Rural America is in the midst of a healthcare access crisis: Hospitals are closing, providers are leaving towns and clinics, fewer people have healthcare coverage, and longer distances to care mean that patients are more likely to delay or forego seeing a provider. These challenges are not new, but they are getting worse.
To address these issues and mitigate the effects of the OBBBA, which cut federal funding to states and created new Medicaid eligibility hurdles, the Trump administration set aside $50 billion for rural healthcare initiatives across the country. In 2026, CMS awarded the first round of state grants under the Rural Health Transformation Program (RHTP), with clear goals: Improve access, strengthen outcomes, reduce disparities, and build systems that last beyond the five-year funding window.
But even if states can build clinics, hire providers, and install telehealth portals, none of it matters if patients can't access them. Transportation is not a peripheral concern in rural health; it’s the front door.
The Data on Rural Health Challenges Is Clear
Nearly 6 million Americans miss or delay medical appointments every year because they lack reliable transportation. In rural areas, the problem is even more pronounced: Rural residents must travel more than twice the distance of urban residents for medical or dental care, and more than half of rural residents (55.8%) cited gas and other travel costs as barriers to care.
Rural residents are also more likely to be older, sicker, and low-income, the exact populations most dependent on others for a ride and least likely to have one available. And while telehealth can help bridge the gap, internet access is not uniformly available. The FCC has found that 22% of rural Americans lack reliable broadband access. Even if broadband is available, telehealth is also not always a clinically appropriate modality for every patient in every situation. Given these factors, it shouldn’t be surprising that 80% of rural residents are medically underserved.
The consequences of these barriers can be costly: Missed primary care appointments accelerate chronic disease progression. Skipped dialysis sessions can become emergency hospitalizations. Delayed cancer screenings can become later-stage diagnoses. Every missed trip is a downstream cost to the patient, to the health system, and to the healthcare programs that RHTP is trying to sustain.
What the RHTP Is Trying to Accomplish and Where Transportation Fits
The RHTP requires states to use federal grants—typically about $200 million a year, depending on the state—to improve access to care, improve health outcomes, foster local and regional partnerships, and invest in innovations sustainable beyond the grant period. Transportation infrastructure meets every one of these criteria.
A well-designed NEMT program embedded in a rural health transformation initiative can reduce no-show rates for participating clinics, enable providers to see more patients per day, and improve financial sustainability. It connects behavioral health patients to appointments they would otherwise miss entirely. It closes the loop on post-acute discharge, reducing the costly readmission cycles that drain rural hospital budgets.
These barriers can have outsized financial consequences. For example, patient no-shows are so prevalent that they cost the U.S. healthcare system an estimated $150 billion a year. A study by the Agency for Healthcare Research and Quality found adult hospital readmissions within 30 days in 2018, with an average cost of $15,200. While many of those readmissions were undoubtedly necessary, some of them might have been avoided with better follow-up care.
The Medicaid NEMT Gap
While some state planners have hesitated to include transportation in their RHTP initiatives, citing concerns about duplicating existing Medicaid NEMT coverage, this concern misreads the actual landscape: Medicaid NEMT has significant coverage gaps. It does not cover rural residents who earn just above Medicaid income limits. It sometimes excludes behavioral health trips. And in non-expansion states, adults without children are almost totally excluded from Medicaid coverage altogether.
Further, Medicaid NEMT is often unavailable for same-day or urgent-access needs (though SafeRide Health does provide these rides when covered by the health plan). Medicaid does not extend to family members and caregivers, whose health maintenance is essential to keeping vulnerable patients stable.
RHTP transportation investments do not duplicate Medicaid NEMT but reach the patients who fall through the existing system; they also address the non-medical trip types that many Medicaid programs do not cover, such as trips to grocery stores to get healthy food or to gyms for exercise. Some states are recognizing these distinctions: According to the Baker Institute for Public Policy at Rice University, 28 states have included transportation as a key health-related social need service and support in their RHTP applications.
Tennessee has included a dedicated rural NEMT initiative into its approved RHTP plan. The state’s Rural Non-Emergency Transportation (RNET) program creates integrated coordination systems, hospital shuttles, and partnerships improving access to care. According to Tennessee’s RHTP grant proposal:
“Hospital-led shuttle programs in Upper Cumberland counties reduced appointment no-shows by more than 25%, saving nearly $600,000 in uncompensated care within 18 months. Community-based ride partnerships in West Tennessee cut travel time to behavioral health services by 30% while improving treatment adherence and patient retention.
These outcomes mirror national evidence: Systematic reviews confirm that reliable nonemergency medical transportation (NEMT) access reduces missed appointments, emergency visits, and overall healthcare costs (BMC Public Health, 2022; Milliman Insight, 2023). RNET is designed to scale these proven successes into a statewide network that standardizes data reporting, expands coverage to all HRSA-defined rural counties, and integrates transportation coordination into the fabric of rural healthcare delivery.”
When integrated into programs such as Tennessee’s, SafeRide Health’s platform gives states benefit controls they can configure to their program parameters. For example, they could choose to approve same-day trips to behavioral health appointments or on-demand discharge rides, when needed, just as different state Medicaid plans have varying coverage and advance-booking requirements for their transportation benefits.
Building a Sustainable Rural Healthcare Transportation Solution
One of the RHTP's core requirements is that funded initiatives leave behind durable infrastructure, not programs that collapse the moment federal dollars stop flowing. This is another argument for transportation. A technology-enabled NEMT model—one that integrates with EHR systems, shares real-time trip data with care teams, and tracks outcomes against clinical benchmarks—builds institutional capacity. It creates data infrastructure. It becomes embedded in how a regional health network operates. That is a sustainable investment, not a line item.
States have a five-year window and a generational opportunity to shore up foundational infrastructure in rural, hard-to-reach areas. States that treat it as such will see better outcomes, stronger ROI on every other RHTP investment they make, and rural communities that are genuinely, measurably healthier.
Transportation is not optional infrastructure. It is foundational infrastructure. SafeRide Health exists to make that case and deliver on it.