A rural North Carolina FQHC used foundation funding to provide free door-to-door transportation to medical appointments, pharmacies, and grocery stores, reducing hospital admissions and generating an estimated $720,544 in net healthcare cost savings over five years.
Rural Eastern North Carolina (ENC) has some of the state's highest poverty and lowest vehicle-access rates with one in five adults living below the poverty level. In 2025, 7.3% of ENC residents lacked access to a vehicle, up from roughly 6.5% of all NC households in 2021. Residents of this subregion experience significant health disparities impacted by the social determinants of health such as limited access to healthcare and transportation constraints. Roanoke Chowan Community Health Center (RCCHC), the Federally Qualified Health Center serving this area, identified transportation insecurity as a persistent barrier keeping patients from reaching non-emergency medical appointments. RCCHC developed Project TRIP (Transporting Residents with Innovative Practices) in 2015 to improve access to healthcare and vital services through transportation.
Project TRIP provides free, individualized, non-emergency transportation operated by private transportation providers to eligible low-income residents. The program aimed to reduce missed and delayed medical appointments, increase access to routine and preventive primary care, and reduce reliance on costlier emergency and inpatient care that often results when chronic conditions go unmanaged. The underlying equity goal was to close the access gap for low-income, largely rural and older residents who lack a personal vehicle or access to public transit.
Residents could use Project TRIP to travel to and from medical and non-medical services such as primary care appointments, pharmacy trips, and other essential destinations such as grocery stores or food banks. Project TRIP drivers not only transport participants to and from their desired destination, but also wait for participants while they attend their appointments to ensure participants have full trip coverage with minimal wait times. Rides were provided by local transportation business owners and drivers, and were not considered rideshare or public transportation.
The program is coordinated by RCCHC staff and case managers, who schedule rides through a telephone call-based system and manage eligibility and logistics. Participants are screened at the Roanoke Chowan Community Health Center for income eligibility and transportation need. To participate, enrollees must agree to be ready and on time for each scheduled pick up or provide at least 24 hours’ cancellation notice.
$159,405 total cost from 2017–2021.
$1,309 to $56,188 annual cost from 2017–2021
$1.00 per mile in a defined geographic area (Bertie, Hertford, Northampton, and Gates counties)
$0.75 per mile outside of the defined area
$0.25 per minute of wait time during patient stops
Project TRIP is funded by the Roanoke Chowan Foundation. Annual cost estimates range from depending on the number of participants enrolled in TRIP and the number of rides given.
Ongoing operating costs are primarily the direct cost of purchasing private transportation services (driver/vehicle costs per ride), managed within RCCHC's budget as the sponsoring FQHC.
Starting around 2020, RCCHC partnered with East Carolina University (ECU) to formally evaluate the program's health and economic impact and to explore replicating it in a neighboring county. That research partnership was supported by a three-year, $252,000 grant from the Duke Endowment to evaluate the program’s outcomes and replication scoping.
A retrospective evaluation compared electronic health record data for 101 Project TRIP users before and after program participation, from 2017 to 2021. The economic analysis, using Agency for Healthcare Research and Quality benchmark costs, found cost savings with healthcare utilization primarily due to reduced hospital admissions and emergency room visits, totaling a net benefit of $720,544 after accounting for the program's transportation operating costs.
Additionally, a companion qualitative study of 20 stakeholders (riders, case managers, and transportation providers) found consistent themes around emotional, health, and financial benefits for riders. Participants emphasized how vital the service was in helping them attend essential healthcare appointments, including primary care, dental visits, and chemotherapy or radiation treatments. Because transportation costs were covered, participants also reported a positive financial impact, while reduced transportation-related challenges helped decrease stress for both participants and their families or caregivers. In addition, Project TRIP helped reduce feelings of social isolation by providing transportation to places that supported social connection and overall well-being, such as gyms and other community settings. Participants also described feeling cared for by Project TRIP drivers, noting that driver training strengthened communication and helped create a welcoming and supportive experience. Finally, the program provided a positive financial impact for participating transportation companies, underscoring the value of this service to the greater community.
Baity, C. (2020). Existing Transportation Program Could Be Replicated to Help Increase Access to Care. East Carolina University Blog. https://news.ecu.edu/2020/07/15/project-trip/
Monast, K., Scott, J., Copeland, C. (2025). Mobility for All: Technology & Transportation Partnership to Improve Rural Service for Underserved Populations Pilot Final Report. Federal Transit Administration. https://www.transit.dot.gov/sites/fta.dot.gov/files/2025-12/Mobility-for-All-Final-Report-North-Carolina-DOT.pdf
Richman, R., Schwartz, A. J., Liu, Haiyong, L., Scott, M., White, W., & Doherty, C. (2024). The evaluation and cost-benefit analysis of a nonemergency private transportation program for low-income adults in a rural setting. Journal of Transport & Health, 39. doi: https://doi.org/10.1016/j.jth.2024.101929
Schwartz, A. J., Richman, A. R., Scott, M., Liu, H., White, W., Doherty, C. (2022). Increasing Access to Care for the Underserved: Voices of Riders, Drivers, & Staff of a Rural Transportation Program. Int J Environ Res Public Health, 19(20). doi: 10.3390/ijerph192013539
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