AUGUSTA — The director of Maine’s Medicaid program told lawmakers Wednesday that her agency is working “day and night” to fix ongoing problems in the program that provides rides to medical appointments for poor and disabled Mainers.
Stefanie Nadeau, director of MaineCare Services for the Department of Health and Human Services, also acknowledged that clients may be abandoning a system that has provided poor service since it started Aug. 1. Nadeau said the state hopes to persuade those users to return, but is reluctant to try until officials are confident that the system is working as intended.
Lawmakers and patients’ advocates continued to question whether the newer – and so far more expensive – rides system will ever work as well as the system it replaced.
Wednesday’s briefing before the Legislature’s Appropriations Committee was the latest update in a saga that started when the state changed its rides program from one in which local agencies arranged and provided rides for Medicaid recipients to one run by regional ride brokers.
Three brokers have one-year contracts worth a total of more than $40 million, but the system has drawn thousands of complaints and left thousands of poor and disabled Mainers without rides to and from appointments.
And Maine taxpayers are paying more for the service than they were last year, although it’s unclear why that’s the case.
A document provided by the Legislature’s nonpartisan Office of Fiscal and Program Review showed that the state paid over $400,000 more for MaineCare rides in the first four months of this fiscal year (through October) than it did in the same period last year.
Some of the $13 million spent in this fiscal year was for final payments to the 22 transportation providers that ran the rides system before Aug. 1. But most of it – $8.6 million – went to the three brokers, Atlanta-based LogistiCare, Connecticut-based Coordinated Transportation Services and the Maine nonprofit Penquis. Those brokers self-reported more than 7,700 missed trips from Aug. 1 to Oct. 5.
Transportation providers and advocates for patients say the higher cost has come with fewer rides and more administrative and staffing burdens for health care providers, some of whom have reported arranging rides themselves because the broker system has failed.
Maine pays the contractors the same amount regardless of how many rides they arrange. DHHS officials note that the contracts include performance standards that authorize the state to cancel contracts at any time.
TOO SOON TO REVERSE COURSE
Nadeau provided data Wednesday showing that missed trips are declining and wait and response times are getting shorter. However, she acknowledged that problems persist. Her testimony left several lawmakers questioning how long the state will stay with the system.
“What will it take to push the department to the brink?” asked Sen. Patrick Flood, R-Winthrop.
Nadeau said that’s a difficult question, with the performance metrics “moving in the right direction.” She said the state must see how well the broker system will work before making any drastic changes that could further disrupt service.
“None of us (in the department) will sit here … and say that any of this is an acceptable level of service,” Nadeau said. She said she has diverted DHHS staff members to work with ride brokers and providers to improve the system.
Advocates, transportation providers and some legislators have said the state has been too lenient with the brokers. Patient advocates have said the state is overly reliant on data showing decreased complaints that doesn’t capture the breadth of the program’s failures.
SOME OPTING OUT IN FRUSTRATION
In October, Daniel Donovan, executive director of the Aroostook Regional Transportation System, told the Legislature’s Health and Human Services Committee that the decrease in the number of complaints did not include people who had abandoned the program in frustration.
Donovan told lawmakers that his organization provided 9,762 rides to low-income patients in September, after giving 16,192 rides in September 2012.
The 6,400-ride drop-off wasn’t unique among Donovan’s colleagues, several of whom reported significant decreases in rides provided. Rick McCarthy, a lobbyist for the Maine Transportation Association, the trade group for ride providers, told the committee that the state should move to cancel contracts.
Multiple reports have shown a flawed system and accountability failures. Last month, the Portland Press Herald reported that Coordinated Transportation Solutions vastly underreported the number of complaints it received in the first month of its $28.3 million contract.
Limiting service complaints is a key requirement of the contracts, but the agreements leave a low bar for compliance. The contracts say complaints must be below 1 percent of the number of patients who are eligible for MaineCare rides, rather than 1 percent of those who use the system.
About 279,000 people statewide, including 205,000 in Coordinated Transportation Solutions’ service area, are eligible for MaineCare rides, but only about 45,000 use the service. That means CTS could report 2,000 complaints per month and still meet the performance standard.
Data provided by DHHS shows weekly fluctuations that don’t support the claims of steady service improvement. On one hand, CTS reported missing 505 rides in the week ending Oct. 5, about one-third of the 1,537 missed rides it reported in the first week of August.
However, there are multiple weeks when missed rides were actually less than the week ending Oct. 5. For example, CTS reported 332 missed rides in the last week in August and 551 missed rides in the week ending Sept. 28.
LEGISLATORS LOSING PATIENCE
The DHHS drafted the performance standards. Officials say there was no reporting system or standard for missed rides in the previous system. Transportation providers simply billed for their services.
The DHHS switched to the program run by ride brokers to address federal concerns that the system in which local agencies arranged and provided rides lacked accountability and transparency.
Mary Lou Dyer, managing director for the Maine Association for Community Service Providers, said the previous system may have lacked transparency, but it worked.
She told lawmakers Wednesday that she has little hope that the new system will work. She cited 16 new complaints from medical providers in the past 10 days, ranging from missed or delayed rides, to people dropping out of the system, to unpaid reimbursement of transportation providers. In one case, a preschool student who needs a gait trainer to walk showed up at school without it because it wouldn’t fit in the driver’s vehicle.
“I’m very pessimistic about this system,” Dyer said. She added in written testimony that her organization questions how state officials “can call this a system when so many extraordinary measures must be taken to accomplish what six months ago happened with few or no glitches.”
Several lawmakers were equally impatient. Rep. Peggy Rotundo, D-Lewiston, said she gets multiple complaints every week.
The Legislature may seek an alternative. Sen. Colleen Lachowicz, D-Waterville, has submitted a bill that would review the rides system and potentially replace it with the previous one.
“People were happier with the old system,” Lachowicz said in a recent media statement. “We’ve given this new system a chance to work and it’s not working. There’s no more ‘wait and see,’ now is the time to fix it.”
Steve Mistler can be contacted at 791-6345 or at: