Unmet Needs and Barriers
We live in a highly rural region. We drive further to meet our daily needs than those who don’t live in rural counties. That costs more, and trips take longer to make. Our road network is sparse and subject to disruption due to weather or natural disasters, meaning we regularly face detours that make a long trip much longer. Let’s face it – Okanogan County can be a tough place to get around with a car. It’s much more challenging without one.
This section summarizes an array of issues that make it hard for people to get where they need to be when they need to be there, conveniently and affordably. These are the challenges that make travel harder than it seems like it should be or more expensive, or consequential when it doesn’t work out right.
Issues are assembled from a variety of public sources: public comments and surveys associated with various planning processes including this update; provider polls; provider discussions and meetings; Community Health Needs Assessments and Okanogan County's Community Health Assessment; transit and service provider plans and reports; statewide plans and data; social media feeds; and other local, regional, and statewide sources.
They are organized by issues that individuals face trying to get where they are going, issues that human services providers confront when helping their clients overcome mobility barriers to access services, and issues that transportation providers have to navigate to deliver reliable rural mobility options that are convenient and affordable.
Let's start with the barriers that individuals contend with when traveling without a car. These are concerns we've heard about from the public and from service human services providers helping them with arrangements about what it is like trying to get around without a car and what is particularly challenging.
Issues that Individuals Face
People who live in Okanogan County and don’t drive face a variety of different barriers and gaps in service that make it hard to get where they are going or make it inconvenient or impractical. These barriers and gaps reflect the challenges for transit services in a rural region, accessibility concerns, cost, and information or knowledge gaps. An individual may find several to be true at one time. We’ve grouped them by type of issue though there are often overlapping issues.
At Some Point People Living an Independent Rural Lifestyle Lose the Ability to Drive
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After a lifetime of driving, advanced age makes driving unsafe for some or all trip purposes. That loss of independence is not an easy transition anywhere, but for rural residents who live in outlying areas it is particularly challenging because there are few alternatives to driving.
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People who’ve always lived an independent rural lifestyle may sustain an injury or disease, or eyesight fails or slight dementia or other chronic conditions develop that eliminates their ability to drive safely, leaving them isolated unless there is travel assistance from some source.
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Working households cannot keep up with inflation. Wages don’t cover basic living expenses. Owning and operating a vehicle is already expensive in rural areas, but soaring gas prices make driving so expensive that people simply can’t afford to drive anywhere but they don’t have other options.
Transportation Services and Facilities Don't Meet Everyone's Needs
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People don’t live close enough to bus service to be able to get to it
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Buses and shuttles don’t run early enough in the morning to get people to their destination on time, or it doesn’t run late enough at night to get them home, or it doesn’t run frequently enough for trip convenience
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Most services don't operate on Sunday, and people need to travel on Sunday.
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People live more than 10 miles outside of cities and so are beyond the service area for on-demand service
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Districts of the Confederated Colville Tribes are not part of the Public Transportation Benefit Area and lack transit access, including the HUDs in Omak and Malott
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People may live close enough to get to the bus and they would take it, but there aren’t safe ways to walk there or safe places to wait for the bus once they get to the stop
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The weather can be too awful to wait for the bus if there’s no shelter
Long-Distance Travel to Destinations Outside Okanogan County is Hard Without a Car
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People need to travel to Wenatchee for medical or other services but don’t understand how to transfer to Link Transit, or how to navigate the bus system once in Wenatchee, and OCTN only goes to Wenatchee on Thursdays
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The Apple Line and OCTN both go direct to Wenatchee but people can’t afford the fare
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People sometimes have to spend the night in Wenatchee because they can’t leave in time to catch the last return trip
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People would take the Apple Line to Wenatchee or Ellensburg, but they can’t get to or from an Apple Line pick-up point
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Veterans’ services are in Spokane, and while it’s possible, it’s a complicated trip with too many transfers and advance reservations for some to handle
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Tribal members need to travel to Spokane for specialty health services like optometry, but without a car it is difficult to get there and back
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It takes so many transfers between systems to get to the airport that people will travel the day before, to play it safe, and spend the night in Spokane to catch a flight out
Inconvenient Processes and Lack of Information Make Travel Even Harder
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People can’t always plan their travel needs two days in advance, which is required for on-demand and NEMT service
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People find the different route schedules for different services confusing; they don’t know who to call for what service, or they don’t know if they qualify for some transportation services, or what services are available where
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Travel from Omak to Spokane requires transfers between three different systems and reservations have to be made in advance for connecting transfers, making this a complicated trip to schedule and navigate
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People have to be able to plan their travel needs in advance to use most on-demand or non-emergency medical transport services (“Medicaid travel”), with reservations typically required at least one day and up to two weeks in advance. This is not always possible.
