Where’s My Ride?
“We waited and the ride never came,” said one disabled man. “I was so cold” another woman said. “They said the heater in the van didn’t work.”
Some time ago residents in Black River Falls shared with me their complaints about non-emergency medical transportation program. Since then, I’ve heard many other complaints from patients and providers.
The number and seriousness of complaints led the Legislature’s Audit Committee - of which I am ranking minority member - to recently approve a full evaluation of the program now administered by St. Louis-based Medical Transportation Management, Inc. (MTM).
Federal law requires the state to provide rides to Medicaid patients who have no other way to get to doctor’s visits. Some patients rely on the service for trips to life-saving cancer and dialysis treatments.
At the Audit committee hearing a man testified kidney dialysis patients were waiting two and three hours to get picked up post dialysis. “You’re tired. You don’t feel well. You need to go home,” he said. A woman with asthma asked the driver to stop smoking in the van. Instead he rolled down the window.
Others described a broken system. People are transported in vehicles in disrepair; doors don’t open from the inside. Patients and caretakers spend long times on hold trying to schedule rides. Families are told no rides are available even while providers are “screaming for business”. One taxi company manager testified he “could do 1,000 rides a day. Now I’m doing 15 or 20 a day for MTM. People say ‘MTM told me you were all booked up.’ But I never received a call.”
Another man testified the number of van companies dropped by 50%. He said many of the remaining companies are not safe or reputable.
The problems appeared in 2011 when the state shifted from a county-based volunteer system to a privatized system run by a transportation broker. The arrangement was supposed to save the state money. But, according to the Milwaukee Journal Sentinel, the only expected cost savings was in a higher federal Medicaid reimbursement rate.
The feds wanted more data on who received rides and for what type of services. The Journal Sentinel reported that volunteer providers could have collected these data. But instead the state chose to move to the private broker model.
In mid-2013, the state changed from one private provider to MTM; however the complaints continued.
Several people who testified complained the structure of the program encouraged skimping on services. One provider testified that the brokerage firm is smoke and mirrors. They are paid to deny services.
Another testified, “They are pocketing the money while thousands of BadgerCare members fail to get to their doctor appointments. This could threaten future levels of funding at the federal level.”
Committee members questioned whether the contract with MTM was properly structured. Representative Peter Barca described what he called a “perverse incentive” - a fixed amount of money for a varying level of service. The company keeps the money it doesn’t use to provide services.
“The way a contract is structured makes a tremendous difference,” Barca said.
Patrick Ryan of the Professional Ambulance Association of Wisconsin told the Milwaukee Journal Sentinel, “The entity that benefits from that is the broker by shedding service, downgrading service, providing obstacles for patients to get to transportation and putting hurdles in the way of transportation providers to get paid for the services they provide."
The state pays more for fewer services.
Testimony clearly indicated a troubled program that isn’t working in the best interest of the people. As Representative Barca said, “When people are in the most sensitive period of their life, we must ensure they receive services and are treated with respect and dignity.”
Citizen complaints drove legislators to seek an audit. Public testimony expanded the audit to a full program evaluation. Citizen input can help auditors get to the bottom of the problem.
Have you or someone you love asked where’s my ride? You should call the Legislative Audit Bureau’s Waste, Fraud and Mismanagement Hotline at 1-877-372-8317.