Rhode Island Medical Home Portal - Transportation and Travel for People with Disabilities

Whether you are travelling by plane, train, or automobile, accessibility and safety are considerations if you or a loved one lives with a disability. More and more, people with disabilities are gaining access to new technologies and public transportation to help them travel safely.

For people with disabilities, transportation provides a vital lifeline to education, healthcare, employment, and community life. The Rehabilitation Act of 1973, as amended, provides discrimination protection to people with disabilities, particularly in Sections 503, 504 and 508. People with disabilities are no longer to be excluded from, denied the benefits of, or subjected to discrimination under any program or activity that receives Federal financial assistance. Safe, reliable transportation is essential in allowing people with disabilities to use and enjoy such programs and activities. From adaptive car seats to non-emergency medical transportation, there are several options for accessibility, depending on your situation.

Child Safety Seats

Children with special needs, such as cerebral palsy, autism, or spinal cord problems may require adaptive car seats or seat restraints for continued safety in cars, buses, and airplanes. Some children may need a more specialized solution if they are in a hip or body cast. Certain medical conditions require more support for the body; challenging behavior may require a more secure (childproof) restraint. Finding the right car seat for your child can be a challenge.

Some children with special needs continue to need a 5-point harness or specialized seat as they grow, and they will need a seat made for larger children. You will not find this type of car seat in the department store, but they are available if you need one. Below are recommendations from parents who have been through the process of ordering a special needs car seat.

Find a car seat safety check site or certified technician near you by calling your local hospital or health department (See Resources at the bottom of the page for further information.)
Speak with the Child Passenger Safety (CPS) technician about their recommendations for your child's safety.
If your child has a physical therapist, ask for a recommendation about a seat.
Ask other parents what their child is using and what they did to get it.
Contact your child's primary care clinician and ask for a letter of medical necessity for the insurance company or Medicaid.
Submit a written request to insurance. If insurance denies the seat, you can appeal the decision. If still denied, look for alternatives resources.
Are there programs in your area that donate or have low-cost seats? (Try your Children's Hospital or Health Department)
Are there any organizations in your area that donate or help with funding? (Independent Living Centers, Lion's Club, special needs organizations)

Wheelchair / Automobile Transport

When traveling as a passenger in an automobile, it is generally safest for the wheelchair user to transfer from her wheelchair to a seat with seatbelts or a child safety seat (car seat) that complies with federal safety standards, and then secure the wheelchair in the vehicle.

If transferring is not feasible, it is very important to secure the wheelchair to the vehicle facing forward, and to use crash-tested seatbelts for the wheelchair-seated rider. It is best if you have a wheelchair that has been designed and crash-tested for use as a seat in motor vehicles, often referred to as a WC19 wheelchair or a transit wheelchair. A WC19-compliant wheelchair provides four easily accessible attachment points that help secure the chair using a four-point tie down system. Even with the tie down system, make sure that the wheelchair user is also using crashworthy and properly positioned pelvic and shoulder belt restraints.

School transportation (bus) will usually recommend that your child have a WC19-compliant wheelchair unless they are transferring to a bus seat. However, your child cannot be denied transportation to school because he does not have a WC19 wheelchair. It is in the child's best interest for the parents and the school transportation team to work together to find the safest option for a child to travel on the school bus. More information is available in the American Academy of Pediatrics School Bus Transportation of CSHCN (AAP) policy statement.

Adapted Motor Vehicles

New technology gives many people with disabilities the opportunity to drive or be transported in their own vehicles with adaptive devices. Some examples include:

wheelchair lifts and ramps
hand controls
modified seating
steering aids

A driving rehabilitation specialist can tell you if it is possible to successfully adapt your vehicle. See the resources section below to locate a specialist in your area.

A qualified vehicle modification dealer installs the devices suggested for your car. This dealer is not the same as the dealer who sold you your vehicle. For a consumer guide to purchasing wheelchair accessible vehicles and equipment see the National Mobility Equipment Dealers Association (NMEDA), also in the Resources below.

Adaptive Driving

Sometimes assistive technology and adaptations are necessary for a young adult or adult with disabilities to drive a vehicle. For more information, go to the Adaptive Driving page. For information on Driver's Education and obtaining a driver's license, go to: Transportation - Where's My Ride.

