January 17

Reform of troubled MaineCare ride system on horizon

DHHS officials and nonprofit agencies say a change to a key contract rule could help end the months of missed medical appointments.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

AUGUSTA — MaineCare’s troubled rides system, which has caused thousands of patients to miss medical appointments over the course of nearly six months, could soon be fixed, lawmakers said Thursday, if upcoming talks between the Department of Health and Human Services and local transportation providers prove fruitful.

click image to enlarge

Stefanie Nadeau, head of MaineCare Services, says the potential ride system solution could be done without law changes or getting a federal OK.

Andy Molloy/2013 Kennebec Journal file

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Cindy Dow is lifted into a KV CAP bus in October at her Augusta home for a ride to a medical appointment. The troubled MaineCare rides system could be on the brink of a solution, lawmakers said.

2013 Kennebec Journal File Photo/Andy Molloy

During a legislative committee meeting on a bill that would scrap the current system and replace it with a program similar to Vermont’s, DHHS officials and representatives of nonprofit transportation agencies appeared to find common ground on a solution that would not require a new law.

The two groups will meet within the next two weeks to consider ways to fix problems that have persisted since the state replaced a system run by local transportation providers with one in which contractors arrange the rides in eight regions statewide.

“They’re going to get together and figure this all out. I know they will,” said Rep. Carol McElwee, R-Caribou.

The potential solution would give the local transportation providers a much better chance of winning state contracts to be awarded this summer.

Since Aug. 1, the state has contracted with two out-of-state companies and a nonprofit in the Bangor area to arrange rides statewide. Local transportation agencies still provide many of the rides.

Because of numerous glitches and logistical problems, thousands of low-income patients have been left without rides to and from doctor’s offices, dialysis treatments, mental health counseling and other services. About 45,000 Mainers use the $40 million-a-year program.

The state announced this month that it will not renew its six contracts with Connecticut-based Coordinated Transportation Solutions – worth a total of $28.3 million – when they expire June 30, because of the company’s poor performance.

The company also failed to take out a performance bond, as required in its contracts.


The solution discussed Thursday would change the way contracts are awarded, giving preference to local transportation providers.

It also would eliminate the “25 percent rule,” which transportation directors said discouraged them from bidding on the contracts last year. The rule prohibits ride brokers from referring more than 25 percent of the arranged rides to themselves.

Since most of the nonprofits that operated the program before Aug. 1 were local transportation agencies, the restriction would effectively make the contracts money-losers for them.

Federal officials had expressed concern that Maine’s previous system could give transportation agencies incentive to assign as many rides to themselves as possible, even perhaps rides that aren’t allowed, such as to the grocery store or the beach.

When the state switched to a flat-fee system with ride brokers, those concerns disappeared because the brokers were to be paid the same amount regardless of how many rides were given.

Stefanie Nadeau, director of MaineCare services, answered questions from the Health and Human Services Committee on Thursday, and said afterward that she has no objection to eliminating the 25 percent rule and offering bidding preferences to Maine agencies. Such changes could be made without approval from the federal government, she said.

MaineCare is funded with a blend of federal and state dollars, and the U.S. Centers for Medicare and Medicaid requires approval for major changes to state-run programs.


The new rules would improve the prospects for local nonprofits to win MaineCare rides contracts, officials said.

“I can tell you that if these changes are made, we would bid on the contracts,” said James Wood, transportation director for the Kennebec Valley Community Action Program. “(If we won a contract) we would be able to spend our time and resources getting people to their appointments efficiently.”

Rep. Ann Dorney, D-Norridgewock, suggested that local agencies should get higher scores in the bidding process.

(Continued on page 2)

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