How Transportation Shapes Health Care Access for Older Adults

As we age, access to transportation greatly influences our ability to maintain independence and engage in essential daily activities. For more than 11 million older adults who no longer drive, reliable transportation often determines whether they can access timely care, manage their chronic conditions, grocery shopping, and stay connected to their communities. Nearly 10% of older adults over age 60 report that lacking dependable transportation has prevented them from attending medical appointments, meetings, work, and performing errands. This challenge is especially pronounced among lower-income older adults. Data from West Health’s National Aging Readiness dashboard (NAR) show that the share of adults age 60 or older reporting that lack of reliable transportation kept them from medical appointments and daily needs varies sharply by income — affecting nearly 19% of those earning less than $15,000 annually, compared to about 7% of those earning $15,000–$50,000, roughly 2% of those earning $50,000–$100,000, and just 1% of those with incomes above $100,000. 

A 2023 survey found that one in five older adults skipped necessary medical care because they did not have transportation. These missed or delayed medical appointments contribute to poorer chronic disease management, higher hospitalization rates, and increased emergency care use — costing the U.S. health care system an estimated $150 billion annually.  

Across the U.S., transportation barriers remain a persistent challenge, particularly for older adults who live in rural areas, are low-income, or have mobility limitations. Structural challenges, such as the availability of transit systems, economic strain, and physical accessibility barriers, shape whether older adults can continue to age safely and independently in their communities. In rural areas, long distances, limited public transportation options, and a shortage of drivers can make even routine appointments difficult to reach. Urban and suburban areas also present unique transportation challenges, including inaccessible sidewalks, unreliable transit schedules, and high costs for ridesharing or taxis. Older adults with mobility limitations or chronic conditions often face compounded difficulties, from physical barriers getting in and out of vehicles to the coordination needed for multiple medical appointments in a single day. Financial constraints add another layer of complexity. Many older adults live on fixed incomes, making some transportation options cost prohibitive. Even when transportation benefits exist, such as Medicaid non-emergency medical transportation (NEMT), administrative hurdles can prevent timely access to care. Transportation access also plays a key role in older adults’ well-being. Roughly 2.3 million older adults report that transportation barriers limit their participation in social activities. Older adults with limited access to transportation also report experiencing loneliness or having depressive/anxiety symptoms. Addressing these barriers is essential to improve physical and mental health outcomes and help older adults remain active in their communities.  

Supporting the Transportation Needs of Older Adults

Recognizing these gaps, many states are exploring various approaches to address the transportation needs of older adults, often as part of broader health and aging strategies. For example, many states use the Federal Transit Administration’s Section 5310 (Enhanced Mobility of Seniors and Individuals with Disabilities Program), to establish transportation initiatives. Transportation, health, and aging services have often operated in silos. However, with policy changes and program funding shifts, state agencies, community partners, and the private sector are coming together to identify and develop innovative solutions.  

By using Medicaid flexibility, cross-agency collaboration (e.g., age-friendly communities, multisector plans for aging, No Wrong Door initiatives), and local innovation, stakeholders are finding new ways to connect older adults to needed transportation supports. Strategies include:  

• Building awareness and navigation supports. Older adults and their caregivers are often unaware of transportation options available in their communities. To help build greater awareness of these options, states like Pennsylvania publish public transit options for older adults and people with disabilities on their website. Additionally, through Pennsylvania’s multisector plan for aging, the state is working to embed dedicated navigators in each Area Agency on Aging who will be trained on available community resources, including transportation services. They will also create an inventory of technology solutions available to assist people with specialized transportation. Missouri’s Department of Transportation supports MO Rides — a statewide resource connecting residents to available transportation services.  

• Reducing cost barriers. Through its multisector plan for aging, California is working to improve transportation navigation for older adults and people with disabilities. One initiative, the California Integrated Travel Project (Cal-ITP), is modernizing the state’s payment infrastructure by implementing contactless payment and automatically applying eligible state program discounts for residents, including older adults, and federally required fixed-route transit discounts. This streamlines public subsidy distribution and makes it easier to access public transit.  

• Using technology, ride-share, and microtransit. Smartphones and related apps present a persistent barrier to technology-based transportation services for older adults. New York State recently expanded a partnership with GoGoGrandparent, to remove these barriers. Riders call a standard phone number and a dispatcher arranges a ride through existing networks. The NYS Office of Aging administers the program, with 32 local offices offering the program for free to older adults. Tennessee’s Medicaid program (TennCare) permanently authorized Lyft Healthcare as a statewide NEMT provider in 2023, after piloting the model in a single county in 2019. For rural areas where rideshare networks may be limited, states and local communities are partnering with microtransit companies like Via to fill the gap.  

• Creating community and volunteer networks. Community-led models are another pathway to support transportation needs. At the national level, ITNAmerica is a non-profit that focuses on creating a transportation network for older adults and people with mobility challenges in communities across the country. In Massachusetts, Martha’s Vineyard’s Older Adult Transportation Coalition was launched in 2021 by over 15 organizations. The Coalition uses a mobility manager to coordinate rides for both medical and non-medical trips. In 2024, they delivered approximately 10,000 rides, with older adults reporting improved quality of life and social connection.  

• Engaging in cross-agency or cross-sector planning. In 2025, the Maryland Department of Transportation, in partnership with Mpact and AARP, hosted a series of roundtable discussions in two communities to discuss transportation connectivity and safety challenges. The discussions led to the creation of the Inclusive Mobility Toolkit to help address the transportation infrastructure challenges in those communities. In Massachusetts, the Department of Transportation developed its Beyond Mobility Strategy Plan, which includes an action item to improve the state’s “collaboration efforts between all agencies involved in providing human services transportation, including seniors, paratransit, and non-emergency medical and social services needs.” 

Looking Ahead 

Access to transportation plays a pivotal role in supporting healthy aging. As transportation barriers are a frequently cited challenge for older adults, states and communities can explore innovative solutions to enhance transportation infrastructure in a way that benefits the needs of older adults. Strengthening cross-agency relationships, engaging with the community, and exploring technology-based solutions are a starting point to achieve that goal.