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The intake process for paratransit and door-to-door service can be intimidating or confusing for many people so they don't use it, or they don’t know they need to prequalify for this service before they can use it
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People have been surprised to learn they don’t meet eligibility requirements for NEMT service with People for People even though they live on very limited incomes
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Reservations for VA-provided transport to Spokane has to be made weeks in advance and is on a space-available basis, meaning veterans often need other ways to access their VA services
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Logistically, it is hard to shop or run a variety of errands in one trip without a personal vehicle
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Many people are intimidated by or confused by automated answering systems or online tools and so will never get past that initial barrier to ask for help, and they don't know to call 2-1-1 for travel information and assistance
Transportation Barriers Can Have Bad Consequences
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People may have a vehicle, but they can’t afford to do necessary repairs or pay for gas without skipping payment of other important household expenditures, and without a car they can’t work so they skip other payments
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Poverty affects young people in Okanogan County hard, and if they can’t afford a car they have a hard time finding a job they can get to by bus or other means, or accessing health services or college or other basic needs of daily life
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Some people who don't drive rely on friends or family to take them places but that is not always convenient, or they don’t want to be a burden and so they don’t ask for a ride
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Many people who don’t drive don’t know how they will evacuate if there is a fire or other natural disaster
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Some people can no longer drive safely, but they’ve never ridden the bus and just can’t imagine that it’s right for them
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Young families forego Early Head Start learning programs because it is very cumbersome to travel by bus with strollers and baby bags, even though they want the educational opportunity and food assistance that comes with attendance
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Our housing shortage causes people to move further out into the backcountry in search of housing they can afford. But transportation costs can easily exceed what they’re saving in housing costs, and if their car or truck fails them, their options are limited.
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Our housing shortage also limits the ability of people who've grown old in outlying areas to downsize and move into town where medical facilities are located and where there are more transportation options, so they continue to drive when they shouldn’t or become homebound and socially isolated without some other kind of support.
Issues that Human Services Providers Confront
Health and human services providers are too familiar with issues their customers and clients face in trying to access the services available to them. In every triennial Community Health Needs Assessment conducted by Federally Qualified Health Centers (FQHC) across the county and Community Health Assessment, lack of reliable transportation surfaces again and again as an issue confounding the delivery of health and human services. This makes it harder to achieve the health outcomes and community wellbeing that rural organizations are working so hard to provide, and puts undue strain on an already over-burdened system. This HSTP highlights some of the issues they encounter in providing services to those in need.
Lack of Reliable Transportation Negatively Impacts Health Outcomes
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Lack of reliable transportation is a primary cause of missed or cancelled appointments. Missed appointments set back patient recovery and often necessitate another long wait for a future appointment, possibly with a deterioration in conditions. At the same time, these last-minute cancellations preclude the opportunity for providers to have seen someone else instead. This creates inefficiencies in service delivery that further strain rural health resources.
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Patients will decline health care services or forego accessing social services because they don’t have a way to get there. This is particularly true for specialty care that requires long-distance travel. Such appointments may even entail an overnight stay because of the travel distance, which may create impossible financial hurdles, too.
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Women without reliable transportation will skip routine prenatal care, and families with young children will pass up routine exams, because of challenges in getting to and from appointments.
