STEVENS POINT, Wis. (WSAU) - What government program costs millions of dollars in tax money, and fails to help the people that need it the most? Many riders and providers say it’s the state of Wisconsin’s Medicaid transportation brokerage.
Atlanta, Georgia based LogistiCare was to be paid $38 million dollars for their three year deal to manage and coordinate medical rides for members of Medicaid, BadgerCare Plus, and some Family Care members. They backed out after losing over six million dollars in 2012. The state then contracted with Missouri based MTM for a three-year deal worth $54 million dollars.
Gary Goyke is a former legislator and a lobbyist representing several transportation groups. He says privatization of Medicaid transportation was supposed to save taxpayers money and deliver a better level of service. Goyke believes the brokerage needs a complete audit outside of DHS to see if they are truly meeting expectations. “If you believe in that (privatization model), then you need to demand that in fact it’s true that a private company can come in will and do a better job than the government did, otherwise that philosophy in that particular instance falls flat. What we’re seeing though, is the exact opposite. It’s costing the taxpayers a lot more, and the meeting today in Stevens Point indicated that pretty universally that the vendors and the riders, the clients, are complaining that it’s being run worse and worse and worse.”
Goyke says the present system fails to provide many rides, and fails to compensate providers equally and fairly... while the broker profits. “The Department (of Health Services) then itself announced that it would audit some three months ago, almost four months ago, and that audit has never taken place, so we’re seeing a 42% increase in the state’s share of the money. It’s gone up rather than down. There was no efficiency of cost. It’s costing more, and yet they’re refusing to audit what’s happening in the program. We definitely do want an audit.”
Specialized Medical Vehicle Association of Wisconsin President Jim Brown manages Wheels of Independence in Wisconsin Rapids. He says another problem is the State Department of Health Services’ chosen broker, MTM, is not treating them equally. For example, contractors under MTM are not held to the same driver standards. “Certain companies, those that are registered with MTM, have certain standards they must meet, and depending on the type of company that you are, some standards for drivers and vehicles are higher than other companies. For those that are not contracted yet with MTM, but that are looking to or may not at all, they basically have no standards to follow at all.”
Providers at the meeting also cited several examples of how MTM doesn’t wish to pay for additional riders going to the same destination, and like the Medicaid guidelines before the brokerage, you could be putting on a large number of miles to pick up a patient that you don’t get paid for.
Peggy Jones from Neillsville-based Abby Vans says they have been forced to let go of drivers they had for many years because of things MTM didn’t like on their driving records from over ten years ago. Brown says they were allowed to keep drivers with similar offenses that were not that old. Brown says the contracted providers for MTM make sure they have safe drivers, but MTM also hires companies for trips that are not under contract, and they may not have the safest & cleanest conditions. “The client needs to be very careful on who their driver is, and the company they’re with, and have to ask themselves and ask the company, “What kind of programs are you following? Who is this driver? How good is he? For most of us, the drivers are well trained and their backgrounds are checked, but for many other companies, they may want to look into the background.”
The transportation brokerage is designed to take ride requests from Medicaid and Family Care eligible members at least a few days ahead of the appointment, and then the broker is to choose the most efficient, economical, and appropriate ride provider for them. The providers receive the requests for rides, and the providers can agree to take the member & turn it back to the broker.
Brown says it was difficult under the state’s first broker, LogistiCare, during 2011 and 2012. He says it’s even worse now, as MTM tries to schedule same-day rides in rural areas that are just impossible to complete on short notice in the allotted time. “All we’re really seeing for the most part is same day trips that aren’t being handled. We don’t know where they’re coming from. We don’t know if in fact the client is getting that trip. Many of the trips that we’re asked to do, we would not be able to get there on time to pick them up let alone get them to their appointment on time.”
Brown says Medicaid eligible members are also being told the transportation services refused to pick them up, when many times, the ride was turned down because they weren’t given enough time to perform the service, or they were never contacted in the first place.
Taxi operators, shared ride providers, wheelchair van operators, and county transportation coordinators claim many former clients have been moved to municipal buses and others have just given up on trying to get to the doctor. Although some can safely ride the bus, many elderly and disabled cannot safely do so. It’s a practice called “shedding rides,” and Goyke says when this happens, the cost is shifted from the tax dollars in the Department of Health Services to the property taxpayers that help support municipal public transportation.
As part of the brokerage under the Department of Health Services, there is supposed to be an established system for riders to register complaints about service from providers and brokers. Brown says most people have no idea who to contact since MTM took over. “The state was to in fact to have told all members (of Medicaid & BadgerCare) that number. If you do not have it, ask your provider. They will provide you not only with the number to complain to, but also a number for the Department of Health Services, and they can even give you your Legislator’s number if you feel you need to go to them to complain about what’s happening with your ride.”
Goyke and the group of about 25 transportation providers from around the state met in Stevens Point Monday. They agree that MTM is not providing good service to riders, and they are not working well with providers. He says what has happened is the state turned independent companies into subcontractors of the broker, while failing to provide the efficiency and improved service levels promised to Wisconsin taxpayers.
Wisconsin’s Department of Health Services pushed for and got their first brokerage as a part of Governor Jim Doyle’s last budget. Governor Scott Walker did not remove the provision or make any changes when he took office.
The group of transportation providers plans to work with legislators to address the problems with the Medicaid transportation brokerage system.