

    Improve Coordination Harmonizing Program Standards and Requirements

    Page 35 GAO- 03- 697 Transportation Coordination changes and could impose
    additional costs for agencies to meet new requirements.

    Some officials advocated expanding the number of agencies involved in
    coordination, establishing interagency forums, and improving central
    clearinghouses as ways to better develop and disseminate guidance on
    coordination. To enhance coordination efforts at the federal level, some
    officials suggested expanding the membership of the Coordinating Council

    on Access and Mobility to include additional federal agencies, so that a
    broader array of agencies that serve the transportation- disadvantaged are
    represented. This could include agencies such as DOL and the Department of
    Education that we identified as being significant because a large number
    of their programs authorize funding of transportation services for the
    transportation- disadvantaged. In addition, establishing state- level
    forums may also facilitate communication among agencies involved in
    coordination and can lead to benefits. For example, one state has

    established an interagency task force on transportation coordination,
    which has resulted in a number of benefits* including the pooling of
    vehicles and the expansion of services* in some areas of the state. Some
    officials and experts suggested that federal agencies provide additional
    guidance and other information that result from forums or other sources to
    clearly define the allowable uses of funds, assist agencies in developing
    cost- sharing arrangements for transporting common clientele, and
    encourage the establishment and participation in interagency forums. This
    additional guidance and information could be better disseminated through a
    central clearinghouse, such as the Coordinating Council*s Web site.

    Some officials and experts believed that incentives or mandates could help
    improve coordination, although others expressed concerns that such actions
    would have negative effects on the ability of local agencies to respond to
    community needs. Officials provided several examples, including the
    following:  Federal grant applications could contain provisions giving
    priority in

    funding to those grantees committed to coordination efforts.  With
    legislative changes, current funds allotted by multiple federal sources

    could be combined into one federal, state, or local fund for
    transportation services for the transportation- disadvantaged.

     Funding opportunities could be tied to federal or state coordination
    mandates so that there are financial consequences for a failure to
    coordinate. Expanding Interagency Forums

    and Providing and Disseminating Additional Guidance and Information on
    Coordination

    Providing Financial Incentives or Mandates

    Page 36 GAO- 03- 697 Transportation Coordination However, officials
    pointed out that these options also had some potential downsides that
    would need to be carefully considered. For example, combining funds into a
    single source could result in some populations

    being unfairly overlooked because smaller agencies at the state or local
    level would be at a disadvantage in competing for funding with larger
    agencies serving more clients. Several officials also raised concerns
    about mandates to coordinate. For example, some officials said that
    mandates might reduce the flexibility of agencies to design and deliver
    transportation services that specifically address their communities*
    needs. In addition, some officials noted that state efforts or mandates
    might not

    guarantee successful local coordination. For example, a city in one state
    we visited was unsuccessful in coordinating its multiple transportation
    services despite state encouragement to do so and despite losing some
    federal funding as a result.

    Successful coordination among programs for the transportationdisadvantaged
    is not a simple matter. One clear need, given the sheer number of programs
    involved, is active and sustained leadership at the federal level. While
    the Coordinating Council on Access and Mobility is positioned to supply
    that leadership, its efforts are constrained in two main ways. The first
    is limited membership: only two departments* DOT and HHS* are members.
    While these departments administer nearly 30 programs that can be used for
    transportation, the Departments of Education and Labor administer almost
    as many. The absence of Education and Labor lessens the ability to muster
    a collective effort for greater coordination. The second constraint is a
    limited ability to translate a strategic vision into a set of actions. At
    present, there are no clear links between the long- term goals in the
    Council*s strategic plan and the individual tasks in its action plan.
    Without such links, the Council risks judging its progress on the basis of
    activities undertaken rather than on the outcomes of those activities and
    their contribution toward achieving long- term goals. Linking these goals
    and actions to the strategic and annual performance plans of participating
    departments* because the

    Council relies heavily on support from its member agencies* would provide
    an additional incentive to pursue coordination activities in the
    departments* activities.

    There is great diversity in the specific suggestions we received about how
    to overcome obstacles to greater coordination. Two of the three main
    options raised by various officials we interviewed* making federal program
    standards more uniform and creating some type of requirement or financial
    incentive for coordination* would require substantial Conclusions

    Page 37 GAO- 03- 697 Transportation Coordination statutory or regulatory
    changes and include potential costs. The third option, expanding forums
    and disseminating guidance, can be done in the

    context of existing laws, regulations, and procedures, and may, therefore,
    be the most expeditious starting point. In this regard, clarification from
    federal agencies about how funds can be used for coordination could help
    state and local agencies overcome some of the obstacles identified.

    Similarly, state and local agencies may be in a better position to
    coordinate efforts if they have more knowledge about what has worked
    elsewhere. Although the Council has a Web site with information about
    coordinating transportation services, some state and local officials were
    unaware of it. State and local officials* point of contact is more likely
    to be the Web site of the department administering the program at the
    federal level. Establishing better links between the Council*s Web site
    and the

    sites of the departments could help connect grantees with information that
    may help them coordinate with other programs, better serve clients, and
    use funds more efficiently.

     To increase communication and collaboration among the major agencies
    involved in providing transportation services for the
    transportationdisadvantaged, we recommend that the Secretaries of the
    Departments of Labor and Education join the Coordinating Council on Access
    and Mobility.

     To promote and enhance federal, state, and local transportation
    coordination activities, we recommend that the Secretaries of the
    Departments of Health and Human Services, Labor, Education, and
    Transportation take the following actions:

     As member agencies of the Coordinating Council on Access and Mobility,
    ensure that the long- term goals in the Council*s strategic plan have
    clear links to the individual tasks in its action plan and that these
    actions are tied to measurable annual performance goals.

     Ensure that strategic and annual performance plans discuss their
    departments* transportation coordination efforts and incorporate longterm
    goals and performance measures that address the need for coordination
    among programs for the transportation- disadvantaged.

     Develop and distribute additional guidance to states and other grantees
    that encourages coordinated transportation by clearly defining the
    allowable uses of funds, explaining how to develop cost- sharing
    arrangements for transporting common clientele, and clarifying
    Recommendations

    for Executive Action

    Page 38 GAO- 03- 697 Transportation Coordination whether funds can be used
    to serve individuals other than the program*s target population.

     Link the Web sites of their agencies involved in providing services for
    the transportation- disadvantaged to the Coordinating Council*s Web site
    and advertise the site in agency correspondence and during conferences or
    other outreach opportunities.

    We provided the Departments of Health and Human Services, Labor,
    Education, Transportation, Housing and Urban Development, and Veterans
    Affairs with draft copies of this report for their review and comment. We
    requested verification of key facts from the Departments of Agriculture
    and the Interior, but we did not seek comments from these departments
    because they did not administer significant numbers of programs that
    benefit the transportation- disadvantaged.

    All six departments generally agreed with the findings and conclusions in
    the report and provided technical clarifications, which were incorporated
    as appropriate. The four departments to whom we made recommendations*
    Health and Human Services, Labor, Education, and Transportation* also
    generally concurred with those recommendations. In particular:

     The Department of Health and Human Services provided written comments on
    the draft of this report which are presented and evaluated in appendix V.
    The department noted that it has initiated actions to implement our
    recommendations, including (1) strengthening the linkage between the
    Coordinating Council*s strategic and action plans, (2) reviewing the
    department- wide strategic plan for opportunities to reflect its
    transportation coordination efforts, (3) developing coordination guidance,
    and (4) linking the Coordinating Council*s Web site to the Department of
    Health and Human Services* Web site. The department also suggested that we
    consider incorporating other researchers* estimates of transportation
    spending by health and human service programs. However, we estimated
    program expenditures only for those programs where there was sufficient
    evidence to support an estimate.

