Thursday, April 24, 2014
While complaints continue about MaineCare's new non-emergency transportation system, some are questioning why the system had to be revamped.
Rebecca Lee gets a ride home from her father from the Goodwill Neurorehab Services at Bayside after her regular MaineCare-funded ride failed to show because of a "medical emergency" on Wednesday, Aug. 7, 2013.
Gordon Chibroski / Staff Photographer
Why did the state dramatically alter a system that, by most accounts, worked well for decades, giving rides to MaineCare recipients who needed them for doctor's appointments, therapy and developmental classes?
"If it ain't broke, don't fix it," said Rep. Richard Farnsworth, D-Portland, co-chairman of the Legislature's Health and Human Services Committee. The committee is scheduled to meet with agency officials next month to discuss the problems.
The state has received hundreds of complaints about missed rides and other snafus since Aug. 1, when two out-of-state companies replaced local providers in coordinating rides.
One of those companies acknowledged problems with the service Thursday and said it was hiring more people to improve its performance.
State officials say money isn't the reason the change was needed – it was a matter of complying with billing requirements by the U.S. Centers for Medicare and Medicaid, which funds the transportation program through MaineCare, the state's Medicaid program.
Maine could have kept its existing transportation system, but it would have lost out on $6.1 million a year in federal reimbursement for the program, Stefanie Nadeau, Maine's director of MaineCare services, said at a meeting of Farnsworth's committee in March.
The $40 million transportation program serves about 45,000 Maine residents.
"This effort was not about cost avoidance," Department of Health and Human Services spokesman John Martins wrote in an email to the Portland Press Herald. "It was about delivering services in a way that was compliant with federal requirements."
Farnsworth said Thursday that, in the spring, money concerns seemed to be the primary reason to go to the new system. He said he and other legislators were skeptical that the system would work well, and the state did have the option of keeping its system of local providers.
The new system separates ride brokers from ride providers, on the theory that doing both jobs raises the potential for conflict of interest.
Two out-of-state companies won ride brokering contracts covering most of the state, except for the Bangor area. Coordinated Transportation Solutions of Connecticut arranges rides under six separate one-year contracts, totaling $28.3 million, and LogistiCare of Atlanta won a $5.1 million broker contract for York County.
"I had concerns that this was injecting an additional layer of bureaucracy that it didn't really need," Farnsworth said.
The Legislature's Appropriations Committee will take up the issue next week, and Farnsworth's committee will look at the problems in September.
During the committee meeting in March, Sen. Ron Collins, R-Wells, pointed out problems with LogistiCare in other states and raised concerns about adding a layer of bureaucracy.
"We had a network throughout the state of Maine that seemed to be working well," Collins said Thursday.
Martins said that paying a flat fee to ride brokers such as Coordinated Transportation Solutions and LogistiCare, instead of a paying a fee for each ride, gives the state and federal governments more cost certainty, and the companies take more financial risk.
State and company officials have been working to solve the problems.
David White, president of Coordinated Transportation Solutions, a not-for-profit company, issued a statement Thursday acknowledging some startup problems, and said it is working to add seven employees to its 40-worker call center in Lewiston.
"We have experienced problems with member pickups that have caused some members to miss appointments or be delayed in getting to or picked up from their appointments," White wrote, explaining that the call center has experienced "much higher call volumes and wait times" during the startup period. "This has made it difficult for members to reach our customer service representatives in a timely manner."
LogistiCare denied Wednesday that there were major problems in York County, claiming 99.7 percent of scheduled trips were made without complaints.
But Collins noted reports of problems with LogistiCare -- a for-profit company that operates in 43 states -- in Missouri, Michigan, Mississippi and Wisconsin.
And Pam Lee of Kennebunkport, whose 27-year-old daughter needs the program for rides to neurological appointments in Portland, told the Press Herald that she has heard from many parents and patients in York County who have had problems.
Jack DeBeradinis, president of the Portland-based Regional Transportation Program, used to arrange rides in Cumberland County but is now making budget cuts and layoffs.
Even though state officials allowed his program to bid to remain a broker, it would have had to make sure that 75 percent of the rides were provided by another agency. So the Regional Transportation Program would have lost business in either situation, and DeBeradinis said the greater risk of being a broker under the new rules wasn't worth it.
DeBeradinis was left with two unappealing choices -- forgo the state contract and give up nearly $3 million a year in federal money, or potentially go out of business. He chose the painful budget cuts -- his agency is laying off four employees and did not fill four vacant positions -- to stay in business.
"Our budget is about half of what it used to be" before Aug. 1, he said.
DeBeradinis said, though, that the problems with the rides may be temporary. "I do believe that (Coordinated Transportation Solutions) is trying," he said.
Penquis, a community agency in Bangor, navigated the new rules and successfully bid on a $7 million annual contract, said Charles Newton, chief executive officer. Bangor is the only region in Maine that kept its local provider for the program.
"It's been going pretty well," Newton said. "For us, Aug. 1 wasn't much different than July 31."
Newton said the problems in the rest of the state may just be growing pains that will be resolved soon.
Courtney Jenkins, a spokeswoman for the U.S. Centers for Medicare and Medicaid, said her agency is monitoring the situation but believes it will improve.
"We believe it will begin to run smoothly soon," Jenkins said. "We want the state to work through the framework that they've chosen."
Joe Lawlor can be contacted at 791-6376 or at: