Transportation nonprofit closes, leaves hundreds without reliable rides to medical appointments

By Catherine Keightley 

Valley Area Stretcher Transport closed last month, impacting hundreds of residents in the Rockbridge area who rely on non-emergency medical transportation to dialysis treatment, hospital discharges and other medical appointments.  

VAST was a nonprofit that provided transportation for patients unable to sit upright safely. The service stopped operations on Feb. 14 after a sharp decline linked to credentialing challenges and the bankruptcy of a third-party broker that connected the organization to riders, according to former director Michelle Watkins.

Tasha Walsh, CEO of Connections Plus Healthcare and Hospice, said the closure has made transportation more costly for some patients, forcing them to rely on emergency services.  

“What happens is people end up calling 911, and emergency management will get them,” she said. “They’ll end up in the emergency room, which is often very unnecessary, very costly and very stressful for the person.” 

Patients face higher transportation costs

Walsh also said patients are now facing higher transportation costs.  

“It’s costing more because we’re using private companies that charge more than VAST,” she said.  

In Virginia, services that transport patients using Medicaid are managed through private brokers contracted by the state’s Department of Medical Assistance Services. Transportation providers must be credentialed with these brokers to receive ride assignments. 

VAST relied on these third-party brokers to coordinate rides, instead of having patients or their insurance companies contact VAST directly. They assigned transportation requests and handled payment for VAST’s Medicaid-covered trips.  

Last summer, one of the major brokers that coordinated transportation for multiple different Medicaid insurance plans filed for bankruptcy and reorganized, disrupting that system. As the insurance companies shifted to new brokers, VAST had to go through a credentialing process before it could receive ride requests and accept Medicaid payments again.  

Watkins said the group expected the process to only take a few weeks but instead lasted more than five months. The organization was unable to drive a significant portion of its patients during that time because about 90% of VAST’s former riders use Medicaid.  

The disruption led to a sharp decline in rides, about a 75% drop from December 2025 to January, which cut off an essential source of revenue. VAST lost the revenue because it could not transport patients whose insurance plans were tied to brokers it was not yet credentialed with.  

“VAST just financially was still very vulnerable as a young organization and not able to withstand that loss,” Watkins said.  

VAST began operation in January 2025 to help transport patients who could not safely travel in a wheelchair or standard vehicle, she said. The service gave 412 rides to 260 people during its time in operation.  

Before VAST launched, many of these patients had to rely on out-of-town providers or costly ambulance rides for non-emergency care, Watkins said, options that were often either too expensive or unreliable. 

Transportation services farther away

Now, patients again must turn to providers outside the county like Kiwi Emergency Medical Services in Buena Vista, Brittany’s Transit Services in Louisa, or Miller’s Transportation Services in Big Island.  

But longer travel distances can increase delays, particularly for patients with tightly scheduled treatments like dialysis.  

“Now that we’re not able to operate, there is an increased chance that they may be late to some appointments, not intentionally, but just because the service providers are so far out of town,” Watkins said. 

Public transportation options in Rockbridge County are also limited. The Maury River Express, the region’s only bus system, drives on a fixed route through Lexington and Buena Vista, with designated stops only. The riders pay a small fee. This leaves many rural areas without access because it cannot provide door-to-door service or stretcher transport.

Patients rely on RATS

Rockbridge Area Transportation Service is the county’s only locally based non-emergency medical transport provider, serving elderly and disabled residents. It accepts insurance, including Medicaid, and private payments. 

In 2025, RATS provided more than 20,000 rides, with demand remaining steady throughout the year. More than three-quarters of its rides are insured by Medicaid, according to RATS Executive Director Stephanie RiCharde, with the rest paid privately through veteran benefits. 

RiCharde said the third-party brokers are becoming difficult for providers to navigate. 

“We and the clients are at the mercy of these companies,” RiCharde said. “That’s not an easy process for any of us to navigate.” 

Recent changes have affected her organization, she said. RATS lost several riders after United Healthcare switched transportation brokers without notifying them, leaving at least five regular patients without service, according to RiCharde. More riders may be affected, but because the trips are assigned by these third-party brokers, RATS cannot fully track the impact. 

“We don’t really know who’s transporting them, or if they are even getting rides,” RiCharde said. “We’ve lost five regular riders, but I’m sure we’ve lost more sporadic riders.”  

RiCharde said the county’s transportation system can be especially challenging for vulnerable populations, including people with disabilities who rely on consistent routines and familiar drivers.  

“They can’t choose who provides their rides,” she said. “Their choice is not part of the system.” 

The people most affected by these gaps are often those with the fewest alternative options, including adults 65 and older or people with physical or mental disabilities, according to RiCharde. Many are also low-income which makes private, costly transportation options unrealistic.  

Beth Henry, a secretary at Carilion Clinic General Surgery, said patients who cannot drive themselves often have limited options. Even though she has only seen one or two patients use VAST, she said the gap it leaves is significant.  

 “If a patient has procedure at the hospital and cannot drive themselves home, there is no transportation for them,” Henry said.  

While that is the case for people who are stretcher bound, RiCharde said, RATS remains an available option for people who are walking or using a wheelchair.

“They were only transporting people who had to be transported laying down,” she said of VAST. “And we only do people who are ambulatory or in a wheelchair.”