Paper bus tickets are no more, a move the Transit Authority of River City says is intended to align Louisville with many other cities and bring the public transit system into the electronic age. But while the move has streamlined travel for many TARC users, it’s also forced area nonprofits serving people with low-incomes to change how they do business.

In the past, many health providers would give patients paper TARC tickets to help them get to and from medical appointments. Studies have found a lack of transportation is one of the biggest barriers to health care access for patients with low-incomes.

The majority of clients who go to Bridgehaven Mental Health Services use the bus to get to and from group and individual therapy sessions every day. And until this month, the health provider would give out two paper tickets to every client — one for the bus ride home, and one to come back for therapy.

Besides making sure clients have a way to come back, Bridgehaven Chief Operating Officer Stewart Bridgman said using the tickets helps them build life skills.

“And that is helping them with that everyday functioning of getting in a routine — doing those kind of things is actually helping their brain develop that organization and work on executive functioning,” Bridgman said. “Mental illness causes a disability because of executive functioning, and executive functioning is part of our brain that helps us organize our day.”

But as of Jan. 7, TARC replaced those paper tickets with a smartcard, similar to a credit card, which bus riders buy pre-loaded for $5. Transit officials says it’s easy to use this card — just a simple tap to board the bus. Plus, loading more money to the card can now be done online. But Bridgman is anticipating the transition may not be so easy for his clients.

“It’s easy for me to say, I just want to get one card that belongs to me — that’s something that makes it easy for the working person,” Bridgman said. “But for our members with organization problems, its how do they keep up with their card, how do you differentiate a card with value and a card that doesn’t have value.”

Ferdinand L. Risco Jr., the interim executive director of TARC, said the agency knows there are people that will need help during the transition.

“With any technological advance, we want to make sure we’re not leaving anyone behind,” Risco said. “But all in all, the ability to manage the account is extremely easy.”

Bridgehaven is part of a partner program with TARC. The mental health provider worked out a deal to have special cards made that are pre-loaded with two rides for clients. Risco said any nonprofit can apply to be a partner with TARC and receive similar benefits.

Shane Lindsay has used that two-way card for his trips to and from Bridgehaven, where he gets treatment for post-traumatic stress disorder and borderline personality disorder. He said it’s pretty easy to use. But he can see how others at Bridgehaven that have mental conditions associated with cognitive challenges — like paranoid schizophrenia — could have a harder time.

“Sometimes you have to be very patient with that person and just keep explaining it until they get it, which is what you have to do with people who have cognitive issues,” Lindsay said.

Even people who don’t have cognitive issues might face challenges with the new TARC card. Lindsay said though he hasn’t had difficulty using Bridgehaven’s two-way pass, he will likely have difficulty at least initially buying the new TARC card to get to other doctor’s appointments. He used to buy one-way paper tickets for about $1.75 to get to his primary care doctor near the University of Louisville. A one-way fare still costs the same — but now Lindsay would either need exact change, or $5 to get that first TARC card.

“With a fixed income, that’s kind of hard. Most of my income goes to utility companies — water, electric,” Lindsay said.

At the moment, he said wouldn’t be able to afford to buy the $5 pre-loaded card.

“I would be owing some friends — that’s a detail I didn’t even know.”

At Shawnee Christian Healthcare Center, staff routinely handed out paper tickets to patients who needed to get home and didn’t have money to use the bus, or for patients who were referred from their office to a specialist. One-third of Shawnee patients have an income below the poverty level, according to Anne Peak, the director of patient and community engagement.

“We know that transportation is one of the most common reasons that people miss their medical appointments,” Peak said, adding that about a quarter of Shawnee patients don’t have access to a car.

Peak said Shawnee isn’t part of TARC’s partner program and doesn’t have access to those pre-loaded cards. Instead, patients there will have to buy their own five dollar TARC cards. Peak said Shawnee is looking at using Uber and other ride-sharing apps to help people get home when possible.

“Five dollars between you and me doesn’t sound like a really big deal,” Peak said. “But when you have people who are trying to figure out how to keep their lights on, how to keep their water running, how to get food on the table, transportation can sometimes fall by the wayside.”

TARC director Risco said the agency isn’t trying to leave anyone behind. Riders can now load money onto their TARC cards online and even on the bus where there is Wi-Fi. Risco also said TARC will transfer any money from a lost or stolen TARC card onto a new one for registered users.

Bridgehaven’s Bridgman said he recognizes those are positive steps — it’s just that the changes might have some unintended consequences for some who use TARC.

“They [patients] have to understand that this is part of the 20th century — you have a food stamp card, sometimes they have security cards for their buildings,” Bridgman said. “But it’s a process. And those people that struggle with that, it just complicates the system for us a little bit.”