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Because it is too hard for them to get to preventive care, people will put off seeking medical attention until conditions result in emergency conditions, resulting in more expensive treatment options with possibly poorer health outcomes or other corresponding issues.
The Road to Recovery Care Requires Reliable Transportation
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People receiving behavioral health treatment or therapy for cognitive or mental health conditions often do not drive and need help with transportation to and from appointments and yet may have conditions that make travel by bus or in a shared vehicle unsafe for others.
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Coordinated efforts to divert people away from the criminal justice system and into mental health and substance use disorder treatment are often stymied by the inability of people who really want treatment to get to health appointments reliably on an ongoing basis because there are no transportation services available to them or suitable for their travel needs.
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Patients being discharged from hospitals may not have a way to get home and unless they are on Medicaid, there are few or no non-emergency medical transportation options available to them. Liability and insurance restrictions typically prohibit transport by staff who want to help.
Clients Don’t Take Advantage of Programs because They Can’t Reach Them
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Children who would benefit from early childhood learning programs don’t attend because it is impractical or even impossible for parents to get them there or back without a car.
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Many patients make too much to qualify for Medicaid or Apple Health – and the free medical transportation that comes with those programs – and yet their wages don’t cover basic living expenses and they cannot afford to drive to obtain services. Federal poverty levels are artificially low and do not account for the majority of low-income people.
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Health and human services providers often function as “travel coaches,” helping their clients plan for how they will get to or from recommended services. This reduced the time available to provide care services, in a region that is already recognized for limited services and long waits for care.
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Insurance and liability concerns preclude organizations from helping with what seems to the public like a simple, straightforward request for assistance.
Issues that Transportation Providers Navigate
Transportation providers work to provide safe and reliable service and where possible, expand it to meet additional needs. They do this while navigating their own universe of challenges and constraints that inform the kinds of services each provider offers, where and when they operate and who they serve. For the most part, these are things our partners have no control over.
Most have something to do with money - how much money they need and how much they can get, what it can be used for, who can be served, how hard it is to get and to administer. These factors are hard-wired into their thinking and planning and implementation, always with the aim of meeting the most need they can with the resources available. This can be helpful context for understanding the nature of barriers and gaps in service identified above and identifying pragmatic strategies that can actually work to address them.
The Color of Money Determines the Services They Can Provide
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State and federal grants make up the lion’s share of revenues that transit agencies and other transportation service providers rely on. State and federal grants are vitally important. They enable us to have services and facilities we wouldn't otherwise be able to afford. They can also be very frustrating. Grants are costly to apply for and costly to administer. Every grant has its own restrictions about how it can be spent, what is required for project tracking and reporting, time frames for expenditure, and more. Big projects or ongoing services often entail multiple grants, combining two or more different sources of funding on a single project and increasing the complexity of project administration. It takes resources to manage grants, resources that may be scarce for some of our partners. Additionally, grants are often restricted to operations within the home county of the agency, despite the fact that rural health services are often located out of county. This requires negotiating case-by-case exceptions for out-of-county service that seem arbitrary to customers and undermining their trust and confidence in service providers. ACH service area boundaries are multi-county but mobility funding is not.
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Transit agencies in Washington rely on retail sales tax revenue for stable, predictable local funding. Our voter-approved 0.4% share of sales tax revenue is the only truly reliable revenue TranGO receives, with the rest of its funding coming from competitive state and federal grants that are unpredictable and fluctuate over time. Okanogan County's rural tax base is much smaller than that in large urban counties and so it doesn’t generate as much here as it does elsewhere. What it does generate provides essential local match TranGO needs for those state and federal grants, in addition to supporting ongoing day to day operations.
Asset Management Is a Priority
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Rural travel is hard on vehicles and mileage accumulates fast. It is important to replace vehicles in accordance with asset management plans before they get unreliable or overly expensive to maintain. But funding is not always available for vehicle replacements on a timely basis. This can cause maintenance costs to increase to keep vehicles in safe and reliable operating order. This can be particularly impactful for non-profits that rely on light duty vehicles since these are not always up to the sustained rigors of rural service.
