Life & the Law Maternal & Public Health

Strengthening the Pro-Life Safety Net: Federal Transportation Policy

Christopher C. Hull, Ph.D.

December 20, 2024

Please login to bookmark

Print / Download

This is Issue 31 of the American Reports Series.

Executive Summary:

Transportation is necessary for pregnant and parenting women in need to find and maintain employment and essential services such as childcare and healthcare.

The U.S. Department of Transportation (DOT) spends more than $100 billion each year on highways, transit, railroads, airports, and other infrastructure, and is also a critical economic regulator, setting safety policy across modes of transport.

Among its various roles, DOT has the capability to assist pregnant women and new mothers in need by leveraging the provision of transportation services at the state and local levels.

The most obvious opportunities for assistance lies with the Federal Transit Administration (FTA), which subsidizes over 4,000 state and local transit agencies across the U.S. via programs that primarily serve low-income populations, including some specific to ride-assistance.

Other opportunities may lie with the Office of the Secretary (itself a substantial grantmaking organization), other DOT agencies, and transportation-related programs under other departments.

I. Introduction

Laid out below are specific ways the U.S. Department of Transportation (DOT) could offer material support to address transportation requirements for pregnant and parenting women in need by leveraging existing programs, including direct aid and funding for transportation programs for that purpose. Transportation is necessary for pregnant and parenting women in need to find and maintain employment and essential services such as childcare and healthcare.

This report also specifies options for helping these women that are achievable through administrative actions, as well as any potential statutory hurdles, outlining whether there is flexibility for a state that wishes to do so to utilize federal dollars/programs to support mothers and families further, especially pregnant and parenting women in need.

There are numerous prior initiatives that could serve as precedent for an all-of-government approach to providing preference to this population of women, especially with the aid of a pro-life president’s executive order and/or similar guidance from departmental leadership.

By way of example, there is the Biden administration’s Justice40 initiative, an administrative effort to focus on its policy priorities via Executive Order (EO), but without specific statutory authorization.[1] Justice40 is focused on climate policy with special considerations for low-income populations. Regardless of whether this specific initiative is likely to continue in a new administration, the precedent is a useful one with an eye toward tailoring transportation and other policies to pregnant and parenting women in need.

Opportunity Zones (OZs) provide another example of prior precedent for a federal government-wide effort to support pregnant and parenting women in need. During the Trump administration, the White House prioritized integrating OZs created by[2] the Tax Cuts and Jobs Act of 2017[3] into implementation of various federal programs through executive actions.[4] While the statutory authority for the concept of OZs is strictly tax-related and meant for implementation by the U.S. Department of the Treasury and the Internal Revenue Service (IRS), the White House Domestic Policy Council of the era was hopeful to find ways to support OZs more broadly. Thus, all grantmaking agencies, including DOT, were instructed to add OZ language to forthcoming Notices of Funding Opportunity (NOFOs) in order to indicate that it was a policy priority to give OZs a leg up in the funding process.[5] Ultimately, DOT issued at least 13 NOFOs with Opportunity Zones language, awarding more than $2 billion in FY 2019 alone.[6] Similarly, DOT and other grantmaking agencies could presumably set a priority of supporting pregnant and parenting women in need under a new pro-life administration, including in federal transportation programs.

II. General Opportunities for Transportation Policy Changes

This policy brief seeks to lay the groundwork for identifying opportunities to strengthen the pro-life safety net in federal transportation programs, exploring ways in which the existing federal safety net might be leveraged to offer life-affirming support to pregnant and parenting mothers, including to:

Foster charitable activity to support pregnant and parenting women;
Protect the civil rights of pregnant moms and their children, both born and unborn;
Encourage social action to help women carry to term and parent or make an adoption plan;
Relieve poor, distressed, or underprivileged moms who are expecting an/another baby; and/or
Work toward eliminating prejudice and discrimination against unborn children.

This brief will identify a range of actions that can be taken to support these goals via administrative actions, including NOFOs, grantmaking guidance, regulatory action, contractor requirements, or others.

NOFOs provide perhaps the single most effective, concrete, rapid way to build in a pregnant and parenting women in need preference for federally funded transportation projects. Following White House or departmental guidance, agencies like the Federal Transit Administration (FTA) could be directed to publish NOFOs that encourage applicants to lay out plans to accommodate the pregnant and parenting women in need cohort and consider their interests in transportation planning.

For instance, DOT’s 2022 study, Analysis of Challenges Facing Pregnant Women Riding Transit, [7] conducted during the Biden administration, can provide a useful basis for carving out a pregnant and parenting women in need preference in awarding DOT grants.

