Wednesday, April 23, 2014
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.
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