Testimony

Statement by
William Raub, Ph.D., Acting Assistant Secretary for Planning and Evaluation, U. S. Department of Health and Human Services
on
Services Funded by Department of Health and Human Services
before the
Committee on Transportation and Infrastructure, and the Committee on Education and the Workforce, U.S. House of Representatives

May 1, 2003

Good morning Chairman Young, Chairman Boehner, Congressman Petri, and members of the committees. I am pleased to be able to testify on behalf of Secretary Tommy G. Thompson, who sends his regrets that he is unable to be with you today.

The Secretary did ask me to convey to you his strong interest in, and concern about the issue of access to the services funded by the Department of Health and Human Services (HHS) and his commitment to working with Transportation Secretary Mineta to continue the progress we have made in coordinating transportation resources and services.

I am the Acting Assistant Secretary for Planning and Evaluation. It is particularly appropriate that I represent the Secretary at this hearing, as the Office of the Assistant Secretary for Planning and Evaluation has been charged with overseeing and encouraging various crosscutting efforts at HHS. As you might imagine, bridging program boundaries in a Department as large as HHS presents challenges. However, Secretary Thompson has challenged us to do exactly that, and we continue to find new ways to collaborate and move towards the "One Department" that the Secretary envisions.

Access to services, as represented by transportation, presents us with several challenging issues but also with opportunities to address this very important issue in innovative ways.

Before I begin describing those challenges and opportunities, I would like to define what the term transportation means to us at HHS in reference to our programs, and to give you a little background on HHS involvement in this issue.

HHS administers over 300 programs, which touch every American throughout their lifetime. The majority of our health and human services programs depend on participants physically presenting themselves at a location to receive the services. So, from our perspective, transportation is a means to an end - it provides timely and appropriate access to the physical site where specific treatments or services are provided. Our concerns are not with the mode of transportation - be it private automobile, agency van or public transportation - but rather that the transportation service meets the specific mobility needs of individual clients, that the cost of the transportation service is reasonable, and that the clients arrive for the service and depart from the service in a timely manner.

Often, the circumstances that bring individuals and families to HHS-funded social and health services also limit their ability to access those needed services. For example, one of the biggest barriers facing people who move from welfare to work -- in cities and in rural areas -- is finding transportation to jobs, training programs and child care centers. Less than 6 percent of the recipients of the Temporary Assistance for Needy Families program (TANF) had access to a private automobile in 1998. Existing mass transit often does not provide adequate links to many suburban jobs at all, or within a reasonable commute time, and many jobs require evening or weekend hours that are poorly served by existing transit routes. Congress acted to address these problems in 1998 through the Transportation Equity Act for the 21st Century (TEA-21). This law authorized competitive Job Access and reverse commute grants to assist States and localities in developing flexible transportation alternatives, such as van services, for welfare recipients and other low-income workers. In addition, TANF funds may be used to match Job Access grant funds for new or expanded transportation services that help welfare and former welfare recipients engage in work activities.

Historically, human services and health care agencies developed client-specific transportation systems to provide this critical link to needed services, in large part because public transportation services could not accommodate the special needs of human services clients. The public transportation services often did not go where human services clients needed to go, nor could many of the clients negotiate the physical challenges of accessing public transportation facilities. Over time, public transportation has become more responsive to the needs of human services clients. Many factors contributed to this evolution, including the passage of the Americans with Disabilities Act (ADA), awareness of changing transportation needs of the general public ridership, and responsiveness to public/private partnerships moving welfare recipients into employment. As a result, public transportation agencies have made great strides in accommodating the transportation needs of special populations, and the coordination of transportation resources and services has become increasingly achievable and effective.

At the community level, the HHS expenditure on transportation represents a significant funding resource to public transportation agencies through contracts with human services agencies. Recent analysis estimates HHS-funded programs spend approximately $2 billion annually on transportation services to provide access to programs and services funded by HHS. This estimate is a conservative figure, as the majority of HHS-funded programs do not track transportation expenditures separately but as part of "support or enabling services" costs. Exact information on how much of that transportation is contracted and how much human service agencies provide in-house is not available. However, all of the HHS funds for transportation follow categorical program lines.

As early as 1977, HHS began exploring the role of transportation and the need for coordination of transportation services through a series of demonstration projects. The results of those projects were mixed. In some communities, coordination efforts resulted in increased service - more rides to more individuals over a larger service area. However, what also became clear was that coordination was neither easy nor inexpensive to achieve, and it was not always the answer to a community's access problems - particularly in rural areas with limited resources.

Substantive HHS/Department of Transportation (DOT) interdepartmental efforts began in 1985, with encouragement from Congress and constituent interest groups to address the issues of service overlap and under-served areas. Through a congressional hearing, States and localities cited federal HHS and DOT regulations as presenting significant barriers to coordinating HHS and DOT transportation resources. In response, HHS and DOT signed a Memorandum of Understanding (MOU) pledging Federal coordination to improve the efficiency and effectiveness of transportation services through the Joint DHHS/DOT Coordinating Council on Human Services Transportation, now known as the Coordinating Council on Access and Mobility (the Council).

The Council is comprised of representatives from several HHS staff and operating divisions, as well as from DOT's Office of the Secretary, Federal Transit Administration (FTA), Federal Highway Administration, and National Highway Traffic Safety Administration (NHTSA). The Director of the HHS Office of Intergovernmental Affairs co-chairs the Council with the Administrator of FTA. Since 1987, the Council has met many times to share information, provide direction and oversight to the technical assistance resource network and to address identified impediments to coordination. HHS also contributes to the work of the National Consortium on the Coordination of Human Services Transportation, which consists of representatives from State and local government associations, human services organizations and public transportation providers.