     Department of Labor officials stated that the department looks forward
    to joining the Coordinating Council on Access and Mobility to improve the
    transportation services provided by federal human service programs. In
    addition, department officials commented that the reauthorization of some
    human service and surface transportation legislation was forthcoming
    during the preparation of this report and that these legislative changes
    Agency Comments

    and Our Evaluation

    Page 39 GAO- 03- 697 Transportation Coordination may impact the future
    directions of the federal programs included in this report.

     The Department of Education provided written comments on the draft of
    this report, which are presented in appendix VI. The department said that
    it would look favorably on an opportunity to join the Coordinating Council
    on Access and Mobility and it would consider developing coordination
    guidance for state and other grantees and instituting methods of linking
    Web- based information resources about transportation.

     Department of Transportation officials said that the Federal Transit
    Administration is committed to accomplishing effective transportation
    coordination and noted that the list of the agency*s activities and
    accomplishments in appendix III of this report demonstrate its commitment
    and support for coordination. It also stated that the administration*s
    proposal for the reauthorization of surface transportation legislation,
    introduced in May 2003, includes provisions that would encourage further
    coordination efforts.

    We are sending copies of this report to the appropriate congressional
    committees and to the Secretaries and other appropriate officials of the
    Departments of Transportation, Health and Human Services, Labor,
    Education, Housing and Urban Development, Veterans Affairs, Agriculture,
    and the Interior. We also will make copies available to others upon
    request. In addition, the report will be available at no charge on the

    GAO Web site at http:// www. gao. gov. If you have any questions about
    this report, please contact me at siggerudk@ gao. gov or at (202) 512-
    2834. Additional GAO contacts and acknowledgments are listed in appendix
    VII.

    Katherine Siggerud Acting Director Physical Infrastructure Issues

    Appendix I: Scope and Methodology Page 40 GAO- 03- 697 Transportation
    Coordination Our scope of work included federal programs that provide
    transportation services to the transportation- disadvantaged. To provide
    information on

    the purposes and types of such federal programs, we first determined the
    universe of programs by reviewing an existing inventory produced by the
    Community Transportation Association of America 1 and a report prepared
    for the Coordinating Council on Access and Mobility. 2 We then
    supplemented and modified this inventory of programs on the basis of
    interviews with agency officials and searches of the Catalog of Federal
    Domestic Assistance. We included only those programs that provide
    nonemergency, nonmilitary, surface transportation services of any kind,
    targeted to transportation- disadvantaged populations. We interviewed
    program administrators to identify the general target population and the
    types of transportation services and trips that are typically provided
    under each program. To address the issues related to program funding,
    effects of coordination, and coordination obstacles and options, we (1)
    conducted interviews and

    document reviews in the pertinent eight federal agencies that administer
    the 62 federal programs that fund transportation services for the
    transportation- disadvantaged; (2) conducted five case studies in Arizona,
    Florida, New York, South Dakota, and Wisconsin; (3) reviewed the
    literature on the challenges encountered in coordinating services for the
    transportation- disadvantaged; and (4) interviewed industry
    representatives and advocacy groups representing elderly and disabled
    populations. We did not verify spending data or estimates received from
    federal agencies for accuracy.

    At the federal level, we interviewed officials from the headquarters of
    the Federal Transit Administration in the Department of Transportation;
    the Administration on Aging, the Administration for Children and Families,
    the Centers for Medicare & Medicaid Services, the Health Resources
    Services Administration, the Office of Intergovernmental Affairs, and the
    Substance Abuse and Mental Health Services Administration in the
    Department of Health and Human Services; the Employment and Training
    Administration in the Department of Labor; the Department of Agriculture;
    the

    Department of Education; the Department of Housing and Urban 1 Community
    Transportation Association of America, Building Mobility Partnerships:
    Opportunities for Federal Investment (Washington, D. C.: March 2002). 2
    Coordinating Council on Access and Mobility, Planning Guidelines for State
    and Local Coordination (Washington, D. C.: Dec. 20, 2000). Appendix I:
    Scope and Methodology

    Appendix I: Scope and Methodology Page 41 GAO- 03- 697 Transportation
    Coordination Development; the Department of the Interior; and the
    Department of Veterans Affairs. We also interviewed federal officials from
    the 10 regional

    offices of the Federal Transit Administration and some regional officials
    in the Departments of Health and Human Services and Labor. The federal
    officials we met with included representatives of the Coordinating Council
    on Access and Mobility from the Federal Transit Administration and the
    Department of Health and Human Services. In conducting our case studies in
    the five states, we reviewed documentation and interviewed more than 100
    officials from state and local transportation and human service agencies
    and service providers, as well as consumers of transportation services. We
    judgmentally chose the

    states to include three states without a state mandate or state
    coordinating body and two states with such conditions. We also chose
    states on the basis of relative concentrations of elderly, disabled, and
    low- income populations, and for some, geographic dispersion. Within each
    state, we spoke with state officials responsible for coordinating
    transportation services for the transportation- disadvantaged and/ or
    overseeing funds from the 62 federal programs we identified. We also asked
    some of these state officials for recommendations of local officials and
    transportation providers to interview in a range of urban, suburban, and
    rural areas and coordinated and uncoordinated programs within the state.

    Finally, we interviewed representatives of professional, industry, and
    advocacy organizations that are part of the National Consortium on the
    Coordination of Human Services Transportation, a group that represents a
    broad spectrum of stakeholders involved with coordination of
    transportation for the disadvantaged. We conducted our work from July

    2002 through June 2003 in accordance with generally accepted government
    auditing standards.

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 42 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Department of Agriculture, Food
    and Nutrition Service Food Stamp

    Employment and Training Program

    Food Stamp Act of 1977, as amended

    7 U. S. C. S: 2015( d)( 4)( I)( i) (I)

    Reimbursement or advanced payment for gasoline expenses or bus fare

    To access education, training, employment services, and employment
    placements

    Low- income persons between the ages of 16 and 59

    $12,952,956 c Department of Education, Office of Elementary and Secondary
    Education 21st- Century Community Learning Centers

    No Child Left Behind Act of 2001

    20 U. S. C. S: 7173( a)( 10) Contract for

    service To access educational services

    Students from low- income families

    $84,600,000 (estimate) d Department of Education, Office of Innovation and
    Improvement

    Voluntary Public School Choice No Child Left Behind Act of 2001

    20 U. S. C. S: 7225a( a) Contract for

    services, purchase and operate vehicles, hire bus drivers and
    transportation directors, purchase bus passes, redesign transportation
    plans including new routing

    systems, offer professional development for bus drivers

    To access educational services and programs

    Students from under performing schools who

    choose to transfer to higher performing schools

    New program, no actual data or estimate available from the federal agency

    Department of Education, Office of Special Education and Rehabilitative
    Services Assistance for Education of All Children with Disabilities

    Individuals with Disabilities Education Act

    20 U. S. C. S:S: 1401( a)( 22), 1411( a)( 1)

    Purchase and operate vehicles, contract for service

    To access educational services

    Children with disabilities No actual data or

    estimate available from the federal agency

    Centers for Independent Living Workforce

    Investment Act of 1998

    29 U. S. C. S:S: 796f- 4( b)( 3) and 705( 18)( xi) Referral,

    assistance, and training in the use of public transportation

    To access program services

    Persons with a significant disability

    No actual data or estimate available from the federal agency

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 43 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Independent Living

    Services for Older Individuals Who Are Blind

    Workforce Investment Act of 1998

    29 U. S. C. S: 796k( e)( 5) Referral,

    assistance, and training in the use of public transportation

    To access program services, for general trips

    Persons aged 55 or older who have significant visual impairment

    No actual data or estimate available from the federal agency

    Independent Living State Grants Workforce

    Investment Act of 1998

    29 U. S. C. S:S: 796e- 2( 1) and 705( 18)( xi)

    Referral, assistance, and training in the use of public transportation

    To access program services, employment opportunities

    Persons with a significant disability

    No actual data or estimate available from the federal agency

    Supported Employment Services for Individuals with Most Significant
    Disabilities