Public Transportation Services

Transportation services allow individuals with disabilities to live independently within their communities by providing accessible public options. The Americans with Disabilities Act requires that new public buses and rail vehicles (such as subway cars) be accessible to people in wheelchairs.

Many new fixed route buses have lifts or ramps for people in wheelchairs. The buses also must have at least two spaces inside for securing wheelchairs. People who are able to use the fixed route bus service should utilize this option whenever possible.

For people who cannot use fixed route bus services, many city transit agencies provide what is known as "paratransit" for eligible travelers. Paratransit services typically use vans or mini-buses equipped with wheelchair lifts or ramps. These vehicles usually do not follow fixed schedules, but instead allow you to call and schedule a pick-up wherever you are. Disability alone does not determine paratransit eligibility; the decision is based on the applicant's functional ability to use a fixed route bus and is not a medical decision. Establishing eligibility requires filing an application that describes the passenger's disability and explains why she is unable to use regular transit, along with the signature of a health care professional.

Non-Emergency Medical Transportation

Non-Emergency Medical Transportation (NEMT) allows patients who are unable to travel on their own due to medical conditions to travel safely from one location to another, locally or for long distances. NEMT can be provided by ground or air, depending on the patient's needs.

Sometimes, patients who are stable but unable to travel by conventional means are required to use non-emergency medical transportation due to oxygen requirements, mobility issues, or for ease and comfort.

Non-Emergency Medical Transportation for Medicaid Beneficiaries

States are required to make NEMT available to Medicaid beneficiaries to assure their access to medically necessary services. Most states cover NEMT to enable Medicaid beneficiaries to obtain covered medical services from both local providers and from hospitals and clinics outside their area. Some states have a prior approval process or may limit the number of trips allowed per month. Many states contract with local agencies to coordinate services. For a summary of your state's Medicaid NEMT eligibility and coverage see the Resources section below.

Train Travel (or rail service)

Amtrak is the major rail transport company in the United States and provides a host of accommodations to travelers with disabilities. Information concerning the accessibility of their trains and stations can be obtained by contacting a reservation representative at 800/USA-RAIL (800/872-7245) or for you may visit Amtrak's website (see the Resource section below).

Air Travel

The Air Carrier Access Act (ACAA) prohibits discrimination on the basis of disability in air travel by requiring U.S. airlines and foreign airlines, providing flights to or from the United States, to offer accessible facilities, accommodations, and other services to passengers with disabilities.

However, unlike most forms of transportation, many aspects of air travel are not covered by the Americans with Disabilities Act (ADA). The Air Carrier Access Act of 1986 (ACAA) is a civil rights law that requires some accessibility for people with disabilities, but not the same level of access that is required on bus and rail services by the ADA. For example, under the ACAA, a person who uses a wheelchair or mobility device is required to transfer to an airplane seat instead of riding in their device. Also, while new safety videos shown on airplanes must be open-captioned, any video entertainment shown is not required to be captioned.

The ADA and its Accessibility Guidelines do apply to airports and airport services. For a step-by-step guide to air travel with a disability, go to the Flying with a Disability link also in the Resources section below.

Flying with Children with Disabilities

If you are a parent or caregiver flying with your child, here are some suggestions:

Before You Go

Be sure to call your airline carrier at least 72 hours ahead of time and inform them of your child’s special needs. Doing so will allow for safe and happy travel onboard the aircraft.
Provide advance notice to your airline or travel agent if you require assistance at the airport. Your airline will assist you through the airport facility and the screening line.
If you require a companion or assistant to accompany you through the security checkpoint to reach your gate, speak with your airline representative about obtaining a gate pass for your companion before entering the security checkpoint.
The limit of one carry-on and one personal item (purse, briefcase or computer case) does not apply to medical supplies, equipment and mobility aids, and/or assistive devices carried by and/or used by a person with a disability.
Pack your medications in a separate pouch/bag to facilitate the inspection process. Ensure that containers holding medications are not too densely filled, and that all medication is clearly identified. It is recommended that passengers refrain from packing any medications that they do not want exposed to X-rays in their checked baggage. Instead, send larger quantities of medication to your destination by mail or another preferred way.
Make sure each of your carry-on items, equipment, mobility aids, and devices, have an identification tag attached.

