State Rep. Richard Farnsworth said he now doubts that the state needed to do the MaineCare ride program overhaul that has led to numerous complaints, based on comments made Monday to the Portland Press Herald by a national Medicaid expert.
“Did we really need to go down this road?” said Farnsworth, D-Portland.
The program gives free rides to low-income Mainers for doctor’s appointments, therapy and classes. Since the new system started Aug. 1, patients have flooded the state and news media with hundreds of complaints of missed rides to doctor’s appointments, therapy and classes.
Although she didn’t have direct knowledge of Maine’s problems, Kathleen Nolan — director of state policy and programs for the National Association of Medicaid Directors in Washington, D.C. — said the federal government would not have forced Maine to revamp its ride system under MaineCare, the state’s Medicaid program.
State officials have said previously that the system was changed primarily to comply with Medicaid requirements, after the U.S. Centers for Medicare and Medicaid Services informed the state that it was “not compliant” with regulations. Maine Department of Health and Human Services officials were not immediately available for comment Monday afternoon.
Hazel Clarke, a senior citizen from Westbrook who has Tourette’s syndrome, is one of many customers unhappy with the changes. She said she has been unable to arrange a ride to doctor’s appointments under the new system.
“I’ve been put on hold for hours and I can never get through,” Clarke said, referring to the new regional ride brokers. “I need to go to my appointments or I could pass out.”
Patients have told the Press Herald that there were few problems with the previous system, run by local nonprofit groups.
But Maine’s decision to switch to national companies to broker rides in most of the state would not have been mandated, Nolan said. Coordinated Transportation Solutions of Connecticut won a $28.3 million contract with the state of Maine, and Atlanta-based LogistiCare secured a $5.1 million state contract.
“The states have flexibility. There are a lot of different ways the states provide this service. There’s a lot of variety,” Nolan said.
Meanwhile, local agencies that previously brokered rides have lost business, and the Portland-based Regional Transportation Program has had to lay off workers. RTP and other local nonprofits still provide some rides, but no longer coordinate them.
Furthermore, the state could have altered the system in a less comprehensive manner and still received the higher federal reimbursement rate it was seeking, Nolan said. The higher reimbursement rate — which is based on the use of regional brokers — is worth $6.1 million to state coffers, Maine DHHS officials have said. But they told the Press Herald last week that money was not the motivation for the change — rather, it was the need to comply with Medicaid requirements.
Nolan said some states contract with local agencies for the broker service, and there’s no requirement to go to a regional broker system to receive the higher reimbursement rate. In Pennsylvania, for instance, each county is responsible for providing the service.
Nolan said the key to the higher reimbursement — from the federal government’s perspective — is for the state to sign contracts with ride providers and brokers that the state can then hold accountable for performance standards.
Under the previous system, agencies that coordinated and provided rides, such as RTP in Cumberland County and York County Community Action Agency, did not sign contracts with the state.
The lack of contracts precluded the state from receiving the higher reimbursement rate for services, Nolan said.
Jack DeBeradinis, executive director of Portland’s RTP, said he would have strongly considered a more formal agreement with the state had a reasonable contract been available to sign. DeBeradinis said that although RTP could have bid on the broker contract, the state’s rules for bidding were counterproductive for a local agency to comply with, especially a requirement that 75 percent of the rides coordinated had to be doled out to other agencies.
The 75 percent rule was not mandated by the federal government, state officials confirmed last week, but was intended to comply with the spirit of Medicaid’s conflict-of-interest concerns.
John Martins, a spokesman for Maine DHHS, said last week that the federal government was concerned about the same agency being the ride broker and the ride provider, and that doing both jobs would be a conflict of interest.
Meanwhile, DeBeradinis said that complaints have not let up. State and company officials have compared the problems to logistical issues that plague many startup operations.
“I don’t see an immediate resolution,” DeBeradinis said. “We’re not seeing any significant improvements yet.”
As for what can be done now, Farnsworth said he believes the best the state can do is revisit the system for next year. The companies are operating under one-year contracts, although the state can terminate the agreements.