The cost of providing nonemergency transportation to Medicaid and other transportation-eligible people has escalated sharply in the United States. In response, many states have reformed their human services transportation delivery systems. In this paper, we assess the results of Kentucky’s comprehensive reform of its transit system, including the impact on the quality of transit service for Medicaid-eligible users. With three sources of data—financial and other service data, a sample of Medicaid-eligible residents, and a sample of the transit providers—we assess the effectiveness of the new system. The data show that patronage levels increased dramatically under the new process, while unit costs declined substantially. Further, despite measures taken to increase efficiency, passengers still expressed satisfaction with the service. We attribute these positive results to an improved structure of accountability. The conclusion contains implications for future reforms.

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Published in Journal of Transportation and Statistics, v. 5, no. 2/3, p. 73-81.

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