Rockingham County commissioners spent the bulk of their Oct. 30 meeting probing options to keep a transportation pilot serving adult medical day care participants operating after the program's grant sunset.

The county's staff presentation described Silverthorn (the local Easterseals adult medical day care operator) as seeking $88,000 a year to maintain a transportation component; staff said Silverthorn asked the county to provide $44,000 to cover January through June 2026. "They're looking for $44,000, to cover the cost of the 2 drivers that will... since the program sunsets in January," a staff member said during the meeting.

The proposal discussed at the meeting would also institute a modest participant fee, with Silverthorn proposing to charge service users $10 to $15 per ride to offset program costs. Commissioners and staff cautioned that even small co-pays could create a barrier for some residents. "$10 a ride doesn't sound like a lot, but... $10 a ride twice a day, 2 to 4 times per week, there's going to likely be people that still aren't gonna be able to afford that," said a commissioner during the discussion.

Commissioners raised three principal concerns: (1) How to sustain the service beyond June 2026 without destabilizing other county-funded programs; (2) whether clients whose Medicaid eligibility is "pending" would be able to continue attending day services if the pilot ends; and (3) whether a modest rider fee would effectively exclude the lowest-income participants.

Board members proposed several next steps rather than taking immediate final action: invite Silverthorn to the next meeting to answer specific questions about funding sources and participant eligibility; ask Silverthorn to identify alternative revenue (grants, fundraisers or philanthropic support) to reduce reliance on county funding; and request staff provide a targeted breakdown showing which participants rely on transportation services and which are Medicaid-approved, pending or uninsured.

Commissioners also asked staff to prepare an analysis that models potential taxpayer cost savings from preventing or delaying institutional long-term care admissions, to help quantify the pilot's return on investment. Several commissioners said they would be willing to provide a partial six-month allocation now but repeated the preference that Silverthorn demonstrate a sustainable plan before the board commits beyond June.

The board scheduled Silverthorn for a follow-up appearance next week to answer clarifying questions and supply requested program-level details. No final funding vote was taken at the Oct. 30 meeting.

Ending: County staff will provide commissioners with participant-level transportation usage data and an estimate of potential Medicaid reimbursement options; Silverthorn will be invited back to answer funding and eligibility questions at the next meeting.