Left Behind: Medicaid Patients Say Doctor Visits Don’t Always Come

States must implement transportation to medical appointments for people with disabilities enrolled in Medicaid. But patients say those rides come late — and sometimes not at all. (Disability Scoop)

Tranisha Rockmore and her daughter Karisma waited at a children’s hospital in Atlanta in July for their ride home.

Karisma had been to Atlanta Children’s Health Care to get his gastrostomy tube repaired, Rockmore said. The 4-year-old, who has several serious medical conditions, is covered by Medicaid, which provides transportation to and from non-emergency medical appointments through private providers.

After learning a ride wouldn’t be available for hours, Rockmore said, she finally gave up and called her sister to take them home to the town of Ashburn, South Georgia, more than 160 miles away. .

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She said this isn’t the first time she’s had trouble with the Medicaid transportation service.

“Sometimes they never come,” said Rockmore, who doesn’t own a car. Many rides have been canceled recently, she said; the company told her they couldn’t find drivers. “Sometimes they make me feel like they don’t care if my child goes to the doctor or not.”

Rockmore’s remarks would no doubt resonate with Medicaid recipients, loved ones and advocacy groups across the country upset by the problems patients have had getting transportation to medical appointments. Not only are some shuttle drivers failing to show up, but some patients have been injured during rides because their wheelchairs weren’t properly secured, according to lawsuits in Georgia and other states.

States are required to provide transportation to medical appointments for adults, children, and people with disabilities under the Medicaid health insurance program. Transport brokers – such as Modivcare, which Rockmore has used – have subcontracts with local providers, often small “mom and pop” operations, to transport patients to and from needed appointments, including for dialysis, adult day care, mental health and addiction treatment. use disorders.

It’s a lucrative business, with transport management contracts that can be worth tens of millions of dollars to companies. The two companies that have contracts in Georgia have donated extensively to the political campaigns of elected officials in the state. The companies, Modivcare and Southeastrans, have also been the subject of complaints, lawsuits and government fines in Georgia and elsewhere. The two companies, however, argue that the complaints relate to only a tiny percentage of the journeys made.

Non-emergency Medicaid transportation “is absolutely a national challenge,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It’s something that pretty much every state we talk to is dealing with. I don’t think anyone has figured that out.

Beth Holloway, 47, of Wharton, NJ, said she had several issues with the rides. “Sometimes they come late, other times not at all,” said Holloway, who has cerebral palsy and lives independently. “I was stuck in doctor’s offices for hours, sometimes in the elements.”

In Los Angeles, Rose Ratcliff and several other patients filed a lawsuit in 2017 against Modivcare, then known as LogistiCare; other local transport brokers; and insurers that administer the state Medicaid program, known as Medi-Cal in California.

The ongoing lawsuit alleges that Ratcliff and other patients like her missed crucial dialysis appointments and faced unsafe conditions during transport. He calls Modivcare the “broken link” in the Medicaid transportation chain and says the company has failed to respond adequately to complaints from customers like Ratcliff.

Katherine Zerone, spokeswoman for Modivcare, said the company does not comment on ongoing litigation. In an initial legal response, he said the issues were with independent transportation providers and their employees, not Modivcare/LogistiCare.

After complaints were filed about Southeastrans’ service throughout Indiana, the state appointed a special legislative commission to review the company’s performance. Indiana now releases detailed complaint data from the Atlanta-based company monthly.

In August, Timothy Mills, a Bloomington man who uses a wheelchair, filed a lawsuit alleging the company violated the Americans with Disabilities Act and other civil rights laws by not providing a vehicle. wheelchair accessible to transport him to and from his appointments. The lawsuit alleges that due to the lack of wheelchair accommodations, Mills missed out on necessary medical care and was even kicked off the patient lists of some of his local doctors.

“While we are unable to comment on pending litigation, we are aware of the matter and strongly disagree with the allegations,” said Christopher Lee, an attorney for Southeasttrans, which operates in seven states and Washington. , DC.

Two decades ago, Georgia was one of the first states to begin using transportation brokers to manage its Medicaid transportation program. The state’s two longtime providers — Modivcare and Southeastrans — will receive a total of $127.6 million from the state this fiscal year. They receive a monthly fee per member that averages $5.60 in Georgia, regardless of the number of trips, if any, made by a Medicaid user. The state was expected to announce new contracts for Medicaid transportation this month.

Georgia imposed a total of $4.4 million in penalties on the two companies from January 2018 to December 2020 for not picking up patients on time and other issues. However, the state Medicaid agency essentially gave them discounts, billing the two companies just $1.2 million during that time, according to letters from the state Department of Community Health obtained through a request for open files. By extending the brokers’ contracts in fiscal year 2018, the national Medicaid agency agreed to limit damages to 25% of the assessed amount, said Community Health Department spokeswoman Fiona Roberts.

Modivcare said it’s the nation’s largest freight broker, controlling about 40% of the market. The Colorado-based public company provides Medicaid transportation in more than 20 states.

Modivcare and other companies claim that only a tiny fraction of the rides they offer lead to complaints. “Our first priority is safe and reliable transportation,” Zerone said. In Georgia, 99.8% of her trips are complaint-free, she said.

Andrew Tomys, Georgia State Director for Southeast, said 99.9% of trips his company services in the state are “free of valid complaints.”

Modivcare and Southeastrans say they investigate each complaint to determine if it is valid. In Georgia, Modivcare reported to the Department of Community Health more than 3,200 late rides or no-shows in one year out of approximately 2.3 million rides. Residents of the Southeast reported just over 900 such issues on around 1.4 million trips.

But patients and their advocates say that in many cases issues go unreported or complaints are ignored.

Georgia should tie any new contracts to fast rides, ease of use for beneficiaries and the overall ride experience, said Melissa Haberlen DeWolf, director of policy for the advocacy group. Voice for the Children of Georgia.

In recent election cycles, Southeastrans and Modivcare — through its former corporate name LogistiCare — have been generous donors to Republicans in Georgia, who have controlled state offices in the state for nearly two decades.

Southeasttrans, as a company, has donated $126,000 to Republican campaigns and committees in Georgia since 2017, according to documents on the Georgia Government Transparency and Campaign Finance Commission website.

Additionally, Southeasttrans co-founder and CEO Steve Adams has donated at least $86,000 to Georgia’s Republican candidates for state office and the state’s Republican Party since 2017, according to filings by the state. State. During that same period, Adams donated $3,800 to two Democratic candidates in the state.

“As a minority-owned business headquartered in Georgia for more than 20 years, Southeastrans and its owner have contributed to a diverse mix of local causes and organizations,” Lee said.

Modivcare, through LogistiCare, has given $48,350 to Georgia Republican candidates in state races since 2017, according to the Georgia Government Transparency and Campaign Finance Commission. He gave $750 to former Democratic state Rep. Pat Gardner, also according to the commission. Modivcare’s Zerone did not respond to questions about the company’s political donations, saying it would be “competitive information.”

Such contributions can help companies buy access to government officials, said Paul S. Ryan, vice president of government watchdog group Common Cause.

“Anytime a special interest doing business with the government can make large contributions to officials handing out contracts or making other government decisions, that’s cause for concern,” he said. “On average, ordinary Americans can’t buy the same influence.”

Tranisha Rockmore said she was so fed up that she wanted to have a car to avoid transportation issues. “I’m at the point where I feel like they don’t care about my daughter,” she said. “You don’t just make children of people like that.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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