I spoke earlier of challenges and opportunities represented by health and human services client transportation needs. I would like to elaborate on these.

Many of the challenges are rooted in the fragmented, categorical nature of the health and human services programs and the transportation programs. The health and social services delivery system in this country is structured around individuals' specific physical or social needs. It is only in more recent years that we have come to recognize that a systematic approach to these needs can yield certain efficiencies and more effective solutions.

Over the years, our coordination efforts have addressed the majority of the specific regulatory impediments to coordination. Several related problems still remain. One of the most frustrating is persistent perceptions of regulatory barriers in our ongoing communication with State and local agencies and grantees.

A related challenge is presented by the specific reporting requirements of individual programs. In an effort to assure accountability for taxpayer dollars, reporting requirements follow the categorical lines of the programs. Transportation coordination, by its nature, requires the transportation providers to obtain, maintain and report data in the myriad of formats each program requires. Simplification and standardization of reporting requirements remains a primary goal of every coordination effort.

There is also the challenge of cost. Coordination efforts represent a cost to the programs that participate. Coordination takes staff time, resources, and information before one even gets to the capital costs of facilities and vehicles and the operating costs. Coordination is a special type of planning, requiring resources to design. Most health and human services programs have specific limits on their administrative and planning costs. Historically, these limits have not taken transportation planning into account.

A related cost challenge has been the allocation of transportation costs between human services and transportation agencies when clients are served are eligible for service under both programs. This is a particular concern when both agencies are trying to reduce service costs.

The greatest challenge we face, however, is recognition and acceptance of the integral role that transportation plays in providing health and social services. Everyone involved in our health and social services programs, from overseeing programs to drafting program guidance, needs to understand an important lesson learned by program operators - carrying out the missions of these programs often requires transportation to ensure eligible clients have access to these services.

  • Research has clearly demonstrated that improved coordination can reduce costs per trip, improve service quality and provide more concise information on community needs. For HHS, this translates to increased self-sufficiency for healthier, more productive clients. For States, in this time of significant budget constraints, client needs can be met at lower cost. For communities, increased access can be translated into increased opportunity to contribute to the life of the community.

  • The President's Management Agenda calls for crosscutting efforts to improve the efficiency and effectiveness of federal government programs. Renewing our commitment to transportation coordination highlights the results oriented, citizen centered and customer responsive approach to human services.

  • As part of the Administration's New Freedom Initiative, our Department has been committed to removing barriers to community integration for people with disabilities. Transportation programs and their coordination with health care, income support, and education services are critical to making community integration and employment a reality for millions of Americans with disabilities. Not only is access to reliable transportation services necessary to maintain employment; it is a critical element of independence, self-sufficiency, and freedom for Americans with disabilities.

  • Transportation is integral to the success of several of Secretary Thompson's priorities. Transportation to primary health care is critical to achieving his goal of closing the gap in health disparities among minority populations. Similarly, lifestyle changes and access to regular primary health care are vital to his chronic disease prevention agenda to reduce the effects of heart disease, asthma, diabetes, obesity and high blood pressure.

  • The Federal Working Group on Child Passenger Safety for Families has been charged by the Secretaries of Transportation and HHS, and the Administrator of the National Transportation Safety Board to review the evidence related to car safety seats and to explore program options to help achieve the goal that every child be correctly restrained in an appropriate child restraining device on every trip.

  • The Administration on Aging is partnering with the Federal Transit Administration (FTA) to increase coordination of planning and funding for transportation services. Data shows that one-third of elders receiving transportation services rely on it for virtually all of their transportation needs. This equates to roughly one million elders who in all likelihood would become homebound were it not for this service. AoA and FTA will work to disseminate information on promising practices and conduct regional technical assistance sessions to promote models and new approaches for coordinating transportation resources.

  • Recently, the Centers for Medicare and Medicaid Services (CMS) has also formed a working group with the FTA to coordinate efforts to improve access to health care services through transportation. This workgroup is developing an action plan including identified objectives and an agenda of work activities and products over a specified timeframe.

HHS continues to fund the Community Transportation Association of America (CTAA) to provide training and technical assistance to States and localities on transportation coordination issues. Now in its 13th year of funding, CTAA receives $1 million annually to assist HHS in enhancing transportation coordination across the nation. Our experience working with States and localities on transportation coordination strategies has demonstrated that the relationships developed through coordination efforts can extend far beyond work on transportation. Once agencies and individuals begin learning of each other's work and building trust, more crosscutting work becomes possible.

Our work with communities has revealed amazing creativity at the local level, as well as many promising practices. One unique approach can be found in Westbrook, Maine, where the newly created Independent Transportation Network provides transportation services 24 hours a day, seven days a week. Local residents can choose the level of service they desire and can afford. If a resident wants service immediately, and wants to travel alone, that is available. However, it will be more costly than if they are willing to wait and ride with others. The system is built on a series of transportation credits. Merchants, human services agencies, and families can all contribute to the ride account for an individual. All transportation is provided in vehicles that were donated to the system - for transportation credits - and the rides are provided by volunteers - many of who earn ride credits. We encourage and support creative approaches such as this, to solving local transportation challenges.

We have provided you copies of the Coordinating Council on Access and Mobility Action plans for fiscal years 2002 and 2003. Working with the Federal Transit Administration as well as with the National Consortium on the Coordination of Human Services Transportation, HHS anticipates increasing success among the coordination efforts. The Council will continue to improve our communication to the field through our individual programs, through the Council website, and through the relationships developed within the Consortium.

I want to thank the members of the Transportation and Infrastructure Committee and the Education and the Workforce Committee for the opportunity to share with you today the Department's commitment to human services transportation coordination, and I look forward to working with you to find improved ways of making these services more affordable and available.

I would be pleased to answer any questions you may have.