The 2022 study provided an overview of the challenges faced by pregnant women using public transit. In particular, it highlighted additional challenges in using public transit faced by women of color, low-income women, caregivers, and those with disabilities, and focused on the importance of transportation access for healthy pregnancies and prenatal care.[8]

The study reviewed public literature covering transit challenges faced by pregnant women, finding that public transit systems are not designed to meet the travel patterns of pregnant women or caregivers. Notably, caregivers often take more complex, non-peak-hour trips. Pregnant women and caregivers often deal with a lack of accessible routes and inadequate station amenities like seating, elevators, and restrooms.[9]

The 2022 study found that pregnant women and caregivers often pay more for transportation due to safety concerns and time inefficiencies. Women typically also make more household-related trips than men, exacerbating transportation burdens. Concerns over personal safety, unclean environments, and overcrowded vehicles can contribute to discomfort and risk for pregnant riders.[10]

In addition to recommending further research on the transit experiences of pregnant women and caregivers, the 2022 study made some policy recommendations for transit agencies, namely to:

Involve more women, including pregnant women, in planning and design.
Promote courtesy campaigns to raise rider awareness and sensitivity towards others.
Improve safety by ensuring all transit station areas are well-lit, security cameras work properly, and amenities are available.
Work with local law enforcement or transit police to review crime statistics and enhance police presence in high-crime areas.
Partner with local health departments to improve access to prenatal and postpartum care.
Utilize the experiences of female employees who are or were pregnant to make better service decisions.
Conduct targeted research to understand the needs of pregnant transit riders across different demographics.[11]

A new pro-life administration could commit to conducting an updated version of the 2022 DOT study with a special focus on pregnant and parenting women in need. Regardless of whether this is done, however, the existing recommendations from the 2022 Biden administration study are helpful in providing ideas for guidance to state and local grantees, particularly those of the FTA.

For example, the 2021 NOFO for the Innovative Coordinated Access and Mobility (ICAM) Pilot Program identifies these specific ways the applicants would be assessed:

Applicants should indicate the short-term, mid-term, and long-term goals for the project. Proposals must provide specific performance measures the eligible project will use to quantify actual outcomes against expected outcomes. FTA will evaluate the project based on the extent to which it was developed inclusively, incorporating meaningful involvement from key stakeholders including consumer representatives of the target groups and providers from the healthcare, transportation, and human services sectors, among others. The applicant must show significant, ongoing involvement of the project’s target population.[12]

Similarly, a NOFO complying with a pregnant and parenting women in need-focused EO, departmental guidance, or other policy decision could insert language inviting applicants to offer how their proposal could assist pregnant women in need and new mothers and identify such assistance as an explicit priority in grant-making.

Proposals below provide more specific examples of how various federal DOT and other programs might seek to leverage more transportation support for pregnant and parenting women in need as a matter of administration policy, in line with any administration’s inherent discretion to husband scarce resources. Secretarial instruction to the various DOT “modes” – components of DOT such as FTA – or agencies in other departments could then prompt the necessary Notices of Proposed Rule Making (NPRMs), guidance circulars, or NOFOs to implement such changes. With or without Presidential- or Secretarial-level instruction in hand, DOT modes and their counterparts in other departments could most quickly respond by inserting pregnant and parenting women in need language into NOFOs and other sub-regulatory guidance, which do not require the same time-consuming steps mandated for formal rulemaking under the Administrative Procedure Act (APA).[13]

A final note: to adhere to the longstanding federal policy prohibiting the use of taxpayer funds for abortion services, as well as to prioritize the use of scarce and limited resources, those considering changes to the NEMT program should define “medical care” and related health services for pregnant and parenting women in need as those supporting positive health outcomes for both the mother and unborn child.

III. Specific Individual Programs

It is possible that in each example below, at least sub-regulatory guidance and NOFOs, and in one case regulatory change, could advantage applicants and partners that highlight assistance to pregnant women and new mothers in need. At this point, one should be cautious about extrapolating the actual incremental funds that might be awarded under a scenario wherein a preference for pregnant and parenting women in need is mandated using a similar approach, whether it is via EO or departmental guidance, but every bit helps.

DOT Office of the Secretary (OST)

OST is itself a sizeable agency, with a series of regulatory and grantmaking responsibilities of its own. Below are two examples of how OST could leverage existing initiatives and resources to support this population of women.

Justice40 Initiative[14]

As noted above, the Justice40 Initiative – established via executive order in the early days of the Biden administration – ensures that at least 40% of benefits from federal investments flow to disadvantaged communities. Today DOT uses this initiative to address transportation equity by increasing access to affordable, reliable, and safe transportation options for rural, suburban, and urban underserved populations. This initiative serves as a precedent for the White House to orient federal agencies toward a policy issue, such as making pregnant and parenting women in need a priority, absent specific authorizing legislation.

