Background President Trump's proposed Fiscal Year 2019 budget would make provision of Non-Emergency Medical Transportation through the Medicaid program optional. The Trump administration has granted waivers to Indiana, Kentucky and Iowa, allowing them to deny rides to non-disabled adults trying to access medical appointments. These adults likely include people with hypertension and diabetes in danger of kidney failure, asthma patients, and potentially people with tuberculosis. Health Care is a human service program. Luckily, the means by which people can be mobile and access health care are being transformed at near-warp speed. I’ll be speaking from nearly 40 years of experience planning, developing and overseeing public and human service agency demand-response transportation services and fixed-route bus operations; proposing and serving as a panel member on Transit Cooperative Research Program projects; and past board service for a center for independent living and a long term care coordinating council. Methods Transit has progressed from fixed-route fixed-stop train and bus services, dial-a-ride, scheduled standing-order, taxi and volunteer-based services to app-based exclusive-ride and shared-ride connections, bike-sharing, car-sharing, and scooters. Market segmentation and community engagement best practices enable transportation providers to offer services and information that will be absorbed and used. I’ll provide insight into mobility customers, the wide array of agencies and regulations subsidizing rides, and discuss a comprehensive community engagement program that leads to effective marketing. Technology is being transformed on several fronts beyond assigning rides to vehicles: mobile platforms for information and fare payment; pipelines to exchange structured data between mobility partners; and accounting and reporting software to support rideshare as well as service evaluation. With this presentation, I’ll describe the current spectrum of transit services, near to mid-term mobility enhancements under development, and promote a structure to sustainably provide mobility. Results Results and Trends are temporary. Transit ridership in the Washington DC metropolitan area and in much of the country has been declining substantially in the past few years. Uber, Lyft and similar services now provide almost the same number of rides as transit, though all require substantial subsidies. I look forward to a bounce-back as partnerships are developed and refined to enable each provider to efficiently and sustainable focus on fully-accessible market segments within a cooperatively coordinated structure. Conclusions Technology advances combined with basic transportation economics and adherence to civil rights laws, will steer transportation providers into offering cooperatively coordinated accessible mobility network. I’ll close with a list of resources.