Transportation is one of the social determinants of health because a person can’t benefit from care they can’t reach. When someone has no car, can’t drive, can’t manage a bus with a walker, or can’t afford repeated rides, appointments get missed, prescriptions go unfilled and treatable conditions get worse. For hospitals, clinics and case managers, that makes a reliable ride as much a part of the care plan as the appointment itself.
This article explains how transportation fits into the social determinants of health (SDOH), who is most affected, and what families and health care teams in Northern Virginia, DC and the Maryland suburbs can do about it.
What are the social determinants of health?
The CDC defines social determinants of health as the nonmedical factors that influence health outcomes: the conditions in which people are born, grow, work, live, worship and age. The framework the CDC uses, from Healthy People 2030, groups them into five domains:
- Health care access and quality
- Education access and quality
- Social and community context
- Economic stability
- Neighborhood and built environment
Transportation doesn’t sit neatly in one box. It depends on money (a car, gas, fares), on the built environment (sidewalks, bus routes, curb cuts), on social context (a neighbor or relative who can drive) and it directly shapes access to health care. That’s why transportation questions show up so often when hospitals and health plans screen patients for social needs.
How transportation access affects health outcomes
The link is concrete. A national analysis of the National Health Interview Survey, published in the American Journal of Public Health and indexed by the NIH, found that 5.8 million people in the United States delayed medical care in 2017 because they did not have transportation. The same study found higher odds of transportation barriers among people living below the poverty line, Medicaid recipients, Hispanic people and people with a functional limitation.
What does a missed or delayed trip look like in practice?
- Chronic conditions drift. A diabetic who skips follow-ups because the bus trip takes two transfers may not find out their numbers have climbed until they end up in the hospital.
- Treatment schedules break. Dialysis, chemotherapy, radiation and wound care all depend on showing up on a set schedule. Missed sessions can set treatment back.
- Recovery stalls. Physical therapy after a stroke or joint replacement only works if the patient gets to the sessions.
- Care moves to the emergency room. When routine visits fall through, problems tend to surface later and in a more expensive setting.
None of these are dramatic on a single day. They add up over months, which is exactly why transportation is treated as a determinant of health rather than an inconvenience.
Who faces transportation barriers to health care?
In our region, transportation barriers rarely look like a remote rural road. More often they look like this:
- Older adults who have stopped driving. Adult children may live nearby but can’t leave work three mornings a week. We cover this in more depth in how transportation barriers affect senior health.
- People who use wheelchairs. A standard rideshare can’t carry a power chair, and a paratransit trip may need to be booked days ahead with a wide pickup window.
- Patients who’ve had sedation. Surgery centers and endoscopy suites typically won’t release a sedated patient to a taxi or to walk to a bus stop alone.
- Patients who can’t sit up. Someone who has to lie flat has very few options besides an ambulance or a stretcher van.
- Households without a car, or with one car and two jobs. The car is at work when the appointment is at 10 a.m.
- Exurban and outer-county residents. Someone in Warrenton or Culpeper may need to travel an hour to a specialist in Fairfax or Arlington.
Language, cognitive impairment and caregiver burnout layer on top of all of these. A patient with early dementia may be able to ride in a car but not navigate a transfer at a Metro station.
How non-emergency medical transportation closes the gap
Non-emergency medical transportation (NEMT) is built for exactly the people ordinary transportation leaves behind. It isn’t an ambulance: there’s no medical care on board, and emergencies go to 911. What it provides is the physical access piece of the puzzle.
Matching the vehicle to the person
H&M Transport offers ambulatory service with door-through-door help, wheelchair service where the rider stays in the chair and it’s secured with four-point securement, stretcher service with at least two crew members, and bariatric service for riders over 300 pounds. When a patient’s mobility is the barrier, the right level of service removes it. See our elderly transport page for how this works for older riders.
Making recurring care predictable
For treatment that repeats, predictability matters as much as access. We set up standing orders for dialysis transport so rides happen on schedule without a new call each time, and return trips run on a 45-minute will-call standard. If you or the clinic can call a little before you’re done, we’ll start a driver your way. The earlier the call, the shorter the wait.
Taking the burden off the family
A family caregiver who no longer has to take half a day off for every appointment is a caregiver who can keep going. A family member can usually ride along when they want to; tell us when you book.
Who pays: Medicaid, Medicare and other options
Cost is often the barrier behind the barrier, so it helps to know what’s covered.
- Virginia Medicaid: Call the transportation number on your Medicaid ID card; the brokers we work with are MTM Health and SafeRide Health. Request H&M Transport specifically when you book your ride.
- DC Medicaid: We serve UnitedHealthcare Community Plan of the District of Columbia members through SafeRide Health.
- Maryland: H&M Transport is not a Medicaid provider in Maryland. In Montgomery County, Medicaid rides go through the county Department of Transportation’s Medical Assistance Transportation Program.
- Medicare: Original Medicare does not cover wheelchair or stretcher vans. Some Medicare Advantage plans include a transportation benefit.
In Montgomery, Prince George’s and DC, riders whose plan’s ride benefit is administered by SafeRide Health can book through the plan and ask for H&M Transport by name. For everyone else, private-pay rates are posted openly on our rates page so families can plan ahead.
What health systems and community organizations can do
Screening for transportation needs is only useful if there’s somewhere to send the patient. A few practical steps:
- Ask early. Put “How will you get to your next appointment?” on the discharge or intake checklist, not after a no-show.
- Ask about mobility, not just access to a car. A patient may have a car in the driveway and still be unable to get into it after surgery.
- Know the benefit. Check whether the patient’s Medicaid or Medicare Advantage plan includes rides and how to book them.
- Set up a transportation partner. Hospitals, skilled nursing facilities, dialysis centers and hospices that work with us book on contracted rates. Our facility partnership page explains how.
- Schedule recurring rides as a series. Standing orders prevent the gap that opens when each ride is booked separately.
Common questions
Why is transportation considered a social determinant of health?
Because it decides whether people can reach care at all. It’s shaped by income, where people live and who they can rely on, and it directly affects access to health care.
Who is most likely to miss care because of transportation?
National survey data points to people living in poverty, Medicaid recipients and people with functional limitations. Locally, we see it most with older adults who’ve stopped driving and people who use wheelchairs.
Does Medicaid cover rides to medical appointments?
How you book depends on the state and plan. In Virginia: call the transportation number on your Medicaid ID card; the brokers we work with are MTM Health and SafeRide Health. Request H&M Transport specifically when you book your ride.
Is non-emergency medical transportation the same as an ambulance?
No. NEMT provides the right vehicle and hands-on help getting in and out, but no medical care on board. For an emergency, call 911.
How can a clinic or hospital set up rides for its patients?
Facilities can set up an account and book on contracted rates. Call (703) 304-7889 or visit our facilities page to get started.
Get a ride on the schedule
If transportation is what stands between you, or your patient, and the next appointment, we can help. Book online or call (703) 304-7889; dispatch answers 24/7. Tell us whether the rider walks with help, uses a wheelchair or needs a stretcher, and we’ll match the vehicle to the need.