Coordinating Council on Access and Mobility (CCAM)[15]

CCAM (pronounced “see-cam”) is an interagency partnership established in 2004 by Executive Order 13330[16] to coordinate Federal agencies’ efforts to fund transportation services for disadvantaged populations.[17] In particular, CCAM works to improve transportation access for individuals with disabilities, older adults, and low-income populations by coordinating federal funding and resources. The Council promotes collaboration between federal agencies to help ensure accessible, efficient transportation options, addressing gaps in services that often affect people with disabilities.

The Council is a DOT-led interagency working group on disability that serves a networking and coordination function. It fell moribund during the Obama administration, but was revived during the Trump administration. A pro-life administration could certainly make use of CCAM to help leverage transportation resources across the U.S. federal government for pregnant and parenting women in need.

For instance, under CCAM’s auspices, in April 2022 FTA promulgated a new guidance document, “Federal Transit Administration Guidance Clarification: Coordination with Human Services Organizations and National Transit Database Reporting.”[18] The guidance sought to reduce overlap between the 130 Federal programs across nine agencies funding human services transportation, as well as clarify reporting into the National Transit Database (NTD).[19] Similarly, a new administration could promulgate new guidance adding reporting on the programs’ impact on pregnant women in need and new mothers in need as well. New CCAM-directed FTA guidance could for example stipulate something like the following:

In accordance with a new priority increasing the priority of pregnant and parenting women in need and their children both born and unborn, award recipients should report on accessibility to their public transportation services in terms of how the services accommodate that population, and demonstrate efforts to increase such accommodation in future grant applications.

Federal Transit Administration (FTA)

FTA is primarily a grant-maker to public transit agencies but also has some regulatory authority. Below are specific FTA programs that present opportunities for a pro-life administration to leverage in benefit of pregnant and parenting women in need.

Section 5310[20] – Enhanced Mobility of Seniors and Individuals with Disabilities Program (CFDA[21]: 20.513)[22]

The Section 5310 program provides funding to improve mobility for seniors and individuals with disabilities. It supports both traditional capital projects like the purchase of accessible buses and vans, and non-traditional projects such as travel training and mobility management. These funds are designed to remove transportation barriers and expand mobility options for underserved populations.[23]

While pregnancy does not ordinarily qualify as a “disability” under federal law, there are relevant considerations involved, nevertheless. A woman’s preexisting medical conditions can be complicated by pregnancy and some pregnant women do develop disabilities. Furthermore, the statute authorizing the Section 5310 program explicitly includes “public transportation projects that exceed the requirements of the Americans with Disabilities Act of 1990 (a.k.a. the ADA, which can be found at 42 U.S.C. 12101 et seq.).”[24]

Accommodations for these women would generally exceed the ADA requirements and definitions, and again, an administration applying its discretion to scarce resources has the authority to prioritize grant awards towards a Presidential policy preference for pregnant and parenting women in need, as many previous administrations have for their policy priorities.

As DOT’s 2022 study, Analysis of Challenges Facing Pregnant Women Riding Public Transit, indicated, pregnant women, “including women who are limited English proficient, lower-income pregnant women, women with low literacy, women with disabilities, and/or women traveling with dependents, face additional challenges and limitations in their ability to access and use public transportation.”[25] The study further emphasizes that “[s]ystem service design, accessibility, passenger amenities, rider policies, and real or perceived safety and security concerns all pose issues.”[26] The published study provides an opening for noting pregnant and parenting women in need as a priority for subrecipients in excess of mandatory ADA considerations.

The most recent FTA circular[27] providing guidance for implementing Section 5310 indicates that the program provides funds for capital and operating expenses to recipients for, among other things, “[p]ublic transportation projects that exceed the requirements of the Americans with Disabilities Act (ADA) of 1990.”[28] This emphasis parallels language from the former New Freedom program,[29] which authorized grants for accessibility projects that exceed the requirements of the ADA. As noted above, although pregnancy is not recognized as a disability in federal law, pregnant women can develop long-term and temporary disabilities. Accordingly, the circular should be amended (proposed new text in bold) to indicate that “In accordance with a new priority prioritizing pregnant and parenting women in need and those of her children, both born and unborn, special consideration will be given to projects that improve accessibility for that population.”

Section 5311[30] – Formula Grants for Rural Areas (CFDA: 20.509)[31]

The Section 5311 program supports the maintenance of existing public transportation services in and expansion of those services to rural areas. Specifically, grants from the program are intended to enhance rural access to health care, shopping, education, employment, public services, and recreation, underwrite intercity bus service, and encourage mobility and employment-related transportation alternatives, inter alia.[32] The Formula Grants for Rural Areas program also includes a set-aside for the Public Transportation on Indian Reservations Program, or “Tribal Transit,” which consists of both formula and competitive grant programs for Indian tribes and rural Alaska Native communities.[33]

