3.1.4 Taxi Services

There are 13 taxi cab operators in North Dakota. They all operate in cities with a population of 5,000 or more. Eleven of the 12 cities in North Dakota that have a population of 5,000 or more residents have commercial taxi service available. Only Valley City, with a population of 6,826, does not have a local taxicab operator.

The number of taxi services in North Dakota has increased from nine to 13 since 1981. The number of cities with taxi services has remained constant except for the fact that Wahpeton now has local service; it did not in 1981.²⁷

The majority of the state's taxicab companies operate traditional, private for-hire services while the operators in Bismarck/Mandan, Williston, Dickinson, and Devils Lake operate in conjunction with and with funding support from local elderly and disabled transit operators. Related support comes from programs administered by the ND Department of Transportation and ND Department of Human Services programs (e.g. Section 5311 funding and Medicaid reimbursements). Bismarck/Mandan's Taxicab Company operates both the local taxi service and the cities' local transit operation.

North Dakota's 13 taxi operators are identified in Appendix E.

3.1.5 Other Publicly Supported/Client-Specific Transportation Services

The Federal Transit Administration, within the U.S. Department of Transportation, has an annual budget of approximately $7.2 billion to provide and support transit services across the country, some of which were discussed in the preceding subsections on fixed-route and dial-a-ride/paratransit bus services. In addition to these FTA-supported programs, there are numerous other sources of federal support for the provision of transportation services.

According to the U.S. General Accounting Office (GAO) in 2003, there are 62 federal programs that fund transportation services. Some of these programs support transportation services that are available to the general public like those discussed in the preceding subsections, but most are restricted to specific clientele groups.

In its June 2003 report, "Transportation-Disadvantaged Populations," the GAO indicated that specific spending information was available on only 29 of these 62 federal transportation programs. These 29 programs incurred expenditures of $2.4 billion in fiscal year 2001. Fifty-two of the 62 programs are in the departments of Health and Human Services (23), Labor (15), Education (8), and Transportation (6).

Departments with a lesser role in transportation include Agriculture, Housing and Urban Development, and Interior.²⁸

Exhibit 3.1 presents a list of transportation programs that the GAO identified as having spent more than $20 million in FY 2001. These programs account for 87 percent of the total identified spending on transportation in the county. For the purposes of this study, Federal Transit Administration programs that were discussed in the preceding subsections on fixed route and dial-a-ride/paratransit were omitted from this list, nationally this amounts to $232.3 million, 9 percent. The remaining 15 programs amount to less than 4 percent of the spending.

Exhibit 3.1
Major Federal Transportation Programs
(Spending of $20 Million or More in FY 2001)²⁹

3.1.6 Medicaid

Medicaid is a federal program which provides health care for certain low-income individuals. Primary beneficiaries include pregnant women, children and teenagers of low income parents, and low-income people who are elderly, blind, or disabled. Each state administers its own Medicaid program. The North Dakota Department of Human Services (DHS) administers its program to approximately 53,000 Medicaid recipients. This total represents about 8 percent of the state's population.

Federal regulation 42 CFR 431.53 requires that states provide assistance to insure that Medicaid recipients have access to and from medical appointments. Medicaid recipients and their families are expected to provide their own transportation if they are able to do so. Needs assessments and subsequent transportation services are handled by county social service offices.

Medical transportation may be local to a nearby doctor but travel may also involve trips to more distant or even out-of-state locations for services that are not available locally. Related travel may be by bus, train, or air, depending on the medical needs of the traveler and available means of transportation. The cost of ambulance service may also be paid by Medicaid if a medical emergency exists.

When there is a proven need for transportation assistance, related services must be provided by an entity that is "enrolled" with DHS. Services are often provided by existing commercial operators, fixed-route bus systems, or local paratransit services, but they may also be provided by individuals who have enrolled with DHS to provide Medicaid-related transportation services. Service providers are reimbursed based on a fee schedule established by DHS.

North Dakota Department of Human Services records indicate that there are approximately 821 active Medicare transportation service providers that provide non-emergency medical transportation to Medicaid recipients. Fifty of these entities are commercial, public, or private, non-profit services; the remainders are individuals who provide occasional services to individuals in their area.

The location of the 50 primary service providers is presented on the map in figure 3.3. As this map indicates, 47 of these providers are based in 16 North Dakota communities and three are based in communities in neighboring states. A list of these primary service providers is presented in Appendix F.

DHS estimates that approximately $1.14 million was spent on non-emergency, Medicaid-related transportation services in North Dakota in calendar year 2003. An additional $691,600 was spent on emergency ambulance services and related supplies.³⁰