EDITORIALS

It went wrong early. But Democratic lawmakers could make new rides setup for Medicaid worse

Mary Mayhew, commissioner of the Maine Department of Health and Human Services, speaks to the Portland Community Chamber on Dec. 4, 2013.
Mary Mayhew, commissioner of the Maine Department of Health and Human Services, speaks to the Portland Community Chamber on Dec. 4, 2013.
Posted Feb. 11, 2014, at 11:36 a.m.

When lawmakers last week revisited the debate over the performance of a delinquent Medicaid transportation broker, the committee meeting should have marked the end of a spate of legislative micromanagement.

Instead, the Legislature’s Health and Human Services Committee has unnecessarily kept a bill alive that would immediately cancel all state contracts with Coordinated Transportation Solutions Inc., one of three rides brokers that started serving the state last summer. It’s also kept another bill alive that would return the rides system largely to its former model.

To be sure, Connecticut-based CTS fell well short of its responsibilities as the state transitioned to a brokerage system to manage Medicaid nonemergency transportation. Immensely frustrated Medicaid recipients who needed to get to the doctor for a checkup or to the clinic for dialysis missed their appointments because they couldn’t get through on new phone lines in order to schedule rides. When they got through, many rides failed to show up.

Missed appointments are bad for patients and bad for health care providers. That’s why transportation for medical services is a guaranteed benefit of state Medicaid plans.

The Maine Department of Health and Human Services has taken responsible steps both to hold CTS accountable and to ensure that Medicaid recipients receive the transportation they require.

DHHS last month announced it wouldn’t renew CTS’ contracts come July 1. In the coming weeks, the department plans to issue a new request for bids. As it prepares the request, the agency is considering changes to expand the pool of bidders. And the agency pledges to ensure the organizations that become transportation brokers secure performance bonds — essentially insurance policies — before their contracts take effect. CTS was required to secure bonds, but it didn’t.

A reactionary bill sponsored by Senate Majority Leader Troy Jackson, D-Allagash, ordering the state to cancel CTS’ contracts immediately won’t help matters because it outlines no backup plan and would only make the situation worse for MaineCare rides recipients.

It’s the Legislature’s role here to hold DHHS publicly accountable for executing a successful program. Its role isn’t to selectively cancel contracts.

At this point its role shouldn’t be to require a new transportation system altogether either.

But that’s what another bill under consideration by lawmakers would do. The legislation, sponsored by Sen. Colleen Lachowicz, D-Waterville, would transition Maine’s brokerage model to the transportation model used by Vermont. The Green Mountain State works directly with seven regional transportation providers and handles the program administration at the state agency level. Under Maine’s brokerage system, designated brokers contract with a network of transportation providers and, as an abuse prevention measure, don’t provide more than 25 percent of rides on their own.

The Vermont model is much like the previous system Maine had that didn’t meet federal requirements and didn’t allow the state to track its providers’ performance.

Under Lachowicz’s bill, Maine would need to secure special federal approval to operate a Vermont-like transportation system. The bill shouldn’t move forward. For one, the Legislature shouldn’t introduce more upheaval into a Medicaid transportation system that has experienced enough since last summer.

Plus, the federal approval timeline probably won’t guarantee Maine has the permission it needs in time for the June 30 end of CTS’ contracts. Operating a Vermont-style transportation system could jeopardize $1.2 million-$6.1 million in federal funding for Maine. And it wouldn’t guarantee transportation for Medicaid recipients at all hours. Transportation in Vermont is largely limited outside of business hours and on weekends.

More states have adopted the brokerage model over the past decade in an effort to save money and track their nonemergency transportation systems’ performance. Between 2001 and 2009, the number of states using brokers grew from 29 to 38. In 2006, the Congressional Budget Office projected $55 million in savings from more states using transportation brokers.

A 2009 study on Georgia’s and Kentucky’s transitions to brokerage systems showed that, following the changes, asthmatic children were more likely to receive needed care, and diabetic adults were less likely to require expensive emergency room care.

In Maine, the brokerage system has had limited time to prove itself. If it’s a way to inject accountability into a $40 million program while saving money and improving access to needed treatments, it deserves a chance to work.

 

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