Document Type

Article

Publication Date

4-2019

Abstract

Public health and social equity hinge upon the accessibility of medical services to all. Lack of access to transportation for routine and non-emergency medical appointments poses a significant barrier to appointment attendance, a barrier that disproportionately impact low income people and other marginalized groups. Healthcare providers also suffer major financial losses when patients are unable to attend their appointments. Prior research and community forums in Androscoggin County, Maine have identified several shortcomings to existing local non-emergency medical transportation (NEMT) services, illuminating the need for transportation options that better address the specific needs of the local population. In this report, we identify unmet transportation needs in Androscoggin County, detail the findings of our research on alternative models of NEMT across the United States, and propose a pilot program for a NEMT system tailored to the local needs and resources in Androscoggin County. This project is conducted in collaboration with Community Concepts Inc. (CCI). We build on the work of a previous Environmental Studies Capstone group from Bates College that identified the specific shortcomings of the current NEMT ride brokerage system from the perspective of the New Mainer community. Through consultations and scholarly research, we found a number of elevated transportation barriers faced by New Mainer users, rural users, users with disabilities, and non-MaineCare users. Our comparative study of different NEMT programs in Maine, New York, Minnesota, and Oregon allowed us to identify the range of different vehicles, transport styles, scheduling services and payment options that exist in NEMT services on a national scale. We synthesize the findings of this research into a proposal for a six month NEMT pilot program to be implemented in Androscoggin County. The pilot program we propose would be operated by CCI as a means of testing out the viability of an alternative to the current LogistiCare system. The program would operate two vans, one as a demand responsive, taxi-style service, and one on a fixed route with pick-up points in the downtown Lewiston-Auburn area and drop-off points at major healthcare providers. In order to address local and cultural needs present in Androscoggin County, our proposal recommends a multilingual ride-scheduling service, driver trainings on implicit bias and mental health first aid, and a representative community board to receive feedback and implement changes in the program moving forward. Fare options and potential funding options are also discussed. We conclude with a set of recommendations for next steps for working towards more accessible, culturally appropriate NEMT services in Androscoggin County.

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