Enterprise-Wide Initiative (EWI) - Transportation

Highly Rural Transportation Grants (HRTG) Program

Background

The Highly Rural Transportation Grants (HRTG) program started at the Department of Veterans Affairs (VA) in 2013 to help Veterans in very rural areas get to their medical appointments. Lack of transportation was a major barrier to care for these Veterans.

The program is open to Veteran Service Organizations (VSOs) and State Veterans Service Agencies in eligible highly rural counties, which are areas with fewer than seven people per square mile. These organizations can apply for grant funding to create and run transportation services that help Veterans reach VA or VA-authorized community health care.

Veterans can use HRTG-supported transportation for long trips and overnight stays for surgery or extended treatment, as well as day trips for primary care, specialty care, and mental health appointments. When organizations apply, they describe their transportation plan, staffing, needed resources, community partners, and a timeline for putting their program into action.

In 2024, each grantee received $50,000 to provide transportation services in their assigned highly rural area, with only one grantee serving any single highly rural area. Grantees may partner with local transportation companies or provide rides directly using their own vehicles.

Goals

The main goal of the HRTG program is to improve access to transportation for highly rural Veterans so they can travel to and from medical appointments with VA and authorized community health care providers. By improving transportation, the program helps Veterans get the care they need to stay as healthy and independent as possible.

HRTG grantee organizations use vans and shuttle buses to transport Veterans, and many of these vehicles are wheelchair accessible. This supports Veterans with mobility challenges and makes it easier for them to receive needed care.

Methodology

In October 2022, the Veterans Health Administration (VHA) Veterans Transportation Program and the Office of Rural Health (ORH) partnered to expand transportation access for highly rural Veterans through the HRTG Enterprise-Wide Initiative (EWI). This partnership supports the daily operations and oversight of the HRTG program.

The HRTG EWI helps pay for salaries, vehicle purchases and maintenance, marketing and advertising, and other operational costs needed to keep transportation services running. A dedicated HRTG Program Manager works closely with grantees to help them successfully carry out their transportation plans and address challenges.

The ORH Center for the Evaluation of Enterprise-Wide Initiatives evaluates how well the HRTG program is working by looking at adoption, reach, and effectiveness. Grantee sites submit quarterly reports that include the number of completed trips, miles traveled, number of highly rural Veterans served, number of locations served, and Veteran satisfaction with the service.

At this time, there are 13 HRTG grantees serving Veterans in 179 highly rural counties across 14 states: Alaska, California, Idaho, Maine, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas, Washington, and Wyoming. A full list of current HRTG grantee organizations, the counties they serve, and contact information is available on the Veterans Transportation Program HRTG web page.

Impact on Rural Veteran Health

From October 2023 to September 2024, HRTG grantees provided an estimated 20,675 rides to medical appointments for about 5,318 Veterans in highly rural areas. These rides supported access to primary care, specialty care, and kidney dialysis.

Veteran feedback shows strong satisfaction with the program. Veterans describe HRTG as filling a critical transportation gap and say it allows them to reach important medical appointments that they might otherwise miss. Veterans also report that drivers and staff treat them with respect and kindness, which makes the experience more comfortable and reassuring.

Grantee organizations also report high satisfaction in working with Veterans to meet their transportation needs. Staff and drivers see the program as very meaningful work, and some describe it as life-saving for Veterans who would otherwise have no way to reach hospitals, surgeries, and follow-up care.

Key Takeaways

The HRTG program directly supports the health of highly rural Veterans by providing reliable transportation to VA and VA-approved community health care providers. By removing the barrier of long and difficult travel, Veterans are more likely to attend appointments and follow through with recommended treatment.

HRTG is especially helpful for older Veterans who live far from medical centers and may face trips of five or more hours one way. In these situations, driving can be unsafe or exhausting, and the HRTG program helps make travel safer and more manageable for these Veterans.

Because HRTG grantees are VSOs or State Veterans Service Agencies, they have flexibility to transport Veterans over longer distances and sometimes across state lines to reach needed care. Overall, the program strengthens access to health care for Veterans living in some of the most remote parts of the country.

References

• United States Department of Veterans Affairs. Grants for Transportation of Veterans in Highly Rural Areas (38 CFR 17).
• United States Department of Veterans Affairs. Grants for Transportation in Highly Rural Areas (VA-HRTG-NEW-2024).
• U.S. Department of Veterans Affairs. Highly Rural Transportation Grants (HRTG) website.

Contact

• Mindy LaCrone, Program Manager, Highly Rural Transportation Grants Program, Veterans Transportation Program. HRTG@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00577.
• Suggested Citation: LaCrone, M. & Stevenson, L. (2025). HRTG (Highly Rural Transportation Grants Program). Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

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