    Workforce Investment Act of 1998

    29 U. S. C. S:S: 795g and 705( 36)

    Transit subsidies for public and private transportation (e. g. bus, taxi,
    and paratransit), training in the use of public transportation

    To access employment placements, employment services, and vocational
    rehabilitation services

    Persons with most significant disabilities

    No actual data or estimate available from the federal agency e Vocational

    Rehabilitation Grants Rehabilitation Act of 1973, as amended 29 U. S. C.
    S:

    723( a)( 8) Transit subsidies for public and private transportation (e. g.
    bus, taxi, and paratransit), training in the use of public transportation

    To access employment placements, employment services, and vocational
    rehabilitation services

    Persons with physical or mental impairments

    $50,700,000 (estimate) e Department of Health and Human Services,
    Administration for Children and Families Child Care and Development Fund
    Child Care and Development

    Block Grant Act of 1990, as amended

    42 U. S. C. S: 9858c States rarely use

    CCDF funds for transportation and only under very

    restricted circumstances To access

    child care services Children from

    low- income families

    $0 (estimate) f Community Services Block Grant Programs Community

    Opportunities, Accountability, Training, and Educational Services Act of
    1998

    42 U. S. C. S: 9904 Taxi vouchers,

    bus tokens General trips Low- income persons No actual data or

    estimate available from the federal agency

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 44 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Developmental Disabilities
    Projects of

    National Significance Developmental Disabilities

    Assistance and Bill of Rights Act of 2000

    42 U. S. C. S:S: 15002, 15081( 2)( D)

    Transportation information, feasibility studies, planning

    General trips Persons with developmental disabilities

    No actual data or estimate available from the federal agency g Head Start
    Augustus F.

    Hawkins Human Services Reauthorization Act of 1990

    42 USCA S: 9835( a)( 3)( C) (ii)

    Purchase and operate vehicles, contract with transportation providers,
    coordinate with local education agencies

    To access educational services

    Children from low- income families

    $514,500,000 (estimate) h Refugee and Entrant

    Assistance Discretionary Grants

    Refugee Act of 1980, as amended

    8 U. S. C. S:S: 1522( b)( 7)( D), 1522( c)

    Bus passes To access employment and educational services

    Refugees No actual data or estimate available from the federal agency

    Refugee and Entrant Assistance State Administered Programs

    Refugee Act of 1980, as amended

    8 U. S. C. S:S: 1522( b)( 7)( D), 1522( c)

    Bus passes To access employment and educational services

    Refugees No actual data or estimate available from the federal agency

    Refugee and Entrant Assistance Targeted Assistance

    Refugee Act of 1980, as amended

    8 U. S. C. S:S: 1522( b)( 7)( D), 1522( c)

    Bus passes To access employment and educational services

    Refugees No actual data or estimate available from the federal agency

    Refugee and Entrant Assistance Voluntary Agency Programs

    Refugee Act of 1980, as amended

    8 U. S. C. S:S: 1522( b)( 7)( D), 1522( c)

    Bus passes To access employment and educational services

    Refugees No actual data or estimate available from the federal agency

    Social Services Block Grants Social Security Act, as amended 42 U. S. C.
    S:

    1397a( a)( 2)( A) Any transportationrelated use

    To access medical or social services States

    determine what categories of families and children

    $18,459,393

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 45 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b State Councils on

    Developmental Disabilities and Protection and Advocacy Systems

    Developmental Disabilities Assistance and Bill of Rights Act of 2000

    42 U. S. C. S:S: 15002, 15025 State Councils

    provide small grants and contracts to local organizations to establish
    transportation projects or collaborate in improving transportation for
    people with disabilities; Protection and Advocacy Systems ensure that
    people with disabilities have access to public transportation as required
    by law All or general trips Persons with

    developmental disabilities and family

    members $786,605 (partial

    outlay) i Temporary Assistance for Needy Families Personal

    Responsibility and Work Opportunity Reconciliation Act of 1996, as amended

    42 U. S. C. S:S: 604( a), (k) Any use that is reasonably

    calculated to accomplish a purpose of the TANF program and the

    allowable matching portion of JARC grants General trips No assistance

    is provided to families without a minor child, but

    states determine specific

    eligibility $160,462,214

    (partial outlay) j Department of Health and Human Services, Administration
    on Aging Grants for Supportive Services and Senior Centers

    Older Americans Act of 1965, as amended

    42 U. S. C. S: 3030d (a)( 2) Contract for

    services To access program services, medical, and for general trips

    Program is targeted to persons aged 60 or over

    $72,496,003 Program for American Indian, Alaskan Native, and Native
    Hawaiian Elders

    Older Americans Act of 1965, as amended

    42 U. S. C. S:S: 3057, 3030d( a)( 2)

    Purchase and operate vehicles To access

    program services, medical, and for general trips

    Program is for American Indian, Alaskan Native, and Native Hawaiian elders

    No actual data or estimate available from the federal agency

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 46 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Department of Health and Human
    Services, Centers for Medicare & Medicaid Services Medicaid Social
    Security Act, as amended 42 U. S. C. S:S:

    1396a, 1396n( e)( 1)( A)

    Bus tokens, subway passes, brokerage services

    To access health care services

    Recipients are generally lowincome

    persons, but states determine specific

    eligibility $976,200,000

    (estimate) k State Children*s Health Insurance Program Medicare,

    Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000

    42 U. S. C. S:S: 1397jj( a)( 26), (27)

    Any transportationrelated use

    To access health care services

    Beneficiaries are primarily children from low- income families, but states
    determine eligibility

    $4,398,089

    Department of Health and Human Services, Health Resources and Services
    Administration Community Health Centers Public Health Service Act, as

    amended 42 U. S. C. S:

    254b( b)( 1)( A) (iv) Bus tokens,

    vouchers, transportation coordinators, and drivers

    To access health care services

    Medically underserved populations

    $4,200,000 (estimate) l Healthy Communities

    Access Program Public Health Service Act, as amended

    42 U. S. C. S: 256( e)( 1)( B)( iii) Improve

    coordination of transportation To access

    health care services

    Uninsured or underinsured populations

    No actual data or estimate available from the federal agency

    Healthy Start Initiative Public Health Service Act, as amended

    42 U. S. C. S: 254c- 8( e)( 1) Bus tokens, taxi

    vouchers, reimbursement for use of own

    vehicle To access

    health care services

    Residents of areas with significant perinatal health disparities

    No actual data or estimate available from the federal agency

    HIV Care Formula Grants Ryan White

    Comprehensive AIDS Resources Emergency Act of 1990

    42 U. S. C. S:S: 300ff- 21( a), 23( a)( 2)( B)

    Bus passes, tokens, taxis, vanpools, vehicle purchase by providers,
    mileage reimbursement To access

    health care services

    Persons with HIV or AIDS $19,500,000

    (estimate) m Maternal and Child Services Grants Social Security Act, as
    amended 42 U. S. C. S:

    701( a)( 1)( A) Any transportationrelated use

    To access health care services

    Mothers, infants and children, particularly from lowincome

    families No actual data or

    estimate available from the federal agency

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 47 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Rural Health Care,

    Rural Health Network, and Small Health Care Provider Programs

    Health Centers Consolidation Act of 1996

    42 U. S. C. S: 254c Purchase

    vehicles, bus passes

    To access health care services

    Medically underserved populations in

    rural areas No actual data or

    estimate available from the federal agency

    Department of Health and Human Services, Substance Abuse and Mental Health
    Services Administration Community Mental Health Services Block Grant

