Senate Transportation hears that Vermont’s demand-response transit and Medicaid NEMT are straining under higher costs, fewer volunteer drivers

The Senate Transportation Committee on April 3 heard that Vermont’s demand-response public transit, including Medicaid nonemergency medical transportation (NEMT), is under growing strain because of rising per-trip costs, fewer volunteer drivers and service consolidations by health providers.

At the hearing, Ross McDonald, public transit program manager at the Vermont Agency of Transportation, told senators the state’s braided demand-response system — in which transit providers use the same call centers, vehicles, drivers and administration for both state transit programs and Medicaid NEMT — produces efficiencies but now faces capacity limits. “We feel those efficiencies and those, shared costs, kinda lift all boats,” McDonald said.

McDonald and other witnesses described a system funded by multiple federal and state streams: FTA Section 5311 and FHWA funds for rural transit and mobility programs; a Medicaid NEMT program managed by the Department of Vermont Health Access (DVHA); and local in-kind match and small private-pay fares. McDonald said the NEMT split is “approximately 56 and 44 federal state,” and characterized Section 5311-funded older-adult and disability services as roughly 80% federally supported, with a 20% local match that can include in-kind hours.

Why it matters: demand-response trips are largely medical and social-care related. Witnesses said a large share of rides serve dialysis, opioid treatment and adult-day services; those long or out-of-area trips drive costs higher and reduce overall vehicle availability for other riders.

Key figures and operational constraints cited at the hearing - Advance booking: Most demand-response trips require about 48 hours’ notice to allow efficient shared-trip scheduling, McDonald said. Short-notice calls are handled when possible but make coordination harder. "That gives us time to schedule, look for those shared, those shared trips, and legs," McDonald said. - Funding and scale: McDonald said roughly $26 million is the overall figure discussed for transit/demand-response operations in the slides shown; of that, he said about $17.18 million is associated with Medicaid/NEMT. He described the NEMT federal/state split (about 56/44) and noted that some program matches are met with in-kind volunteer hours. - Volunteer drivers and costs: Providers reported a long-term decline in volunteer capacity. Speakers said volunteer trips now account for about 48% of demand-response trips (down from roughly 60% pre-COVID). One provider estimated 175–200 active volunteer drivers statewide, below pre-pandemic levels and below internal targets; several witnesses said they had hoped to reach about 300 volunteers. The IRS mileage reimbursement increase (to $0.70 per mile, effective Jan. 1) was flagged as increasing operating costs. - Background checks and contractor limits: Witnesses said Medicaid-contracted trips require a rigorous set of checks that can prevent use of third-party ride-hail drivers or some institutionally employed drivers. McDonald and others said the Medicaid/NEMT contract currently requires eight separate background checks for drivers (examples listed later in the hearing included national and state criminal checks, child- and adult-abuse registries, DMV checks and federal exclusions checks). Providers urged exploring limited variances or harmonizing checks across institutions to increase usable driver pools.

What providers said - Jen Moulton, executive director of Tri-Valley Transit, described recruitment and retention challenges for volunteer drivers and the operational need for dedicated volunteer-coordinator staff. She said volunteers today often offer fewer hours than pre-pandemic volunteers did, increasing reliance on paid drivers and raising costs. - Gail Grama of (Bridal/Brattleboro) Community Transportation urged the committee to have the state budget office include transportation impacts in fiscal analyses for bills that affect childcare, health care, housing and other statewide services; she also proposed state-funded “community cars” that volunteers could use so they do not have to put miles on personal vehicles. - Elaine Haitko, identified at the hearing as executive director of the Vermont Public Transit Association, supported exploring variances and administrative changes to allow institutional drivers (for example, staff at treatment centers) to be used more readily where safe and appropriate. She also described increased case-management-like work by providers verifying eligibility, coordinating appointments and following up on no-shows — work that adds staff time and administrative cost. - Steven Falbel, consultant (Sedgemont Hill Consulting), suggested mobile service models (for example, mobile dialysis or mobile opioid treatment units) as an alternative to longer patient transports to sparse regional clinics.

Concerns about health-care consolidation and service shifts Committee members pressed witnesses on how hospital or clinic closures and program consolidations affect transit demand. Witnesses said shifting dialysis or specialty-care appointments to a fewer, farther location often locks vehicles into long runs and removes capacity from a provider’s service area, raising costs and reducing the ability to serve other riders. McDonald said a closure or reduction can create tens of thousands of dollars in extra annual mileage for providers, depending on the closest available facility.

Policy options and asks raised Witnesses and committee members discussed multiple possible responses, without specific legislation adopted at the hearing: better early notification and cross-system planning when hospitals or clinics change service models; a targeted outreach campaign and expanded volunteer-recruitment staff; use of in-kind and state funds to broaden local match so federal dollars can cover more trips; funding for dedicated volunteer coordinators and planners at providers; and exploring dedicated revenue sources for transit and demand-response services.

Senator Sam Westman urged consideration of dedicated revenue: “I would say a dedicated revenue source would be a very helpful tool in your toolbox,” he said, linking stable funding to the ability to plan and retain staff.

What the committee did and next steps There were no formal votes or motions at the hearing. Committee members asked providers and the Agency of Transportation for follow-up data (more granular trip and cost breakdown by fund source, counts of surveyed riders, and better regional estimates of the fiscal impact of clinical closures). Providers offered to return with more detailed cost estimates and a list of practical policy changes (for example, background-check variance language and options for state-funded volunteer vehicles) that the legislature could consider.

Ending note: witnesses emphasized that demand-response transit is now functioning as a de facto safety-net service integrating transportation with health and social services. Several providers said modest investments in coordinators, planning capacity or targeted interventions for a small number of very high-utilization riders could yield disproportionate gains in system capacity.