An administration prioritizing pregnant and parenting women in need could direct Section 5311 funds toward infrastructure projects that spell out accommodations for pregnant women in need and new mothers in need. For instance, FTA recently promulgated a new guidance circular, “Rural Areas Formula Grant Programs Guidance” (C 9040.1H), a consolidation of guidance for grants under Section 5311.[34] The circular includes eligible projects such as transit facilities and, for example, encourages subrecipients to incorporate plans for future growth and accommodations for low income people, people with disabilities, and also new kinds of vehicles and vehicle technologies. Similarly, an updated circular could emphasize pregnant and parenting women in need accommodations for subrecipients, for instance by modifying the language below to read:

Demonstration of Benefits

Describe how the proposed project will improve transit efficiency and increase or sustain ridership;

Describe how the proposed project will improve or maintain mobility, increase reliability, or eliminate gaps in service;

Describe how the proposed project will improve or maintain transit service to important destinations and services; and

Describe how the proposed project will improve quality of life in the community or improve access to jobs, education, health care services, and environmental benefits.

[Describe how the proposed project will assist pregnant and parenting women in need and their children both born and unborn in accordance with a new policy increasing the priority of that population.] ^[35]

Likewise, a new FTA circular providing guidance on implementing Section 5311 indicates that “[a] rural transit provider may design its Section 5311-funded services to “maximize use by members of the general public who are transportation disadvantaged.”[36] The provider may use funds for incidental uses, such as meal delivery, and this provides an opportunity to include an emphasis on pregnant and parenting women in need with a change like the following:

Transportation-disadvantaged people include seniors, people with disabilities, and low- income individuals. Transit service providers receiving assistance under … Section 5311 may coordinate and assist in providing meal delivery service for homebound people on a regular basis, if the meal delivery services do not conflict with the provision of transit services or result in a reduction of service to transit passengers. [In accordance with a new policy increasing the priority of pregnant and parenting women in need, as well as their children, both born and unborn, such funds also may be used to provide accommodation for such women for homebound services and transportation as a discrete category of low-income individuals, particularly as their condition may directly affect their mobility.]

Section 5307[37] – Urbanized Area Formula Funding program (CFDA: 20.507)[38]

The Urbanized Area Formula Funding program (49 U.S.C. 5307) provides federal funding to governors and designated recipients for transit capital projects, operational support, and transportation planning activities in urbanized areas.[39] For the purposes of Section 5307, an “urbanized area” is one with a population of no fewer than 200,000, as determined by the Census Bureau.[40]

Similarly to the Section 5311 program mentioned above, FTA has recently promulgated a new guidance circular for Section 5307 (C 9050.1A).[41] A further new circular could encourage subrecipients to consider pregnant and parenting women in need accommodations in submitted plans for facilities and programs.

For instance, DOT’s 2022 study on challenges pregnant women face in transit reported that pregnant women in both urban and rural regions often delay or miss medical appointments due to the lack of accessible and affordable transportation options.[42] Traditional public transit services may not align with the locations of doctor’s offices, clinics, hospitals, or the scheduling of appointments. Reformulated guidance should address these concerns, with a particular emphasis on these women.

The FTA circular providing guidance for implementing this program indicates in particular “projects funded as ‘job access and reverse commute [JARC] projects’ must be designed to provide transportation for welfare recipients and eligible low-income individuals.”[43] This and related sections of the circular could be amended to explicitly mention the needs of pregnant and parenting women, for example as follows:

(3) Welfare Recipients and Eligible Low-Income Individuals. Projects funded as “job access and reverse commute projects” must be designed to provide transportation for welfare recipients and eligible low-income individuals. The term “low-income individual” is defined as an individual whose family income is at or below 150 percent of the poverty line, as that term is defined in Section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by that Section, for a family of the size involved. [In accordance with a new policy increasing the priority of pregnant and parenting women in need, as well as their children both born and unborn, special consideration should be given to JARC projects that improve accessibility for pregnant women and new mothers in need.] Projects that serve the general public without specific route or design characteristics intended to respond to the needs of these populations may not be eligible as a JARC project. However, JARC projects do not need to be designed exclusively for these populations. […]

(5) Eligible Projects. Examples of activities that could be eligible JARC projects that go beyond services providers of public transportation may otherwise commonly deliver include, but are not limited to, the following: […]

(e) Ridesharing and carpooling activities for reverse commutes or to better connect low-income individuals and welfare recipients[, including pregnant women and new mothers in need, as well as their children both born and unborn]; […]

(g) Promotion, through marketing efforts, of the: (i) use of transit by low-income individuals and welfare recipients with nontraditional work schedules [including pregnant women and new mothers in need, in accordance with a new policy increasing the priority of pregnant and parenting women in need, as well as their children both born and unborn]; (ii) use of transit voucher program by appropriate agencies for welfare recipients and other low-income individuals; (iii) development of employer-provided transportation such as shuttles, ridesharing, carpooling; or (iv) use of transit pass programs and benefits under Section 132 of the Internal Revenue Code of 1986…[44]