    ADAMHA Reorganization Act, as amended

    42 U. S. C. S: 300x- 1( b)( 1) Any

    transportationrelated use

    To access program services

    Adults with mental illness and children with emotional disturbance

    No actual data or estimate available from the federal agency

    Substance Abuse Prevention and Treatment Block Grant

    ADAMHA Reorganization Act, as amended

    42 U. S. C. S: 300x- 32( b) Any

    transportationrelated use

    To access program services

    Persons with a substance related disorder and/ or recovering

    from substance related disorder

    No actual data or estimate available from the federal agency

    Department of Housing and Urban Development, Office of Community Planning
    and Development Community Development Block Grant

    Housing and Community Development Act of 1974

    42 U. S. C. S: 5305( a)( 8) Purchase and

    operate vehicles General trips Program must serve a majority of lowincome

    persons $6,761,486

    (partial outlay) n Housing Opportunities for Persons with AIDS AIDS
    Housing

    Opportunity Act 42 U. S. C. S: 12907( a)( 3) Contract for

    services To access health care and other services

    Low- income persons with HIV or AIDS and their families

    $190,252 (partial outlay) o Supportive Housing

    Program McKinney- Vento Homeless Assistance Act of 1987, as amended

    42 U. S. C. S: 11385 Bus tokens, taxi

    vouchers, purchase and operate vehicles To access

    supportive services

    Homeless persons and families with children

    $14,000,000 (estimate) p Department of Housing and Urban Development,
    Office of Public and Indian Housing Revitalization of

    Severely Distressed Public Housing Housing and

    Community Development Act of 1992, as amended

    42 U. S. C. S: 1437v( l)( 3) Bus tokens, taxi

    vouchers, contract for services

    Trips related to employment or obtaining necessary supportive services

    Residents of the severely distressed housing and residents of the
    revitalized units

    $700,000 (estimate) q

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 48 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Department of the Interior,
    Bureau of Indian Affairs Indian Employment

    Assistance Adult Indian Vocational Training Act, as amended

    25 U. S. C. S: 309 Gas vouchers To access

    training Native American persons between the ages of 18 and 35

    No actual data or estimate available from the federal agency

    Indian Employment, Training and Related Services r Indian Employment,

    Training and Related Services Demonstration Act of 1992

    25 U. S. C. S: 3401 Gas vouchers Employment related Low- income

    Native American persons

    No actual data or estimate available from the federal agency

    Department of Labor, Employment and Training Administration Job Corps
    Workforce Investment Act of 1998

    29 U. S. C. S:S: 2888( a)( 1), 2890

    Bus tickets To access Job Corps sites and employment services

    Low- income youth $21,612,000

    Migrant and Seasonal Farmworker s Workforce

    Investment Act of 1998

    29 U. S. C. S:S: 2801( 46), 2912( d)

    Mileage reimbursement To access

    employment placements or intensive and training services

    Low- income persons and their dependents who are primarily employed in
    agricultural

    labor that is seasonal or migratory

    No actual data or estimate available from the federal agency

    Native American Employment and Training Workforce

    Investment Act of 1998

    29 U. S. C. S: 2911( d)( 2) Bus tokens,

    transit passes, use of tribal vehicles and grantee staff vehicles, mileage
    reimbursement for participants operating *car

    pool* services To access

    employment placements, employment services

    Unemployed American Indians and other persons of Native American descent

    No actual data or estimate available from the federal agency

    Senior Community Service Employment Program

    Older Americans Act of 1965 42 U. S. C. S:

    3056( c)( 6)( A) (iv) Mileage

    reimbursement, reimbursement for travel costs,

    and payment for cost of transportation

    To access employment placements

    Low- income persons aged 55 or over

    $4,400,000 (estimate) s

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 49 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Trade Adjustment

    Assistance - Workers Trade Act of 1974, as amended

    19 U. S. C. S: 2296( b) Mileage

    reimbursement, transit fares

    To access training Persons found

    to be impacted by foreign trade, increased imports, or shift in production

    No actual data or estimate available from the federal agency

    Welfare- to- Work Grants to Federally Recognized Tribes and Alaska Natives
    t Personal

    Responsibility and Work Opportunity Reconciliation Act of 1996

    42 U. S. C. S: 612( a)( 3)( C) Any

    transportation related use, though purchasing vehicles for individuals is
    not allowable

    To access employment placements, employment services

    American Indians and other persons of Native American descent who are
    long- term welfare recipients or are low- income

    No actual data or estimate available from the federal agency

    Welfare- to- Work Grants to States and Localities t Personal

    Responsibility and Work Opportunity Reconciliation Act of 1996

    42 U. S. C. S: 603( a)( 5)( C) Any

    transportation related use, though purchasing vehicles for individuals is
    not allowable

    To access employment placements, employment services

    Long- term welfare recipients or low- income individuals

    No actual data or estimate available from the federal agency

    Work Incentive Grants Workforce Investment Act of 1998, as amended

    29 U. S. C. S:S: 2801( 46), 2864( d)( 2)

    Encourage collaboration with transportation providers

    To access one- stop services

    Persons with disabilities who are eligible for

    employment and training services

    No actual data or estimate available from the federal agency

    Workforce Investment Act Adult Services Program

    Workforce Investment Act of 1998, as amended

    29 U. S. C. S:S: 2801( 46), 2864( e)( 2)

    Mileage reimbursement, bus tokens, vouchers

    To access training Priority must

    be given to people on assistance and low- income

    individuals No actual data or

    estimate available from the federal agency

    Workforce Investment Act Dislocated Worker Program

    Workforce Investment Act of 1998, as amended

    29 U. S. C. S:S: 2801( 46), 2864( e)( 2)

    Transportation allowance or reimbursement, bus/ subway tokens

    To access transition assistance in order to find or qualify for new
    employment

    Includes workers who have been laid off, or have

    received an individual notice of termination, or notice that a facility
    will close

    No actual data or estimate available from the federal agency

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 50 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Workforce Investment

    Act Youth Activities Workforce Investment Act of 1998, as amended

    29 U. S. C. S:S: 2801( 46), 2854( a)( 4)

    Public transportation To access

    training and other support services

    Youth with low individual or family income No actual data or

    estimate available from the federal agency

    Youth Opportunity Grants Workforce

    Investment Act of 1998, as amended

    29 U. S. C. S:S: 2801( 46), 2914( b)

    Bus tokens To access program services

    Youth from high poverty areas, empowerment zones, or enterprise
    communities

    $415,000 (estimate) u Department of Labor, Employment Standards
    Administration Black Lung Benefits

    Program Black Lung Benefits Reform Act of 1977

    30 U. S. C. S: 923 Mileage

    reimbursement, transit fares, taxi vouchers

    To access health services Disabled coal

    miners No actual data or estimate available from the federal agency v
    Department of Labor, Veterans Employment and Training Service

    Homeless Veterans* Reintegration Project Homeless

    Veterans Comprehensive Assistance Act of 2001

    38 USCA S:S: 2011, 2021 Bus tokens To access employment services

    Homeless veterans No actual data or

    estimate available from the federal agency

    Veterans* Employment Program Workforce

    Investment Act of 1998, as amended

    29 U. S. C. S:S: 2801( 46), 2913 Bus tokens,

    minor repairs to vehicles

    To access employment services

    Veterans No actual data or estimate available from the federal agency

    Department of Transportation, Federal Transit Administration Capital and
    Training Assistance Program for Over- the- Road Bus Accessibility

    Title 49 Recodification, P. L. 103- 272

    49 U. S. C. S: 5310 To make

    vehicles wheelchair accessible and training required by ADA

    General trips Persons with disabilities $2,877,818

    Capital Assistance Program for Elderly Persons and Persons with
    Disabilities

    Title 49 Recodification, P. L. 103- 272

    49 U. S. C. S: 5310 Assistance in

    purchasing vehicles, contract for services

    To serve the needs of the elderly and persons with disabilities

    Elderly persons and persons with disabilities

    $174,982,628

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 51 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Capital Investment

