People on Medicaid in North Carolina who have no way to get doctor’s offices have for years relied on counties to coordinate their trips. The state is considering handing that job over to a private broker, but local officials and advocates for older people worry the change will result in fewer rides for people with disabilities and the elderly.
The counties coordinate van runs that take Medicaid patients to doctor’s appointments, older people to senior centers for meals, and people with disabilities or those trying to get off welfare to their jobs. These non-medical trips are supported by a variety of grants. Putting a Medicaid recipient on van with a person with a disability going to work or an older person headed to a senior center helps keep costs low, public transit officials said.
“Our senior clients use our program to go to the doctor under Medicaid; on the way home they may stop and go to the grocery store under a DOT grant, said Don Willis, transportation manager for Wake County. “They call one place. It keeps the costs under control.”
The state has asked private companies to bid on the work counties now do coordinating trips for Medicaid patients, saying that a broker will save money and make it easier for the state to monitor the system. A agreement with a broker would mean that Medicaid and non-Medicaid trips could not be combined.
The deadline for companies’ bids is Dec. 18.
Using a broker will save the state money, said State Rep. Nelson Dollar, a Cary Republican. And information on riders collected in one place will allow for easier identification of people misusing the system, he said.
Most states use brokers to coordinate some or all of their Medicaid transportation services, Dollar said, and that’s led to savings.
“We’re looking for all the opportunities we can to have a more efficient system, to give people the service they need and save dollars we need to save in the Medicaid program,” he said.
Opponents of the move say loss of the ability to combine Medicaid trips with those funded by the state transportation department and other source will bring higher costs overall.
‘It really has us worried’
The state Department of Health and Human Services declined to make someone available to talk about hiring a broker. Officials did not want to be interviewed while companies are bidding on the job, said Chrissy Pearson, senior adviser to the acting agency secretary.
The federal government found problems with state oversight in 2008 and 2011 in reviews that found people were taking trips who were not eligible for travel and that people who asked for help were not being notified when their requests were denied.
But the prospect of ripping Medicaid travel – and its $54 million in government reimbursements – from the coordinated system has counties, advocates for the elderly, and public transportation officials worried that remaining services will be left weaker and less able to meet travel needs.
About 92,000 people used non-emergency Medicaid transportation last year.
Many older people rely on government vans to get to senior centers for meals, to medical appointments and to grocery stores in trips paid with grant money, said Joan Pellettier, director of the Triangle J Area Agency on Aging. Without Medicaid in the mix, the public transportation systems become less efficient, has less money, and will likely serve fewer older riders, she said.
“It really has us worried,” she said.
Letters to state agency heath and human services and transportation chiefs from county managers and public transit officials talk about fewer rides for travelers, higher costs for counties, and increased fares for clients if Medicaid trips are coordinated by a broker. For example, Rutherford County officials said that Medicaid transportation accounts for 38 percent of county transit trips, but provides nearly half the money and allows the system to run at no cost to the county. Having a broker-run Medicaid transportation could result in lost staff jobs and the need for local money to support the transit system.
Linda Wallace, executive director of the Public Transportation Association, said she worked with a group to solve the problems found in the federal reviews and that counties have improved.
‘To nobody’s advantage’
Though other states have brokers, they don’t all have coordinated transportation systems that are recognized as among the best in the country, Wallace said.
She maintained that the state was moving toward a broker without having done the proper background work. She pointed to the numerous questions about the work from potential bidders that the state could not answer.
Making a change too quickly and without throughout analysis “is not to anybody’s advantage,” she said.
For an October report to legislators, DHHS officials talked to Wisconsin officials about the best ways to run a system and what should be required of brokers. But a few weeks ago, the company that provided Medicaid transportation for Wisconsin, LogistiCare, was let out of its contract. According to the Associated Press, the state’s Department of Health Services released a statement saying the company didn’t have enough information to submit a reasonable cost estimate.
John Bode, a lobbyist for LogistiCare in North Carolina, expects at least six companies will bid for the job here. Bode worked on getting the legislature to find and hire a broker, but said he wasn’t the only one.
“About seven or eight different people have been working on that project,” he said.
The state could be in jeopardy of having to return money to the federal government for persistent Medicaid transportation problems, he said. And with the Medicaid program likely to grow under the new federal health care law, Bode said, it makes sense to have one transportation coordinator rather than 100.
“I believe that in the long term, we’re all going to be better off if we have a statewide system,” he said. “It really is a function of getting it up and getting it going.”
Staff writer Thomas Goldsmith contributed.