Prior to the issuance of the recent circular including guidance on 5307 discussed above, an FTA notice from May 2024 outlined program updates for FY2024 following passage of the Consolidated Appropriations Act of 2024 along with full-year apportionments, allocations, and plans for many grant programs like 5307.[45] A similar notice will be expected following enactment of FY2025 appropriation, and as such, should include an emphasis on pregnant and parenting women in need, such as the changes suggested below to section IV. Program Information, C. Urbanized Area Formula Program (49 U.S.C. 5307):

Eligible Expenses

Eligible activities include planning, engineering, design and evaluation of transit projects and other technical transportation-related studies; capital investments in bus and bus-related activities such as replacement, overhaul and rebuilding of buses; crime prevention and security equipment; construction of maintenance and passenger facilities; and capital investments in new and existing fixed guideway systems, including rolling stock, overhaul and rebuilding of vehicles, track, signals, communications, and computer hardware and software. [In accordance with a new policy prioritizing pregnant and parenting women in need, eligible activities should include, where feasible, considerations for accommodating pregnant and parenting women in need, as well as their children both born and unborn.][46]

Areas of Persistent Poverty (AoPP) Program (CFDA: 20.505)[47]

This program administered by the FTA provides funding for planning, engineering, or development of technical plans for transit projects in areas identified as those of “persistent poverty.” For FYs 2020[48] and 2021,[49] such areas were defined as either a county that has consistently had 20% or more of the population living in poverty over the prior 30 years, or any census tract with a poverty rate of at least 20%. In the Infrastructure Investment and Jobs Act (IIJA), approved Nov. 15, 2021,[50] Congress expanded such areas to include any territory or possession of the United States,[51] and also added “historically disadvantaged communities” to the program.[52]

According to the Biden Administration, the AOPP Program supports “increased transit access for environmental justice (EJ) populations, equity-focused community outreach and public engagement of underserved communities and adoption of equity-focused policies, reducing greenhouse gas emissions, and addressing the effects of climate change,”[53] though there is no explicit statutory basis for such a claim.[54]

As DOT’s 2022 study on pregnant women navigating transit indicated, low-income pregnant women and new mothers are especially dependent on public transit and many certainly come from historically disadvantaged communities.[55] Adding a pregnant and parenting women in need emphasis to this program has a clear justification as these women are already among the target population to serve through AoPP.

A 2021 NOFO issued for this program laid out Biden administration policy priorities on racial equity and environmental goals as criteria in evaluating applications.[56] A new administration should take the opportunity the next time they offer a NOFO for AoPP to include an emphasis on pregnant and parenting women in need:

Demonstration of Benefits

Applications will be evaluated based on how well they describe how the proposed planning, engineering, or development of technical or financing plans address the existing condition of the transit system, improve the reliability of transit service for its riders, enhance access and mobility within the service area, [and] accelerate innovation in areas of persistent poverty to serve unmet needs … The following factors will be considered:[…]

[…]

iii. Enhanced Access and Mobility.

FTA will evaluate the potential for the planning, engineering, or development of technical or financing plans to lead to improved access and mobility for the transit riding public, such as through increased reliability, improved headways, creation of new transportation choices, or eliminating gaps in the current route network [with a special focus on how to accommodate the transit needs of pregnant and parenting women, and those of their children both born and unborn, in accordance with a new priority placed on such women].

Section 5311(c)(2)[57] – Public Transportation on Indian Reservations (Tribal Transit Program) (CFDA: 20.509) (set-aside from Section 5311)[58]

This program provides funding specifically for capital investment, operating expenses, and planning projects related to public transportation in rural tribal communities. It is designed to enhance transit access and improve safety, equity, and environmental sustainability within tribal reservations.[59]

In FY2024, FTA issued a NOFO[60] for this program and listed evaluation criteria for applications. A pregnant and parenting women in need emphasis should be added when a new administration issues a new NOFO for 5311(c)(2) in FY2025:

Demonstration of Benefits

Describe how the proposed project will improve transit efficiency and increase or sustain ridership;

Describe how the proposed project will improve or maintain mobility, increase reliability, or eliminate gaps in service;

Describe how the proposed project will improve or maintain transit service to important destinations and services; and

Describe how the proposed project will improve quality of life in the community or improve access to jobs, education, health care services, and environmental benefits.

[Describe how the proposed project will assist pregnant and parenting women in need, as well as their children both born and unborn, in accordance with a new priority placed on such women.]

Federal Highway Administration (FHWA)

FHWA is the primary DOT grant-maker, providing a majority of the department’s grants. The agency does have some regulatory authority as well via its Manual on Uniform Traffic Control Devices (MUTCD). Below is a program that may present opportunities for policy change to improve pregnant and parenting women in need’s access to transportation services, particularly in rural and tribal regions.