    Grants Transportation Equity Act for the 21st Century

    49 U. S. C. S: 5309 Assistance for

    bus and busrelated capital projects

    General trips General public, although some projects are for the special
    needs of elderly persons and persons

    with disabilities $17,500,000 (estimate) w Job Access and

    Reverse Commute Transportation Equity Act for the 21st Century

    49 U. S. C. S: 5309 note Expand existing public

    transportation or initiate new service

    To access employment and related services

    Low income persons, including persons with disabilities

    $85,009,627 Nonurbanized Area Formula Program Title 49

    Recodification, P. L. 103- 272 49 U. S. C. S:

    5311 Capital and operating assistance for public transportation service,
    including paratransit services, in nonurbanized areas

    General trips General public, although paratransit services are for the
    special needs of persons with disabilities

    $0 (partial obligation) x Urbanized Area Formula Program Title 49

    Recodification, P. L. 103- 272, as amended

    49 U. S. C. S: 5307 Capital

    assistance, and some operating assistance for public transit, including
    paratransit services, in urbanized areas

    General trips General public, although paratransit services are for the
    special needs of persons with disabilities

    $36,949,680 (partial obligation) y Department of Veterans Affairs,
    Veterans Benefits Administration Automobiles and

    Adaptive Equipment for Certain Disabled Veterans and Members of the Armed
    Forces

    Disabled Veterans and Servicemen*s Automobile Assistance Act of 1970

    38 U. S. C. S: 3902 Purchase of

    personal vehicles, modifications of vehicles

    General trips Veterans and service members with disabilities

    $33,639,000

    Department of Veterans Affairs, Veterans Health Administration VA Homeless
    Providers Grant and Per Diem Program

    Homeless Veterans Comprehensive Service Programs Act of 1992

    38 U. S. C. S: 7721 note 20 vans were

    purchased under this program

    General trips Homeless veterans $565,797

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 52 GAO- 03- 697
    Transportation Coordination Program

    Popular title of authorizing legislation

    U. S. Code provisions authorizing funds for transportation

    Typical uses as reported by program officials

    Types of trips as reported by program officials

    Target population as defined by program officials a Fiscal year

    2001 federal spending on transportation b Veterans Medical Care

    Benefits Veterans* Benefits Improvements Act of 1994

    38 U. S. C. S: 111 Mileage

    reimbursement, contract for service

    To access health care services

    Veterans with disabilities or low incomes

    $126,594,591

    Total (reported or estimated spending on transportation services for the
    transportationdisadvantaged) $2,445,453,139

    Sources: GAO analysis of information from the Departments of Agriculture,
    Education, Health and Human Services, Housing and Urban Development, the
    Interior, Labor, Transportation, and Veterans Affairs; the Coordinating
    Council on Access and Mobility; the Catalog of Federal Domestic
    Assistance; the U. S. Code; the Code of Federal Regulations; and the
    Community Transportation Association of America.

    a A supplemental source for the target populations was the Catalog of
    Federal Domestic Assistance. b Actual outlays or obligations on
    transportation are given for programs that track this information. All
    data are outlays, except for the following programs, which are
    obligations: Capital Investment Grants, Urbanized Area Formula Program,
    Nonurbanized Area Formula Program, Job Access and Reverse Commute, Capital
    and Training Assistance for Over- the- Road Bus Accessibility, Capital
    Assistance Program for Elderly Persons and Persons with Disabilities,
    Automobiles and Adaptive Equipment for

    Certain Disabled Veterans and Members of the Armed Forces, and Veterans
    Medical Care Benefits. Actual data and estimates are the total for the
    program, unless otherwise noted as partial outlays or obligations in the
    table. When actual information was not available, estimates are given
    based on information provided by program officials or the officials agreed
    with an estimate made by another source. c According to a program
    official, outlays for the Food Stamp Employment and Training Program have
    increased due to changes in the program from the 2002 Farm Bill. The 2002
    Farm Bill eliminates the

    $25 per month cap that the Department of Agriculture will reimburse the
    states for transportation and other work costs incurred by participants.
    In fiscal year 2002, federal outlays for transportation were $18,523,535.
    d A program official said that 10 percent of total program outlays would
    be a conservative estimate of

    transportation outlays. e Grantees report total expenditures and
    unliquidated obligations made by the state Vocational

    Rehabilitation (VR) Agency for transportation services provided to
    individuals served under the State VR Services Program for a fiscal year.
    Total obligations include both federal and nonfederal funds under the
    State VR Services Program, the supplemental federal funds awarded to the
    State VR Agency for the cost of supported employment services under the
    Supported Employment Program, and funds from other rehabilitation sources.
    The Department of Education does not collect data on the specific sources
    of funds used for transportation obligations under the program. However,
    based on information available from total annual obligations on a national
    aggregate basis, a program official estimated that of the total amount
    reported for transportation, about 96 percent would be from the State VR
    Services Program, and of that amount approximately 76 percent would be
    federal funds. Similar estimates could not be made for the Supported
    Employment Program. f A program official said that, while transportation
    is an allowable use of funds, using funds for

    transportation is not encouraged. Program officials estimate that
    transportation expenditures are zero or close to zero for this program. g
    Fiscal year 2001 data are not available because transportation was not an
    area of emphasis until fiscal year 2002. The preliminary fiscal year 2002
    outlays for transportation projects totaled $1,084,798. h A program
    official estimated that transportation outlays were 8.3 percent of total
    outlays.

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 53 GAO- 03- 697
    Transportation Coordination i This is a partial outlay based on voluntary
    reporting by grantees. Full outlays are not available

    because, according to a program official, grantees were not required to
    report transportation outlays prior to fiscal year 2002. Fiscal year 2002
    data are incomplete, however preliminary data on transportation outlays
    from 46 of the 51 grantees totaled $2,215,498. j This is a partial outlay
    based on the amount grantees reported as non- assistance outlays in a

    category exclusively for transportation. States reported an additional
    $356.5 million as outlays on assistance in a category that includes
    transportation and supportive services, however program officials were
    unable to determine what percentage of the outlays on assistance were
    spent on transportation. k Program officials indicate that federal data on
    nonemergency medical transportation are not

    available. Estimate assumes that transportation outlays are 0.73 percent
    of total program outlays, based on previous research, including a survey
    of state Medicaid programs. l According to a program official, grantees
    report total outlays for transportation and it is not possible to

    distinguish between federal and nonfederal funds. The official said 22
    percent of total transportation outlays would be a good estimate of the
    federal portion of fiscal year 2001 transportation outlays. m Estimate of
    transportation outlays is based on data from grantee*s budget allocations,
    as suggested

    by an agency official. n This is a partial outlay for transportation
    through the Community Development Block Grant program. This figure
    includes transportation outlays for the Entitlement program, but excludes
    the State

    Administered program. o This is a partial estimate because, according to a
    program official, data on transportation outlays are

    not available from all grantees. The program official could not provide an
    estimate of outlays for transportation for all grantees. p HUD provided
    data for transportation spending by 3,187 grantees in fiscal year 2001
    that totaled

    $7,221,569. According to HUD program officials, there are a total of 6,323
    grantees, about twice as many as reported data. The officials therefore
    estimated that about $14,000,000 would have been spent on transportation
    from all grantees in fiscal year 2001. q Estimate of outlays for
    transportation is based on a program official*s review of the budgets from
    15 grantees who renewed their grants in fiscal year 2001. The official
    projected total transportation

    outlays for the program based on these 15 grantees. r Public Law 102- 477
    is applied to allow tribal governments to consolidate funding from several
    federal

    programs. These include: the Department of Health and Human Services*s
    Temporary Assistance for Needy Families, and Child Care and Development
    Fund programs; the Department of Labor*s Native American Employment and
    Training, and Welfare- to- Work Grants for Federally Recognized Tribes

    programs; and the Bureau of Indian Affairs* Employment Assistance, Indian
    Social Service and Welfare Assistance, Adult Basic Education, and Higher
    Education programs. The Indian Social Services and Welfare Assistance
    Program is not used for transportation outside 102- 477. The Adult Basic
    Education and Higher Education programs do not target transportation-
    disadvantaged populations as defined in this study outside of 102- 477.
    The Employment Assistance program and the HHS and DOL programs provide
    transportation assistance separately from 102- 477. s A program official
    estimated that transportation outlays were approximately 1 percent of
    total

    program outlays. t Program funding from fiscal year 1998 and 1999 may
    still be spent, but the program no longer receives funding. u Estimate of
    transportation outlays is based on a program official*s review of grantee
    obligations. v According to a program official, fiscal year 2001 data are
    not available due to changes in the program*s reporting system. The
    official reported that transportation outlays for fiscal year 2002 totaled
    $478,408.

