Health Ratings and Unmet Transportation Needs in Indiana's Aged and Disabled Home and Community-Based Services Waiver Program.

Abstract

Lack of transportation can be a barrier to healthcare access for older adults. State-administered home and community-based services (HCBS) often include transportation to aid in independent living. Indiana provides HCBS to Medicaid enrollees 60 and older through an Aged and Disabled (A&D) Waiver. A Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collects data about these services, including transportation. Since 2021, Indiana has collected HCBS CAHPS data annually from A&D waiver participants for internal quality improvement, including demographics, self-reported overall and mental health ratings, and unmet needs. Among 4,199 CAHPS survey respondents, 22.1% reported an unmet need in transportation to medical appointments. Survey-weighted logistic regression was used to estimate how participant characteristics were associated with transportation unmet needs. Poor ratings of physical health and female sex were associated with greater unmet transportation needs. Black/African American race was associated with fewer unmet transportation needs and may reflect Black respondents were more likely to have urban residence than White respondents. These findings suggest health status and other patient characteristics should be considered when addressing older adults' unmet transportation needs.