Transportation for adults with disabilities: Medicaid rides, paratransit, waiver rides, and work programs

An adult with a disability usually gets around by combining programs, because no single one covers every trip. Medicaid pays for rides to medical care, ADA paratransit takes eligible riders to any destination near a bus route, a Medicaid waiver can pay for trips written into a service plan, and vocational rehabilitation pays for rides tied to work or training. Local nonprofits and county programs fill in what is left. This guide is for adults under 65, their families and the case managers who help them, with one section and one first call for each option.

Adults 65 and older have a few more programs, such as the aging network and PACE, which are covered in free rides to appointments for seniors. The first step for everyone is the same: decide what the trip is, then pick the program that pays for that kind of trip.

Which program fits which trip?

Each program pays for a different kind of trip. This table matches the trip to the program and the first call.

Medicaid rides: trips to covered medical care

Medicaid arranges a ride to covered care for a member who has no other way to travel. Its federal definition covers the expense of getting to medical examinations and treatment, so a trip to the pharmacy or a dialysis center may be covered while a trip to a friend’s house is not (what Medicaid transportation covers has the details). The first call is the ride number on the member’s card or plan handbook.

For a member with a disability, CMS tells states to weigh the member’s support needs, and its guide notes that members with disabilities often need more than curb-to-curb help. So say what you need when you book:

• The type of wheelchair or walker, and whether it folds.
• Whether the rider needs help from the door of the home to the vehicle, which is door-through-door service.
• Whether an aide or family member will ride along. Medicaid can cover the cost of an attendant when one is necessary. If a personal care aide is a covered service for the member and goes along on the trip, CMS says an additional transportation attendant is not necessary.

ADA paratransit: any trip, for riders who cannot use the bus

ADA paratransit takes an eligible rider to any destination within three-fourths of a mile of a bus route, for any purpose. A transit agency running local fixed routes has to offer it to people whose disability prevents them from using those routes, and eligibility turns on the disability, not on age or income. The fare can be up to twice the regular fare, and the agency cannot rank trips by purpose.

Eligibility can be limited to some trips. FTA’s examples of conditions include days when symptoms of multiple sclerosis are worse and distances to the bus stop beyond a set number of blocks. How to apply for ADA paratransit walks through the application, the 21-day decision and the appeal, and the paratransit entry explains who qualifies and how it differs from Medicaid rides. The first call is the paratransit office of the transit agency.

Waiver rides: community trips in a service plan

A Medicaid home and community-based services waiver can pay for rides the regular benefit does not: trips to the day programs, jobs and community activities named in the person’s service plan. Waiver transportation explains how it works, and can Medicaid transportation take you to work covers job rides.

A waiver is a separate program from the Medicaid card. Each one has its own application, can limit how many people it enrolls, and may keep a waiting list. Before arranging a second ride, ask the day program whether its rate already includes the trip, because CMS tells states that when a service such as adult day health or day habilitation includes the ride between home and the program, the service definition has to say so.

For someone already enrolled, the waiver case manager is the first call. A person who is not enrolled can ask the state Medicaid agency or the local Aging and Disability Resource Center which waivers are open to them.

Vocational rehabilitation and work incentives

State vocational rehabilitation (VR) pays for transportation a person needs to take part in a VR service, such as training or a job placement. The federal list of services includes transportation, and its definition covers travel and related expenses, including a personal care attendant’s travel and relocation for a job far from home (34 CFR 361.5(c) and 361.48(b)). The first call is the VR counselor, since the ride has to be part of the person’s employment plan.

Social Security has two work rules that count the cost of getting to work, one for impairment-related work expenses and one for a plan to achieve self-support. Neither pays for a ride directly, and can Medicaid transportation take you to work explains both. A person paying for a vehicle can also look at grants for a wheelchair van.

Local programs: independent living centers, county rides and volunteers

When no program above fits, local organizations fill the gaps, and a good place to learn what exists is a center for independent living. These nonprofits are run by and for people with disabilities. ACL says every center offers information and referral, independent living skills training, peer counseling, advocacy and transition support, and that a center can add transportation assistance based on what its community needs. ACL’s DIAL search lists the centers near you, along with other local disability organizations.

An Aging and Disability Resource Center is a second door. ACL describes these centers as sources of objective information and counseling about long-term services and supports for older adults, people with disabilities and their families, and says contact information for many of them is available through the Eldercare Locator.

Some local rides are paid for through a federal program for this group. Section 5310 grants go to states and other designated recipients for transit projects that meet the special needs of seniors and people with disabilities and for alternatives to public transportation that help them get around. The money passes to subrecipients, which the law defines as state or local government agencies, private nonprofits and public transit operators, so an individual does not apply to the federal government. Ask the county, a nonprofit that serves people with disabilities or a center for independent living which of them runs a ride program, and how to sign up. Some of these programs run on volunteer drivers, which volunteer driver programs explains.

A rider who can use the regular bus on some trips has one more option. Transit systems that receive federal urban formula funds must charge no more than half the peak fare outside peak hours to riders who cannot use transit effectively without special facilities, planning or design because of a disability, and to anyone who shows a Medicare card.

Taxis and private wheelchair vans

When no program pays, a rider can book a taxi or a private wheelchair van. Under 49 CFR 37.29, a taxi company may not refuse service to a person with a disability who can use its vehicles, may not refuse to help stow a mobility device, and may not charge higher fares or fees for carrying a person with a disability and equipment. The rule does not require a taxi company to own accessible cars, so a rider who cannot transfer out of a wheelchair needs a wheelchair van service. Wheelchair transportation cost shows what those rides run, and an ABLE account can pay for them, as ABLE account transportation explains.

For ride companies that serve adults with disabilities

A rider with a disability can have trips paid by different programs, such as a Medicaid ride to dialysis and a paratransit trip to the grocery store. In HealthRide, a rider’s standing schedule can run as recurring trips, and each trip carries the rider’s equipment needs, such as a wheelchair or oxygen, so it is matched to a vehicle that can handle them. The payer summary in reports shows completed trips by payer.