Security

Inform screening officials of your child's disability and what he is able or not able to do during screening.
Carry documentation to support any medical or behavioral conditions, and offer suggestions to security staff on how to minimize issues during the screening process.
Security officers should never remove your child from his wheelchair. Only parents are allowed to transfer their child, and you can refuse if it is not in your child's best interest. You can ask the security officers to use alternate screening measures while your child remains seated in her wheelchair.
If your child is able to stand and walk, have him walk through the metal detector, as it can make the process much faster.
Officers in the United States are not required to pat down minors with disabilities; however, other countries may have different regulations. In both the US and Canada, officers will visually or physically inspect and test any seat cushions, pouches, and packs attached to the chair.
In regards to taking pictures and filming, the TSA allows you to do so as long as it doesn’t interfere with the screening process. That being said, some laws, state statutes, or local ordinances may prohibit taking pictures or filming.
Most importantly, know you have the right to be with your child throughout the entire travel process; speak up if anything makes you or your child uncomfortable.

Hidden Disabilities

Persons with a hidden disability can, if they choose, advise security officers that they have a hidden disability and may need some assistance, or that they need to move a bit more slowly than others.
Family members or traveling companions can advise Security Officers when they are traveling with someone who has a hidden disability, which may cause that person to move slowly, become agitated easily, and/or need additional assistance.
Family members or traveling companions can offer suggestions to Security Officers on the best way to approach the person with a hidden disability, especially when it is necessary to touch the person during a pat-down inspection.
Family members or traveling companions can stay with the person during a public or private screening; however, they may be required to be re-screened if they provide assistance to the person.

TSA Cares Helpline
TSA Cares is a helpline that assists travelers with disabilities and medical conditions. TSA recommends that passengers or caregivers call 72 hours ahead of travel for information about what to expect during security screening, and to ensure time to coordinate checkpoint support with the TSA Customer Service Manager at the airport if needed.

When a passenger with a disability or medical condition calls TSA Cares, a representative will provide information about screening that is relevant to the passenger’s specific disability or medical condition, or will refer the passenger to disability experts at TSA.

Travelers may call TSA Cares toll free at 1-855-787-2227 Monday through Friday 8 a.m. – 11 p.m. EST and weekends and Holidays 9 a.m. – 8 p.m. Travelers who are deaf or hard of hearing can use a relay service to contact TSA Cares or can e-mail TSA-ContactCenter@dhs.gov.

Disability Notification Card for Air Travel
A handy tool for travelers with a disability is the TSA Disability Notification Card ( PDF Document

69 KB). You can print the card and complete the blanks which will inform TSA officers of a disability in a concise and discrete manner. See link in the Resources section below.

Boarding and Flying

Seating
Children under 2 are not required to have a paid ticket and can sit in a parent’s lap, but for many children this creates anxiety or behavioral issues on a long flight. For children with mobility or behavioral issues, request seating where there are no passengers in front of you. The bulkhead of a cabin has extra leg space and with no seat in front of you, no one can recline into your space. Some airlines reserve this space for people with disabilities, so call ahead to ask for this.

For a child with sensory integration issues, a flight can be overwhelming. A plane filled with people, the loud engine, ear pressure, and turbulence can understandably create anxiety for your child, yourself, and sometimes other passengers. Be sure to bring anything that might calm your child, and consider an airplane safety harness. Request seating in the bulkhead.

Before bringing a child safety seat or specialty harness, contact the manufacturer and the airline to make sure it is FAA approved. See Resources section below for information about child safety on airplanes. The Kids Fly Safe, CARES Airplane Safety Harness for Children is now approved for use by kids, teens and adults with special needs. See the Resources section below.

Wheelchair accessibility
All airports are wheelchair-accessible. Contact the airline to find out what their procedures are for a gate check of the wheelchair. As a precaution against loss or damage, always remove the detachable parts before your wheelchair is stored, and label the chair with your name, address, and destination airport. Generally, your child can use her own chair until the boarding process. If she is able to walk a short distance, you can request a seat near the entrance doors. If she needs assistance boarding the plane, request an aisle wheelchair at boarding and de-boarding. Your child's wheelchair will then be stored conveniently for immediate availability on arrival. If there is any damage to the wheelchair, inform the airline and inquire about repair/replacement policies.

Flying in a Stretcher
Many larger, international airlines can accommodate a traveler in a stretcher, although you will have to fly with the necessary medical supervision. Transport of a stretcher often requires the purchase of 6-9 seats to cover the airline's cost of lost seating. Medical clearance is required, and we recommend you contact the relevant airline as early as possible to inform them that you will need to fly in a stretcher.