Rural and Tribal Assistance Pilot Program[61]

This discretionary program provides financial and technical assistance to rural and tribal communities for project development related to transportation infrastructure. It aims to support these communities in accessing larger DOT credit or grant programs.

While the $10 million set aside for this pilot program is a relatively small amount, it’s important to be comprehensive on the program side, because programs that are small now could be expanded later. This is a pilot that will be revisited in the next surface transportation infrastructure bill in 2026-2027.

The FY2022-FY2023 NOFO[62] issued for this program in June 2023 emphasized the importance of applicants complying with “Administration and National Policy Requirements”:

Performance under this Program will be governed by and in compliance with the following requirements as applicable to the type of organization of the recipient and any applicable sub-recipients.

It is the policy of USDOT to reflect Administration priorities and incorporate criteria related to climate change and sustainability, racial equity including environmental justice, critical infrastructure security and resilience, Title VI and other federal Civil Rights laws, and barriers to opportunity, labor, and workforce in its grant programs, to the extent possible and consistent with law.

A new administration operating under Presidential executive orders prioritizing pregnant and parenting women in need, should similarly outline its policy requirements:

Performance under this Program will be governed by and in compliance with the following requirements as applicable to the type of organization of the recipient and any applicable sub-recipients.

It is the policy of USDOT to reflect Administration priorities and incorporate criteria related to [accommodating pregnant and parenting women in need, as well as their children both born and unborn, in accordance with a new priority placed on serving such women,] to the extent possible and consistent with law.

Medicaid (Department of Health and Human Services)

While it is outside of DOT, the Medicaid program does include a transportation program that a future pro-life administration could leverage in aid of pregnant and parenting women in need, as described below.

Non-Emergency Medical Transportation (NEMT)[63] program (CFDA 93.778)[64]

NEMT is a Medicaid benefit that provides transportation assistance for eligible beneficiaries who have no other means to get to necessary medical appointments. NEMT services are governed by federal Medicaid regulations and help provide access to healthcare services for low-income individuals. It is administered under Medicaid’s broader medical assistance program. It is possible that HHS administrators may be able to use this program in particular to extend transportation aid to pregnant women and new mothers in need.

Recipients of NEMT funding – states are the eligible primary grantees – apply for and receive these funds through a structured process within Medicaid. Each state must submit a “state plan” to the Centers for Medicare & Medicaid Services (CMS) detailing how NEMT services will be administered, including eligibility criteria, covered transportation types, and any limitations. The state plan acts as a foundational document, outlining the scope and goals of NEMT services while ensuring compliance with federal Medicaid regulations. Once CMS approves a state’s plan, funds are allocated, and the state can reimburse NEMT providers for eligible transportation services, helping Medicaid beneficiaries get access to essential healthcare appointments.

Note that because NEMT falls under the Medicaid program, its funds must not be used for abortion-related services. More specifically, the program must comply with the Hyde Amendment’s restrictions,[65] which for Fiscal Year 2023 is found in Sec. 506(a) of the Consolidated Appropriations Act, 2023 (Public Law No: 117-328),[66] stating that “[n]one of the funds appropriated in this Act, and none of the funds in any trust fund to which funds are appropriated in this Act, shall be expended for any abortion.”[67]

For instance, a future administration might amend 42 C.F.R. Section 431.53[68] via an NPRM to add pregnant and parenting women in need to the regulations governing NEMT, while making clear that resources under that regulation may not be used for abortion-related transportation, in this way:

Assurance of transportation. A State plan must—(a) Specify that the Medicaid agency will ensure necessary transportation for beneficiaries[, including pregnant and parenting women in need,] to and from providers; and (b) Describe the methods that the agency will use to meet this requirement[, including compliance with statutory restrictions prohibiting the use of appropriated funds, or trust fund resources to which funds are appropriated, for abortion].

IV. Conclusion

Transportation presents a critical challenge to pregnant and parenting women in need, providing critical pathways to employment, healthcare, and childcare. The U.S. Department of Transportation (DOT) and other federal agencies could play a pivotal role in facilitating access to essential services for these women within the scope of existing programs and funding if properly leveraged. This study identifies multiple opportunities within the current framework of federal transportation programs to better serve this population through immediate administrative actions, sub-regulatory guidance, and program adjustments—particularly through programs like Section 5310 for enhanced mobility and Section 5307 for urban transit assistance.

To effect these changes, a targeted initiative at the Presidential or Secretarial level could set a priority on grantmaking and guidance adjustments across federal programs, embedding a preference for services that meet the unique needs of pregnant and parenting women. This structured focus could help realign some of DOT’s extensive resources to create a stronger, life-affirming transportation safety net that supports maternal and child health, reinforces family stability, and facilitates access to critical services for this vulnerable population.