    Appendix II: Inventory of Federal Programs Providing Transportation
    Services to the Transportation- Disadvantaged Page 54 GAO- 03- 697
    Transportation Coordination w According to a program official, there are
    three distinct allocations of funds under the Capital

    Investment Grants: the New Starts allocation, which funds new rail
    projects; the fixed- guideway modernization allocation, which provides
    funding to maintain and update aging rail systems; and the bus allocation,
    which provides funding for the purchase of buses, bus- related equipment
    and

    paratransit vehicles, and for the construction of bus- related facilities.
    Because the Capital Investment Grants fund projects that provide services
    for the general public, the transportation- disadvantaged likely benefit
    from many projects funded through each of the three allocations, but
    information was not available to estimate what portion of these funds for
    the general public benefit the transportationdisadvantaged. However, the
    program official said that the bus allocation would likely provide the
    most direct benefit for the transportation- disadvantaged and the
    obligation level could be estimated by totaling allocations to purchase
    vans, buses for the elderly or disabled, or paratransit vehicles and
    equipment. x The Nonurbanized Area Formula Program funds projects that
    provide services for the general public,

    however grantees can use up to 10 percent of their funds to provide
    complementary ADA paratransit services. Although grantees did not report
    obligations for complementary ADA paratransit, a program official said
    that transportation- disadvantaged populations might benefit from other
    services provided

    through this grant, such as demand- responsive services. However, the
    program official could not identify the amount of spending that directly
    benefits the transportation- disadvantaged. y According to a program
    official, the Urbanized Area Formula Program funds projects that provide

    services for the general public, however grantees can use up to 10 percent
    of their funds to provide complementary ADA paratransit services. The
    figure listed in the table is the total obligations that grantees reported
    for providing complementary ADA paratransit services. Although grantees
    may benefit from other services provided through this grant, such as
    demand- responsive services, the amount spent on complementary ADA
    paratransit is the only portion that program officials could identify as
    directly benefiting the transportation- disadvantaged.

    Appendix III: Federal and State Coordination Efforts Page 55 GAO- 03- 697
    Transportation Coordination Federal and state efforts to coordinate the
    services for the transportationdisadvantaged provided through their
    programs vary widely. This

    appendix offers some examples of those efforts. In 1999, we reviewed the
    coordination efforts of the Coordinating Council on Access and Mobility, a
    body of representatives from the U. S. Department of Transportation (DOT)
    and the U. S. Department of Health and Human Services (HHS). 1 We made
    several recommendations for improving coordination between these two
    agencies. Table 5 shows the recommendations and actions taken in response.

    Table 5: Federal Actions Taken in Response to GAO Recommendations for
    Improving Coordination Recommendations from 1999 GAO report Specific
    actions completed or products

    issued in response Actions in progress and further concerns The DOT/ HHS
    Coordinating Council on Access and Mobility should adopt a prioritized
    strategic plan.

    In August 2000, the Coordinating Council adopted a prioritized strategic
    plan for fiscal years 2000 to 2004 and distributed the plan to its
    members.

    The plan has not been updated or distributed widely because the Council is
    now focused on a more *product- oriented* approach. The plan will be
    updated at the end of 2003. The entire Coordinating Council has not met
    formally since December 2000, but specific workgroups have been developing
    action agendas and interagency agreements. The Coordinating Council should
    develop an action plan with specific responsibilities. The Council
    developed and issued an action plan in fiscal year 2003 and a

    number of actions have been completed, such as producing a series of *how
    to* publications on using intelligent transportation systems to assist in
    the coordination of HHS programs with local transit agencies.

    Other actions were not completed by the expected date, such as the
    preparation of a promotional brochure on state Medicaid brokerage
    initiatives. Also, the outcome of actions is unknown due to the lack of an
    annual report.

    The Coordinating Council should issue an annual report on its major
    initiatives and accomplishments to the Secretaries of DOT and HHS. No
    annual report has yet been issued. The Council plans to issue its first
    annual

    report in June 2003.

    1 U. S. General Accounting Office, Transportation Coordination: Benefits
    and Barriers Exist, and Planning Efforts Progress Slowly, GAO/ RCED- 00- 1
    (Oct. 22, 1999). Appendix III: Federal and State Coordination

    Efforts Federal Coordination

    Appendix III: Federal and State Coordination Efforts Page 56 GAO- 03- 697
    Transportation Coordination Recommendations from 1999 GAO report Specific
    actions completed or products

    issued in response Actions in progress and further concerns DOT and HHS
    should ensure that planned coordination efforts reinforce one another.

    The document *Planning Guidelines for Coordinated State and Local
    Specialized Transportation Services* was issued by the Council in December
    2000 and distributed to state and local transit agencies. The guidelines
    are also available on the Web sites of the Council and DOT*s Federal
    Transit Administration (FTA). These guidelines provide information to
    facilitate the coordination of transportation services for 12 HHS and 10
    DOT programs.

    Distribution to health and human service providers may not have been as
    thorough. According to some regional FTA and HHS officials we interviewed,
    the guidelines might have more impact if they are delivered to human
    service agencies and providers. Other officials mentioned the need for
    more specific guidance, such as models for cost sharing.

    DOT and HHS should direct their regional working groups to assess
    obstacles to transportation coordination.

    The Council*s strategic plan provides for regional coordination action
    plans, including the identification and assessment of obstacles to
    transportation coordination.

    All 10 of the regions produced action plans, but most have not been
    updated since fiscal year 2000. In addition, the outcomes of actions are
    not routinely tracked. The FTA and HHS regional offices are jointly
    sponsoring conferences in spring 2003 for state transportation and human
    service officials to, among other things, identify obstacles to
    coordination and best practices in successfully overcoming them. The
    Coordinating Council should strengthen its Web site and make information
    available on obstacles to coordination and strategies to overcome them.

    The Council*s official Web site was discontinued due to lack of funding,
    but another site was established in May 2002, operated by FTA in
    conjunction with the Community Transportation Association of America. The
    site is linked to FTA*s Web site. (www. fta. gov/ CCAM/ www. index. html)

    The Coordinating Council*s Web site is not yet linked to HHS*s Web site.
    The Council*s Web site does not contain an explicit list of obstacles to
    coordination or strategies to overcome them, but it does contain links to
    several reports that address these issues. Source: GAO. As a result of
    items in the Coordinating Council*s strategic plan and action

    plan, FTA and HHS have undertaken multiple efforts to coordinate
    transportation services provided through their programs. Other federal
    agencies are also involved in coordination activities. Examples of federal
    coordination efforts include the following:

     The FTA and HHS*s Administration on Aging have entered into a memorandum
    of understanding to increase coordination of transportation for older
    adults. For example, the agreement says that FTA and the Administration on
    Aging will work together to better coordinate the provision of funding
    opportunities to the aging services and transportation networks for the
    purpose of fostering coordination of transportation services and
    developing innovative service delivery models.