Medical Certification and Medical Equipment
Medical certification is only required for:

a passenger requiring medical oxygen during a flight – contact the airline for specifics on oxygen use
a passenger who will probably require extraordinary medical assistance during the flight
a passenger traveling on a stretcher or in an incubator
a passenger with a communicable disease

Contact your airline for specific requirements for oxygen tanks, concentrators, suction machines, pulse oximeters and other medical devices needed during flight.

Flying with a Service Animal
The Americans with Disabilities Act of 1990 (ADA) allows Service dogs and emotional support animals to travel in the cabin of the aircraft as long as the dog does not obstruct an aisle or any other area used for emergency evacuations.

Although general in-flight rules will always be enforced by every airline company, the processes of actually making reservations, passing the ticket counter, check-in, security checkpoint, and gate may vary slightly, depending on the airline and airport. By reviewing the websites for individual airlines and airports, you'll learn the specific guidelines.

International Travel
More and more, people with disabilities are traveling abroad. Individual countries have their own standards of accessibility for travelers with disabilities. Research and preparation is important for safe and accessible international travel. See the international travel link in the Resources section below for further information on international travel for individuals with disabilities.

Resources

Information & Support

For Parents and Patients

National Highway Traffic Safety Administration Child Car Seat Inspection
Child Care Seat Inspection Station Locator.

Safe Kids
Car seat check-up events.

The Association for Driver Rehabilitation Specialists
The Association for Driver Rehabilitation Specialists was established in 1977 to support professionals working in the field of driver education / driver training and transportation equipment modifications for persons with disabilities through education and information dissemination.

National Mobility Equipment Dealers Association (NMEDA)
NMEDA is a nonprofit association that supports nearly 600 manufacturers, dealers and driver rehabilitation specialists that work together to improve the transportation options for people with disabilities. NMEDA is the only organization for the adaptive mobility industry that monitors its members to ensure they abide by the safety standards of the National Highway Traffic Safety Administration, Federal Motor Vehicle Safety Standards, and NMEDA’s Quality Assurance Program.

Transporting Children with Special Health Care Needs
This statement reviews important considerations for transporting children with special health care needs and provides current guidelines for the protection of children with specific health care needs, including those with a tracheostomy, a spica cast, challenging behaviors, or muscle tone abnormalities as well as those transported in wheelchairs.

Adapting Motor Vehicles for People with Disabilities
The information in this brochure is based on the experience of driver rehabilitation specialists and other professionals who work with individuals who require adaptive devices for their motor vehicles.

Paratransit Eligibility Handbook (ADA)
Section 223 of the Americans with Disabilities Act of 1990 (ADA) requires that public entities which operate non-commuter fixed route transportation services also provide complementary paratransit service for individuals unable to use the fixed route system. The regulations issued by the U.S. Department of Transportation, which implement this portion of the law, specify to whom and under what circumstances this service is to be provided. Dated 1993.

Access Travel Center
Here you will find ground and air transportation listings for traveling to and from medical facilities such as doctor's offices, diagnostic testing centers, outpatient clinics and hospitals.

Medicaid Benefits: Non-Emergency Medical Transportation (NEMT)
States are required to make NEMT available to Medicaid beneficiaries to assure their access to medically necessary services but have the option to provide it as a State Plan service or as an administrative expense, with either option eligible for federal Medicaid matching funds.

Amtrak
Amtrak supports the Americans with Disabilities Act and has worked to make facilities more accessible to customers with disabilities.

Flying with a Disability
Disability air travel information and advice.

TSA Disability Notification Card ( PDF Document 69 KB)

Flying with Children with Special Needs
Tips to make traveling less stressful.

Kids Fly Safe, CARES Airplane Safety Harness for Children
CARES harness is already certified for kids 22-44 lbs for all phases of flight.

International Travel for Individuals with Disabilities
Individual countries have their own standards of accessibility for travelers with disabilities, so it is important to conduct research in advance and think about your needs throughout the course of your trip.

Authors

Author:

Tina Persels - 9/2013

Contributing Authors:

Shena McAuliffe, MFA - 9/2013
Gina Pola-Money - 9/2013

Content Last Updated:

2/2014