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Abstract

Introduction: The rural aging population in Michigan struggles to access medical care often available only at significant distances due to limited health system resources and provider shortages. Access to routine care is challenged by lack of non-emergency medical transportation (NEMT). The Iosco County Commission on Aging provides home-delivered meals to eligible county residents. The Rural Health Group investigated the needs of home-delivered meal recipients (aged ≥60 years) for healthcare transportation access. Utilizing data from this investigation, we examined if medical care needs were hindered by problems with transportation in rural Iosco County, Michigan.

Methods: We conducted a cross-sectional survey with 84 interviews among 233 recipients of home-delivered meals. Data collection included interviews in recipients' homes on healthcare needs, transportation norms, vulnerability due to isolation and living conditions, and barriers for accessing medical-related services. All respondents were ≥60 years old. Percentages were used to compare respondents who did not report disruptions of their health care needs due to a lack of transportation to those who experienced disruptions or cancellations.

Results: We found that 26% (n=22) experienced disruptions of care related to transportation problems, and 9.5% (n=8) experienced delayed or cancelled medical care due to lack of transportation. Respondents in more remote areas were most likely to report disrupted or cancelled care. Public transportation options, including NEMT as a benefit of Medicaid, within Iosco County were not used for lack of access. Respondents reported how transportation barriers resulted in missed healthcare appointments and how they relied on family/friends for medical care transportation.

Conclusions: Transportation options in Iosco County for NEMT are inadequate and poorly coordinated. We recommend enabling healthcare providers to ensure transportation for patient appointments and that the Michigan Medicaid-NEMT program should be overhauled to deliver NEMT coverage easily for entitled recipients in need.

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