Christopher C. Hull, Ph.D., is the President of Issue Management Inc., a full-service public affairs firm focused on achieving policy results. Dr. Hull holds a Ph.D. with distinction in American Government from Georgetown University, and an undergraduate degree magna cum laude in Comparative Government from Harvard University. He has served as Chief of Staff in the U.S. House of Representatives; the Majority Caucus Staff Director of a State Senate; Executive Vice President of a major national think tank; and Legislative Assistant/Legislative Correspondent in the U.S. Senate. He is the author of Grassroots Rules (Stanford Press, 2007), as well as more than 100 book chapters, peer-reviewed articles, conference papers, and op-eds.

The author wishes to thank the Charlotte Lozier Institute staff, especially Senior Editor and Director of Publications Genevieve Plaster, M.A., Deputy Editor Ben Cook, Ph.D., and Senior Research Associate Tessa Cox, for their extraordinary attention to detail in their review of this study, and former senior Executive Branch officials for their significant contributions to this study as well.

[1] President Biden’s EO 14008, Jan 27, 2021, view: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/27/executive-order-on-tackling-the-climate-crisis-at-home-and-abroad/

[2] https://www.irs.gov/credits-deductions/businesses/opportunity-zones

[3] https://www.congress.gov/bill/115th-congress/house-bill/1/text

[4] https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-establishing-white-house-opportunity-revitalization-council/

[5] https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-establishing-white-house-opportunity-revitalization-council/

[6] https://www.transportation.gov/briefing-room/us-department-transportation-unveils-interactive-map-encourage-investment-underserved

[7] https://www.transit.dot.gov/sites/fta.dot.gov/files/2023-07/FTA-Report-No-0211-rev.pdf

[8] https://www.transit.dot.gov/sites/fta.dot.gov/files/2023-07/FTA-Report-No-0211-rev.pdf

[9] https://www.transit.dot.gov/sites/fta.dot.gov/files/2023-07/FTA-Report-No-0211-rev.pdf

[10] https://www.transit.dot.gov/sites/fta.dot.gov/files/2023-07/FTA-Report-No-0211-rev.pdf

[11] p. 13, view: https://www.transit.dot.gov/sites/fta.dot.gov/files/2023-07/FTA-Report-No-0211-rev.pdf

[12] https://www.govinfo.gov/content/pkg/FR-2021-10-07/html/2021-21969.htm

[13] https://www.law.cornell.edu/wex/administrative_procedure_act

[14] https://www.transportation.gov/equity-Justice40

[15] https://www.transit.dot.gov/coordinating-council-access-and-mobility

[16] https://www.federalregister.gov/documents/2004/02/26/04-4451/human-service-transportation-coordination

[17] https://www.transit.dot.gov/sites/fta.dot.gov/files/2022-04/FTA-Guidance-Clarification-on-Coordination-and-NTD-Reporting.pdf

[18] https://www.transit.dot.gov/sites/fta.dot.gov/files/2022-04/FTA-Guidance-Clarification-on-Coordination-and-NTD-Reporting.pdf

[19] https://www.transit.dot.gov/sites/fta.dot.gov/files/2022-04/FTA-Guidance-Clarification-on-Coordination-and-NTD-Reporting.pdf

[20] 49 U.S.C. 5310, “(A) public transportation projects planned, designed, and carried out to meet the special needs of seniors and individuals with disabilities when public transportation is insufficient, inappropriate, or unavailable; (B) public transportation projects that exceed the requirements of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.); (C) public transportation projects that improve access to fixed route service and decrease reliance by individuals with disabilities on complementary paratransit; and (D) alternatives to public transportation that assist seniors and individuals with disabilities with transportation.” https://uscode.house.gov/view.xhtml?req=(title:49%20section:5310%20edition:prelim)%20OR%20(granuleid:USC-prelim-title49-section5310)&f=treesort&edition=prelim&num=0&jumpTo=true

Note, pregnancy is not considered a disability under the ADA, but some pregnancy-related conditions may be considered disabilities under the ADA if they substantially limit a major life activity.

[21] “CFDA” stands for “Catalog of Federal Domestic Assistance.” In 2018, CFDA was replaced by the Assistance Listings available through SAM.gov, home of the System for Award Management. The unique identifying numbers for each Award Listing are still commonly known as “CFDA numbers.” This transition means that the CFDA numbers and descriptions of federal assistance programs, such as grants, loans, and other types of aid, are now found within the Assistance Listings database on SAM.gov. This database continues to serve as the primary source for information on federal assistance programs, providing details on eligibility, application procedures, and other relevant information. The switch to the SAM.gov platform has streamlined and centralized access to federal assistance information, enabling entities to manage their information, access federal contracting opportunities, and find assistance listings, which include details about various federal programs and financial aid options.