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Maintaining a State of Good Repair with regular preventive maintenance is important for vehicle safety and is a cost-effective way to enhance system efficiency and reliability. That is best done on site by a trained workforce dedicated to that function, and requires agency-owned facilities for that purpose. TranGO does not have its own facilities. It rents its administrative space and relies on third-party providers for routine maintenance and repairs. Simple preventive maintenance can leave buses out of commission for extended periods of time, impacting service delivery. New facilities are very expensive, but in 2025 TranGO secured a sizeable grant to build its own facilities. Any shortfall in funding will require additional state or federal funds to expedite completion of this regionally significant facility.
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Non-profits and small transportation organizations may not have the staff capability or facilities to maintain their own vehicles. Instead, they rely on service through private shops that may not be able to meet the quick turnaround needs of providers, leaving vehicles out of service and disrupting travel. This is compounded by those with wheelchair lift-equipped vehicles that require more specialized maintenance services.
Making Long Distance Travel Easy is Hard
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A number of essential health services are not available locally, increasing demand for long-distance trips that are difficult and/or expensive to provide, especially if they entail specialized vehicles or personnel.
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The Apple Line is a valuable intercity bus connection that goes from Omak to Wenatchee and on to Ellensburg with three roundtrips daily. Though it is expensive, it avoids the need to transfer to Link transit in Chelan that is required when using TranGO service. More people might use the service if it was possible to make timed service connections, especially at Brewster and Pateros. However, it is hard for rural transit agencies to communicate and coordinate with a large national carrier like Northwest Stage Lines, making service connections to this state-funded service impractical.
Operating Costs Can be an Unsustainable Budget Wild Card
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As fuel costs go up, operating expenses for transit agencies and other travel providers go up too. Fuel cost impacts service providers as it does individuals and can constrain transportation service availability when it is needed most. Providers relying on multi-year operating grants likely didn’t budget for the recent surge in fuel costs associated with Middle East conflicts
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Complicated reimbursement rates for certain grants mean that some non-profit providers are reimbursed only for the part of a demand-response trip when the passenger is physically in the vehicle. They are not reimbursed for agency expenses incurred while picking up the passenger, waiting for them to complete their treatment, or returning to base after dropping the passenger back home. In a region where people routinely travel over 50 miles one-way for health services, these ineligible expenses can render such service unaffordable for the provider and thus make it unavailable to those who need it most.
Some Places Are Simply More Accessible Than Others
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Sometimes agencies receive requests for on-demand door-to-door service or ADA-accessible paratransit service that can’t be accommodated because people live on narrow, unimproved or primitive roads that a wheelchair-lift equipped vehicle can’t navigate or which has no place for a vehicle to turn around. People often overestimate the accessibility of their rural property. By the time they need mobility support, they may not have the capacity to address the issues.
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How our communities are built – how they develop and where - directly impacts the mobility choices individuals have and the ability of transportation providers to offer convenient, reliable services when and where it’s needed. This will always be true. Land may be cheaper there but when senior housing, social services, and health care facilities are located on the outskirts of town or in outlying areas, it is much harder to help people get where they need to be when they need support than it is when they are centrally located in town.
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It is vitally important that we not lose the health and human services we have locally and wherever possible, that our communities can grow those services over time. We are already challenged to provide all of the out-of-county and long-distance travel assistance people need today to access necessary health services. Any further erosion of local services will only exacerbate that condition, making it harder for more people to access the care they need. In this regard, the availability of local health care resources is a regional transportation concern.
These are some of the challenges our transportation partners navigate with every service hour and passenger trip they provide, and they do a good job at it. There’s a lot being done now to make sure people can get where they need to be, whether or not they drive, but maybe we can do more. We're trying to be smart in how we approach rural transportation services and doing what we can to foster a strong and resilient mobility network. Read on to learn about strategies that can help us preserve the services we have today and make them even better for residents of Okanogan County.
This information can be found in Chapter 4 of the 2026 Human Services Transportation Plan report