September 9, 2015
“Just how many ‘no shows’ are acceptable?” I asked Medicaid Director Kevin Moore at a recent Audit Committee Hearing. “Is 4,154 people left without a ride too many?”
Wisconsin needs a different system for getting seriously ill elderly and disabled to their medical appointments. A recent audit showed poor services provided by a private company contracted to give rides to some elderly and disabled.
A Rock County resident arranged for a wheelchair van. But the vehicle sent did not have a wheelchair lift. The wheelchair bound person missed their appointment. A developmentally disabled Dane County person walked home in a thunderstorm after being stranded at the clinic. A paralyzed Richland County resident could not get a ride to a surgery appointment.
These are just a few of the cases from a recent audit conducted by the nonpartisan Legislative Audit Bureau. Auditors wrote, “from August 2013 through June 2014, we found 4,154 instances in which transportation providers did not arrive to provide a scheduled trip and 55,320 instances in which they arrived more than 15 minutes late to take recipients to their appointments.”
The State Medicaid Director has a contract with a private St. Louis-based firm, Medical Transportation Management (MTM), to provide non-emergency medical transportation to almost 70,000 people in Wisconsin. MTM is a “broker” which organizes rides to pick up and deliver Medicaid recipients to medical appointments.
I have received many complaints from families, patients and local transportation companies. One disabled resident in Black River Falls told me about traveling in a van with no heater on a cold Wisconsin winter day. An Eau Claire woman waited more than an hour for a ride with her sick daughter. When constituents tried to complain they ended up getting the run-around.
Medical transportation companies – hired by MTM – were so discouraged that over half of them responding to an Audit Bureau survey said they were dissatisfied or strongly dissatisfied with MTM. Scheduling was one area of concern.
The audit reported on many problems, including examples of poor management. Auditors found that MTM sent faxes to transportation companies requesting a ride after the trip was supposed to be provided. They then charged the company with failing to provide the trip.
The disastrous treatment of Wisconsin transportation companies has led to a huge exodus of companies willing to provide rides for medical visits to Medicaid recipients. Prior to the brokerage system, Janet Zander testified, “Wisconsin had approximately 200 specialized medical vehicle (SMV) providers. Today, there are only about 80 providers operating in the state.” Especially hard hit are rural areas.
Mr. Moore, the Medicaid Director, testified he accepted the auditors’ recommendations and was amending the contract with MTM. “We know there are challenges that we didn’t know before the audit,” he told the committee. “We’ve taken aggressive action.” He also encouraged people to let him know if things were not working. “If we don’t know what’s wrong, we can’t fix it. If they [riders] don’t complain, we won’t know. Please call us.”
Many advocates testified that the system was not set up to succeed. “The broker is paid for all rides, regardless of whether the ride shows up or gets a rider to their destination late,” said one advocate. This system creates a “perverse incentive” that encourages MTM to skimp on providing services. When they skimp, others sometimes pick up the cost. Molly Nolte from Rock County told of services so poor the county dipped into its own limited funds to provide rides.
Ms. Zander and many other advocates told committee members that without an adequate transportation system for the elderly and disabled to get to medical appointment, more folks would end up sicker, in the hospital, with the state spending more.
“We need a complete overhaul of this system,” testified Representative Peter Barca who spearheaded efforts to approve the audit. He listed several ways in which the current system rewards MTM to discourage riders and pay for fewer rides. “We need to look at a different type of contract.”
I agree. Even majority party members of the Joint Finance Committee agree. They added a pilot study to explore a new system into the state budget. The governor vetoed the idea.