     FTA and HHS*s Centers for Medicare & Medicaid Services are developing an
    action plan between them to address the coordination of Medicaid funded
    transportation.

    Appendix III: Federal and State Coordination Efforts Page 57 GAO- 03- 697
    Transportation Coordination  Department of Labor (DOL) and DOT officials
    are developing guidelines about using Workforce Investment Act 2 funds for
    programs funded under

    DOT*s Job Access and Reverse Commute Program.  Some federal regional
    offices have interagency working groups to discuss

    transportation and other areas of mutual concern. Four of the 10 regions
    have formal working groups that meet regularly to discuss ways to use
    federal funds more efficiently, including for transportation services.
    These groups include officials from FTA, HHS and, in some regions, the
    Departments of Labor, Education, Housing and Urban Development, Veterans
    Affairs, and others. In 4 other regions, FTA and some components of HHS
    work together informally. One of the regions also has a formal working
    group that meets quarterly to discuss Workforce Investment Act programs.

     A study undertaken on behalf of DOT and HHS examined seven specific
    planning strategies that can be used as part of a flexible regional
    planning process for coordinating transportation services of health and
    human

    service and transit agencies. The report is available on the Coordinating
    Council*s Web site. 3  The Community Transportation Association of
    America (CTAA) is an

    organization consisting primarily of rural and small community
    transportation providers, and it serves the dual role of transportation
    industry representative and mobility advocate. It also has responsibility
    for updating and maintaining the Coordinating Council*s Web site. CTAA
    sponsored a National Summit on Coordination in May 2003 to encourage
    federal, state, and local coordination. The participants* who came from
    federal departments, human service agencies, state associations, and
    transit providers* discussed, among other things, obstacles to
    coordination and strategies for addressing them.

     CTAA established a Web site for the National Transit Resource Center, an
    information clearinghouse funded by DOT and HHS. 4 The site contains links
    to the Coordinating Council as well as to the Community Transportation
    Assistance Project (CTAP) and the Rural Transit

    2 P. L. 105- 220. 3 Volpe National Transportation Systems Center,
    Innovative State and Local Planning for Coordinated Transportation, (U. S.
    Department of Transportation, February 2002). 4 http:// www. ctaa. org/
    ntrc.

    Appendix III: Federal and State Coordination Efforts Page 58 GAO- 03- 697
    Transportation Coordination Assistance Program (RTAP). CTAP, funded by
    HHS, provides information about transportation issues, such as
    accessibility, coordination, funding

    opportunities, training, management, and legislation and regulations. CTAP
    also compiled a comprehensive list of federal funding resources for
    community transportation providers. The purpose of RTAP, funded by FTA, is
    to provide training and technical assistance for rural public
    transportation operators, improve professionalism and safety of rural
    public transit services, promote efficiency and effectiveness of rural
    transit services, and support coordination with human service
    transportation.

     HHS and CTAA have developed and distributed an Employment Transportation
    Toolkit designed to help communities improve access to transportation for
    employment purposes.

     DOL is working with CTAA and DOT to implement several rounds of pilot
    projects testing various transportation strategies in support of local
    onestop employment and training centers. 5 According to DOL officials,
    these strategies can include referral services, transportation
    information, transportation services coordination, mobility management,
    and other transportation strategies.

     DOL also provides funding to CTAA to convene regional workshops among
    workforce development, human services, transportation, and business
    communities, and to update a technical assistance toolkit for employment
    transportation. The toolkit includes promising practices from the state
    and local levels, as well as information on how businesses can be
    employment transportation partners.

     According to agency officials, DOL*s Employment and Training
    Administration sponsored a *Promising Practices* project that includes
    transportation coordination efforts.

     The National Consortium on the Coordination of Human Services
    Transportation* an initiative of FTA and HHS, under the direction of CTAA*
    plans to design and conduct a survey of state Medicaid directors to
    compile data on the Medicaid transit pass program, brokerages, and other
    transportation funding mechanisms within Medicaid; develop a new

    5 In an effort to coordinate service delivery for employment and training
    programs, the Workforce Investment Act established one- stop centers in
    all states. Individuals seeking employment opportunities and training can
    receive services from more than a dozen federal programs that are required
    to offer their services through these one- stop centers.

    Appendix III: Federal and State Coordination Efforts Page 59 GAO- 03- 697
    Transportation Coordination brochure outlining the benefits of the
    Medicaid pass program; develop case studies of successful brokerage
    programs and design a brochure

    describing them; identify promising practices and obstacles in human
    service transportation coordination and develop strategies for addressing
    these obstacles; and provide outreach on coordination efforts and
    resources. 6  The federally- funded Transportation Research Board, an arm
    of the

    National Academy of Sciences, has several completed and ongoing projects
    on transportation coordination, including the following:

     In June 2000 the board issued *Welfare- to- Work: Integration and
    Coordination of Transportation and Social Services.* This report
    identifies obstacles former welfare recipients face in making the
    transition to work and suggests practical strategies to improve access to
    job opportunities.

     A draft report of TCRP Project B- 24, *Toolkit for Rural Community
    Coordinated Transportation Services,* is expected in June 2003. The
    objective of this research is to develop a practical toolkit for use by
    local communities, state agencies, and tribal governments in planning and
    implementing coordinated community transportation services in rural areas.

     The final report of TCRP Project H- 26, *Economic Benefits of
    Coordinating Human Service Transportation and Transit Services,* is
    expected in late 2003. The executive summary has been made available for
    distribution. In this project, the researchers are examining the economic
    benefits associated with various strategies and practices for coordinating
    health and human services and transit providers, as well as additional
    benefits (beyond costs) that might be obtained through further
    coordination efforts.

     TCRP Project H- 30, *Strategies to Increase Coordination of
    Transportation Services for the Transportation Disadvantaged,* has an

    6 To date, the consortium consists of the AARP, Amalgamated Transit Union,
    American Association of State Highway and Transportation Officials,
    American Public Transportation Association, American Public Human Services
    Association, American Public Works Association, American Red Cross,
    Association of Metropolitan Planning Organizations, Children*s Health
    Fund, Community Transportation Association of America, Easter Seals
    Project Action, National Association of Area Agencies on Aging, National
    Conference of State Legislatures, National Governor*s Association, and the
    Taxicab, Limousine, and

    Paratransit Association.

    Appendix III: Federal and State Coordination Efforts Page 60 GAO- 03- 697
    Transportation Coordination expected completion date of January 2004. The
    objective of this

    research project is to develop strategies for initiating or improving
    coordination of local and regional publicly funded transportation services
    for the transportation- disadvantaged.

    Coordination of transportation services at the state level varies. We
    visited two states with formal coordinating bodies, one state with a
    formal arrangement between two agencies, and two states with no formal
    coordination. Table 6 identifies the states* coordination arrangements and
    the agencies involved in formal coordination efforts.

