By alex king

Medical Transportation in the Qualla Boundary (N.C.)

In late January, I had the opportunity to visit the Cherokee Indian Reservation in Western North Carolina, where CTAA has been working with the Eastern Band of Cherokee Indians (EBCI) as a part of USDA-sponsored Tribal Passenger Transportation Technical Assistance Program. CTAA has been working with the EBCI over the past several years to enhance and expand the scope and effectiveness of Cherokee Transit’s trips to health care destinations.

cherokee_transit_1.jpgCherokee Transit’s service area extends across the Qualla Boundary – a territory owned by the EBCI that spans across portions of multiple counties. The mountainous region is over 80 square miles and the longest route can take over an hour to travel due to the challenging roads and terrain. With a number of health care destinations located within the boundary, including both dialysis clinic and a newly built Cherokee Indian Hospital, the system has a long history of providing transportation to medical destinations.

Enhancing and expanding the scope of Cherokee Transit’s services to these destinations became the focus of CTAA’s work with the tribe as EBCI was recently designated by the State of North Carolina as the Medicaid Non-Emergency Medical Transportation (NEMT) provider within its tribal area. Besides medical services, the Tribe has expanded responsibility to accommodate the provision of transportation for beneficiaries enrolled in the State of North Carolina’s Medicaid program. The recent follow up meeting with Tribal Members was to identify how the transition has been going, any challenges they have faced, and successes in implementation of this expanded aspect of their services.

Conversations with Cherokee Transit Management staff – Kevin Tafoya, Michael Slee, and Kristin Lane – provided valuable information on the agencies medical transportation services as well as current challenges and goals for the future. A new(ish) statewide Medicaid reporting and technology system, NCTracks, has been a growing process for NEMT providers in the region. While Cherokee Transit does not work directly within NCTracks, staff must coordinate with transit agencies from the counties in their services area to receive trip approvals and reimbursement requests. And to be expected, as with any new technology, there have been some growing pains.

cherokee_transit_2.jpgOne area where Tribe takes great pride is their daily dialysis runs. Dialysis patients are nearly half of their medical trips, requiring two full time drivers to cover the daily need. Kevin and Michael were particularly proud of the drivers they have running these routes, and mentioned the care and skill they have when working with this important subset of their riders. However, the region has been experiencing a growing demand for dialysis. The local dialysis clinic may choose to expand the facility over the next few years – which would result in Cherokee Transit likely needing to increase trip capacity as well.

Medical transportation is both a challenging yet rewarding subset of transportation trips. Cherokee Transit remains focused on the important services that play a key role in their local community’s health. No matter what they decide to focus on next, their dedication and commitment to serving their diverse community is clear. Their website puts their commitment to providing public transportation perfectly, “public transportation beautifully fits both the region’s need to promote air quality and the Cherokee tradition of communal sharing.”


The Community Transportation Association of America (CTAA) and its members believe that mobility is a basic human right. From work and education to life-sustaining health care and human services programs to shopping and visiting with family and friends, mobility directly impacts quality of life.