October 12, 2013

Vermont avoided Medicaid transportation problems occurring in Maine

Maine lawmakers say the state should use Vermont as a model for a new system.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

Maine could have avoided the rampant problems it has had with its non-emergency medical transportation system for Medicaid recipients by looking to Vermont, critics say.

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Sheena Patel, 27, is dropped off at her South Portland home by an RTP bus after her day at “Affinity,” an outpatient rehabilitation facility in Portland.

John Ewing / Staff Photographer

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But Maine officials say they have no plans to switch to a system similar to Vermont’s, even though that’s possisble if service problems persist.

Vermont, like Maine, recently revised its Medicaid transportation system to satisfy federal requirements. But unlike Maine, Vermont maintained a system of local nonprofits to provide rides to low-income residents who have no other transportation. Vermont officials say the changes have generated hardly any complaints.

Maine hired contractors to coordinate rides, but not provide them, in a regional system that started Aug. 1. The result has been thousands of complaints about disjointed service and patients missing rides to medical appointments.

“We all look at the problems in Maine and say, ‘We really did the right thing,’ ” said Jim Moulton, chairman of the Vermont Public Transit Association.

Moulton helped state officials craft Vermont’s system, which started a year before Maine’s. He said Vermont considered a system more like what Maine ended up with, but ultimately decided to keep its local nonprofits operating the service.

Some Maine lawmakers say the state should switch to a Vermont-style system to extract itself from the mess that began Aug. 1, when two out-of-state companies started arranging rides for low-income patients across Maine.

“Vermont is exactly the model we should be using,” said Rep. Richard Farnsworth, D-Portland, House chair of the Legislature’s Health and Human Services Committee. “I’m not sure why (the Department of Health and Human Services) is being so stubborn about it. The only thing I can think of is, they made a decision and they can’t admit that they were wrong.”

Rep. Peggy Rotundo, D-Lewiston, said she has heard that Vermont’s system works well, and Maine should be looking at what that state is doing.

But Maine officials reiterated Friday that they are committed to the system they devised to comply with federal rules for accountability and transparency.

“We believe in the model,” said Stephanie Nadeau, director of MaineCare services, the state’s version of Medicaid.

Nadeau said about 20 states have systems similar to Maine’s and many work without major problems.

“We are seeing movement in the right direction,” she said, but Maine is in contact with Vermont officials, whose system could inspire some adjustments without a move to scrap the regional system.

“We are looking at any and all opportunities to improve on the delivery system that we have today,” Nadeau said.

One possibility is canceling the contracts with the companies that Maine hired to arrange the rides.

The contracts can be canceled for any reason, and the company that now arranges rides in most of Maine, Connecticut-based Coordinated Transportation Solutions, is on the equivalent of probation for subpar performance. The state has given the company until Dec. 1 to fix service problems, including missed rides and long wait times for people who call to arrange transportation.

But Nadeau said the state intends to keep its system, even if it cancels contracts.

The way states deliver such services is crucial to public health and to controlling medical costs, said Paul Hughes-Cromwick, senior health economist at the Michigan-based Altarum Institute, who studies non-emergency medical transportation.

“The evidence is unequivocal. You get a good value for what you’re spending,” he said. “When these folks have access to their appointments, what you’re really doing is offsetting a huge expense down the road. When you take it away, all hell can break loose.”

He said the people who are served by the transportation system can’t access health care if they can’t get to it.

(Continued on page 2)

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