[22] https://www.transit.dot.gov/funding/grants/enhanced-mobility-seniors-individuals-disabilities-section-5310

[23] https://www.transit.dot.gov/funding/grants/enhanced-mobility-seniors-individuals-disabilities-section-5310

[24]https://uscode.house.gov/view.xhtml?req=(title:49%20section:5310%20edition:prelim)%20OR%20(granuleid:USC-prelim-title49-section5310)&f=treesort&edition=prelim&num=0&jumpTo=true

[25] p. 1, https://www.transit.dot.gov/sites/fta.dot.gov/files/2022-02/FTA-Report-No-0211.pdf

[26] Ibid.

[27] FTA C 9070.1H, Chapter II Program Overview, 1. Statutory Authority, p. Page II-1, Nov 1, 2024, https://www.transit.dot.gov/sites/fta.dot.gov/files/2024-09/C9070.1H-Circular-11-01-2024.pdf

[28] 42 U.S.C. 12101 et seq.

[29] https://sam.gov/fal/2aff680d82a7437299eaafc0dc0dcee3/view

[30] 49 U.S.C. 5311, “The Secretary may award grants under this section to recipients located in rural areas for- (A) planning, provided that a grant under this section for planning activities shall be in addition to funding awarded to a State under section 5305 for planning activities that are directed specifically at the needs of rural areas in the State; (B) public transportation capital projects; (C) operating costs of equipment and facilities for use in public transportation; (D) job access and reverse commute projects; and (E) the acquisition of public transportation services, including service agreements with private providers of public transportation service.” Note Set asides for: 49 U.S.C. 5311(c)(2) Public Transportation on Indian Reservations Program and 49 U.S.C. 5311(c)(3) Appalachian Development Public Transportation Assistance Program. https://uscode.house.gov/view.xhtml?req=(title:49%20section:5311%20edition:prelim)%20OR%20(granuleid:USC-prelim-title49-section5311)&f=treesort&edition=prelim&num=0&jumpTo=true

[31] https://www.transit.dot.gov/rural-formula-grants-5311

[32] https://www.singleaudit.org/program/?id=20.509

[33] https://www.transit.dot.gov/notices-funding/fy-2024-notice-funding-opportunity-public-transportation-indian-reservations

[34] https://www.transit.dot.gov/sites/fta.dot.gov/files/2024-09/C9040.1H-Circular-11-01-2024.pdf

[35] https://www.transit.dot.gov/notices-funding/fy-2024-notice-funding-opportunity-public-transportation-indian-reservations

[36] FTA C 9040.1H, “Rural Areas Formula Grant Programs Guidance,” Nov 1, 2024, p. 21-4, https://www.transit.dot.gov/sites/fta.dot.gov/files/2024-09/C9040.1H-Circular-11-01-2024.pdf

[37] 49 U.S.C. 5307, “Grants.-The Secretary may make grants under this section for- (A) capital projects; (B) planning; (C) job access and reverse commute projects; and (D) operating costs of equipment and facilities for use in public transportation in an urbanized area with a population of fewer than 200,000 individuals, as determined by the Bureau of the Census.” https://uscode.house.gov/view.xhtml?req=(title:49%20section:5307%20edition:prelim)%20OR%20(granuleid:USC-prelim-title49-section5307)&f=treesort&edition=prelim&num=0&jumpTo=true

[38] https://www.transit.dot.gov/funding/grants/urbanized-area-formula-grants-5307

[39] https://www.transit.dot.gov/funding/grants/fact-sheet-urbanized-area-formula-grants-program

[40] See 49 U.S. Code § 5307(a)(1)(D) and 49 U.S. Code § 5307(a)(2), https://www.law.cornell.edu/uscode/text/49/5307

[41] https://www.transit.dot.gov/sites/fta.dot.gov/files/2024-09/C9050.1A-Circular-11-01-2024.pdf

[42] p. 5, https://www.transit.dot.gov/sites/fta.dot.gov/files/2023-07/FTA-Report-No-0211-rev.pdf

[43] FTA Circular 9050.1A, Page IV-31, https://www.transit.dot.gov/sites/fta.dot.gov/files/2024-09/C9050.1A-Circular-11-01-2024.pdf.

[44] FTA Circular 9050.1A, pp. IV-31-2, https://www.transit.dot.gov/sites/fta.dot.gov/files/2024-09/C9050.1A-Circular-11-01-2024.pdf

[45] https://www.federalregister.gov/documents/2024/05/31/2024-11934/fta-fiscal-year-2024-apportionments-allocations-and-program-information

[46] https://www.federalregister.gov/documents/2024/05/31/2024-11934/fta-fiscal-year-2024-apportionments-allocations-and-program-information

[47] https://www.transit.dot.gov/grant-programs/areas-persistent-poverty-program

[48] https://www.congress.gov/116/plaws/publ94/PLAW-116publ94.pdf

[49] https://www.congress.gov/116/plaws/publ260/PLAW-116publ260.pdf