    Table 6: Examples of State Coordination of Services for the
    Transportation- Disadvantaged State Type of coordination Statewide

    coordinating body Departments/ organizations involved in formal
    coordination Arizona None None None

    Florida State- administered brokerage system Commission for the

    Transportation Disadvantaged  Departments of Transportation, Education,
    Veterans Affairs, Children and Families, Elder Affairs, Labor and
    Employment Security

     Agency for Health Care Administration

     Florida Transit Association

     Community Transportation Coordinators

     Transportation operators

     Nontransportation business community

     Florida Association for Community Action

     Early Childhood Council

     Representatives for the disabled, elderly, rural, and urban populations
    New York None None None South Dakota Statewide planning

    body Transportation Planning and

    Coordinating Task Force

     Departments of Transportation, Human Services, Social Services, Labor,
    and Health

     Coalition of Citizens with Disabilities Wisconsin None for entire state
    None  Departments of Transportation and Workforce Development jointly
    administer Wisconsin Employment Transportation

    Assistance Program (WETAP) Source: GAO.  Arizona does not have formal
    transportation coordination efforts at the

    state level, though some state agencies work together informally, and some
    localities have similar arrangements. For example, an official from the
    Jobs Administration in the Department of Economic Security said that

    the Administration works with the Department of Transportation to try to
    avoid duplication of services in rural areas.  Florida has a state
    coordinating body that oversees local coordination

    efforts among most programs. This body is called the Commission for the
    Transportation- Disadvantaged and was created in 1989 by the Florida State
    Coordination

    Appendix III: Federal and State Coordination Efforts Page 61 GAO- 03- 697
    Transportation Coordination Legislature to oversee the implementation of
    coordinated transportation disadvantaged services. The commission appoints
    local Community

    Transportation Coordinators who are responsible for the arrangement or
    delivery of transportation services for transportation- disadvantaged
    persons, either by brokering services or by providing transportation
    directly. Agencies are required to purchase transportation through the
    coordinated system, unless the services offered do not meet the needs of
    the client or the agency can find a lower cost alternative that meets the
    same safety standards.

     New York does not have a formal coordinating body, but some state
    agencies work together informally and many local agencies have entered
    into brokerage agreements. Officials from the Departments of Labor and
    Transportation say they have been working together to identify needs and
    initiate transportation projects for employment programs. In addition,
    five

    state agencies review and comment on applications for FTA*s Transit
    Capital Assistance Program for Elderly Persons and Persons with
    Disabilities.

     South Dakota has a state coordination task force that provides guidance
    to local coordination efforts, but not all localities or programs have
    developed coordinated systems. South Dakota established its Transportation
    Planning and Coordinating Task Force in 1998 at the initiative of the
    governor*s office. Additionally, the Departments of Human Services and
    Transportation require all of their programs or applicants to coordinate
    with other resources in the community.

     Wisconsin does not have a single body in state government that
    coordinates all of Wisconsin*s services for the
    transportationdisadvantaged, but some state and local programs do
    coordinate. The state Departments of Transportation and Workforce
    Development jointly administer the Wisconsin Employment Transportation
    Assistance Program (WETAP), which uses a combination of federal, state,
    and local funds to provide transportation for low- income residents to get
    to jobs and employment services. WETAP applicants are required to
    demonstrate coordination, and only one grant application is accepted per
    county. Other agencies are also working to improve coordination. The
    Departments of Transportation and Health and Family Services are trying to
    coordinate Medicaid transportation. In addition, the Department of Health
    and Family Services convened a conference in August 2002 to discuss ways
    to

    improve coordination of transportation for people with disabilities.

    Appendix IV: Informational Resources on Coordination

    Page 62 GAO- 03- 697 Transportation Coordination Coordinating Council on
    Access and Mobility, www. fta. dot. gov/ CCAM/ www. index. html

    Community Transportation Association of America, www. ctaa. org Workforce
    Investment Act Transportation Resources, www. doleta. gov/ usworkforce/
    resources/ transport. asp

    Community Transportation Association of America. 2002. Building Mobility
    Partnerships: Opportunities for Federal Investment.

    Washington, D. C.: Community Transportation Association of America.
    Coordinating Council on Access and Mobility. 2000. Planning Guidelines for
    State and Local Coordination. Washington, D. C.: Coordinating Council on
    Access and Mobility.

    Creative Action, Inc. 2001. Coordinating Transportation Services: Local
    Collaboration and Decision- Making. Prepared for Project Action. Akron,
    OH: Creative Action, Inc.

    National Governor*s Association. 2002. Improving Public Transportation
    Services through Effective Statewide Coordination. Washington, D. C.: U.
    S. Department of Health and Human Services and U. S. Department of
    Transportation.

    Volpe National Transportation Systems Center. 2002. Innovative State and
    Local Planning for Coordinated Transportation. Washington, D. C.: U. S.
    Department of Transportation.

    Westat. Economic Benefits of Coordinating Human Service Transportation and
    Transit Services. Transit Cooperative Research Project of the
    Transportation Research Board. Forthcoming.

    Westat. Toolkit for Rural Community Coordinated Transportation Services.
    Transit Cooperative Research Project of the Transportation Research Board.
    Forthcoming.

    National Transportation Consortium of States, Ecosometrics, Inc., and the
    American Public Works Association for the Coordinating Council on Access
    and Mobility. 2000. Working Together: A Directory of State Coordination
    Programs, Policies, and Contacts: 1999- 2000. Washington, D. C. Appendix
    IV: Informational Resources on

    Coordination Web Sites

    Reports

    Appendix V: Comments from the Department of Health and Human Services

    Page 63 GAO- 03- 697 Transportation Coordination Appendix V: Comments from
    the Department of Health and Human Services

    Note: GAO comments supplementing those in the report text appear at the
    end of this appendix.

    Appendix V: Comments from the Department of Health and Human Services

    Page 64 GAO- 03- 697 Transportation Coordination See page 7.

    Appendix V: Comments from the Department of Health and Human Services

    Page 65 GAO- 03- 697 Transportation Coordination See comment 2. See
    comment 1.

    Appendix V: Comments from the Department of Health and Human Services Page
    66 GAO- 03- 697 Transportation Coordination The following are GAO*s
    comments on HHS*s letter dated May 30, 2003.

    1. HHS suggested that we consider incorporating other estimates of
    transportation spending by health and human service programs, particularly
    one estimate that assumed transportation spending accounted for 5 percent
    of total program spending. In developing our

    estimate of transportation spending, we only included actual or estimated
    figures for which the agencies could provide supporting evidence. For
    those programs that had actual or estimated spending information, on
    average, about 3 percent of total spending for those programs was devoted
    to transportation. We do not know whether this 3 percent is an appropriate
    estimate of transportation spending for other programs because grantees
    are generally not required to report transportation spending information
    to the federal agency administering the program. Furthermore, several
    officials who administer programs that had no spending data told us that
    transportation services probably represented less than 1 percent of their
    total program spending.

    2. HHS proposed that we identify the levels, sectors, and affiliations of
    officials and others we interviewed. In all agencies and locations we
    talked with key human service and transportation officials responsible for
    the delivery and coordination of human and transportation services. We
    interviewed more than 100 officials in numerous federal, state, and local
    transportation and human service agencies as well as individuals
    representing service providers, consumers, and professional and industry
    advocacy organizations. In our scope and methodology section (see app. I),
    we generally describe the responsibilities and affiliations of those we
    interviewed. GAO Comments

    Appendix VI: Comments from the Department of Education

    Page 67 GAO- 03- 697 Transportation Coordination Appendix VI: Comments
    from the Department of Education

    Appendix VI: Comments from the Department of Education Page 68 GAO- 03-
    697 Transportation Coordination

    Appendix VII: GAO Contacts and Staff Acknowledgments Page 69 GAO- 03- 697
    Transportation Coordination Katherine Siggerud (202) 512- 2834 or
    siggerudk@ gao. gov Rita A. Grieco (202) 512- 2834 or griecor@ gao. gov
    Randall Williamson (206) 287- 4860 or williamsonr@ gao. gov In addition to
    the individuals above, Christine Bonham, Bradley Hunt, Bert Japikse,
    Jessica Lucas- Judy, Sara Ann Moessbauer, Hilary Murrish, Ryan

    Petitte, Stanley Stenersen, and Andrew Von Ah made key contributions to
    this report. Appendix VII: GAO Contacts and Staff

    Acknowledgments GAO Contacts Staff Acknowledgments

    (542009)

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