Maine is looking to revamp its $83 million Medicaid transportation system, taking the step six years after thousands of Mainers needing rides to their medical appointments were left at the curb.

The overhaul could include consolidating an array of transportation services – including rides to doctor’s appointments, for child welfare services and for those with intellectual disabilities or mental illness – into one system.

The reforms would potentially streamline similar services under one umbrella and could be implemented by next spring. By far the largest of the services is non-emergency medical transportation, which accounts for 2.4 million of the 2.5 million rides the state’s Medicaid transportation system provides annually.

Overall, 55,000 Mainers per year get a ride from Medicaid, according to state statistics, for a system that costs $83 million per year. Of that sum, $30 million is state tax money, with the remainder coming from federal tax dollars.

The system underwent a crisis in 2013, when thousands were left without rides after the Maine Department of Health and Human Services changed the way it provided the rides.

In August 2013, a switch from a fee-for-service system run by nonprofits to a private brokerage system was besieged with complaints, as thousands missed rides to medical appointments. By the following spring, Maine DHHS had improved the system and refused to renew a contract with one of the private brokers, Connecticut-based Coordinated Transportation Solutions.

The state established a requirement that ride brokers keep track of complaints and self-report the complaints to the state. The self-reported complaints declined from 0.7 percent of all rides in 2013 to about 0.2 percent of all rides in 2019. That equates to several thousand complaints per year out of the 2.4 million rides given.

For non-emergency medical transportation, the system is currently a mix of nonprofit groups and private brokers, including private broker LogistiCare Solutions of Georgia, and Maine nonprofits Penquis Community Action Agency and Waldo Community Action Partners. For other services, such as child protective services or rides for mental health patients, a number of Maine nonprofits provide transportation.

The administration of Gov. Janet Mills is now pushing for further reforms to the system and has convened a working group to come up with recommendations.

Jackie Farwell, spokeswoman for the Maine Department of Health and Human Services, said in an email response to questions that the working group already has come up with some recommendations. The working group is advocating for standardized safety and performance standards for all ride services, such as on-time performance and background checks on drivers.

“DHHS convened the workgroup and has developed recommendations to improve the quality, efficiency and consistency of transportation programs provided through MaineCare, as well as through other offices within the department,” Farwell said. “We recognized an opportunity to better coordinate these services.”

The on-time performance for Maine’s non-emergency medical transportation system is 85 percent of all rides given, better than Connecticut’s 81 percent on-time performance, DHHS said. States operate different types of systems and have different ways of measuring performance, so national or comprehensive state-by-state comparisons are difficult.

However, according to the Kaiser Family Foundation, a national health policy think tank, a well-functioning Medicaid rides system helps low-income patients better manage chronic health conditions, including asthma, heart disease and diabetes, and expecting mothers get better pre-natal care. Those who lack rides risk having their medical problems “escalate to a need for emergency care,” the foundation said.

Maine’s ride providers are taking a wait-and-see approach.

“The working group is taking a thoughtful approach – listening to consumers and health care providers for direction, so I trust the process,” said Steven Richard, non-emergency medical transportation director for Penquis, a Bangor nonprofit.

Myra Orifice, engagement manager with LogistiCare, which provides Medicaid non-emergency medical transportation rides for much of southern Maine, said that there may be some changes to the non-emergency medical transportation system, but she sees it as more of a way to make all Medicaid ride systems in Maine have similar “safety and performance measures.”

This month, the state will host a number of public meetings for those interested in how the system may change, including at DHHS offices in Houlton, Lewiston, Bangor and Portland. The Portland public meeting will be 5:30 p.m. on Nov. 25 at DHHS offices, 151 Jetport Blvd.

 

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