Sunday, December 8, 2013
Until recently, thousands of MaineCare patients could set up appointments to see doctors or undergo treatments such as dialysis or chemotherapy and be reasonably sure about transportation to their care providers' offices.
Local nonprofits got people where they needed to go, when they needed to go there.
On Aug. 1, however, the state debuted a revamped ride system that's left many low-income Mainers without any way to access medical services.
State officials have received more than 2,000 complaints from patients -- many seriously ill -- whose rides never showed up or who couldn't reach the two private out-of-state contractors that now coordinate rides for most of the state.
People are hurting, and it's the state's responsibility to make sure they get the help they've been promised.
Since the controversy came to light, the state Department of Health and Human Services has made two points: that it faced a federal mandate to overhaul the MaineCare ride program, and that it's too early to cancel contracts with the two companies that have been the focus of all the complaints.
The agency, though, doesn't have a solid case on either count. It could have kept a locally controlled system and still complied with U.S. government guidelines; instead, it opted for a system that isn't working.
Problem was avoidable
The state can get out of this arrangement at any time. And it should, clearing the way for the return of a system that doesn't leave patients on the curb when they should be getting the services they need to become and stay healthy.
Previously, local nonprofits both arranged and provided non-emergency rides to MaineCare patients. It was a setup that patients liked but that prompted questions from federal regulators, who said the same agency shouldn't be both setting up and giving rides.
The Department of Health and Human Services was given options to comply with federal regulations. According to a national Medicaid expert, the federal government would not have forced Maine to have regional coordinators arrange the rides. In fact, a local contractor won the ride contract for the Bangor area -- and riders there have had fewer problems.
MaineCare recipients in the rest of the state haven't been as lucky:
* A mother in Old Orchard Beach said her 3-year-old son was dropped off at the wrong house after his day at a preschool for developmentally challenged children. (He eventually was brought home safely.)
* A Winslow woman has found it difficult to secure transportation to the eye doctor, where she undergoes treatment to help preserve what's left of her vision.
* Because of logistical issues, a woman from Kennebunkport has missed out on therapy intended to improve her brain's functioning.
* A Skowhegan man with a degenerative disc disease has missed two medical appointments and been put on hold for hours trying to arrange rides.
People in need stranded
As these examples show, the problems with the MaineCare ride program have affected vulnerable people.
Maine is a largely rural state where the population is dispersed and public transportation options are few. MaineCare patients who can't get to appointments for regular care could get sicker or even die.
"I can't miss. This is my life," a Shapleigh woman who's on dialysis for kidney failure told the Portland Press Herald. (She said she hasn't missed a ride but fears she will.)
One doesn't have to be moved by the plight of these patients to make a case for providing low-income people with reliable transportation to the doctor. There's also a pragmatic argument in favor of a functioning MaineCare ride program. It reduces expenses for the publicly funded program by helping Medicaid recipients get the care they need to avoid becoming so ill that they have to go to the emergency room or be admitted to the hospital.
Time to set boundaries
The state official in charge of the MaineCare ride program has said that it's too soon to cancel the contracts for the service.
But several thousand complaints have come in already. Department of Health and Human Services employees have even been called on to help the private contractors, LogistiCare and Coordinated Transportation Services, by taking overflow calls and email or fax appointments to the ride brokers. (This hardly supports the belief that businesses are, by definition, more efficient than government.)
The language in the contract with the private firms allows the state to terminate the agreement at any time if the companies aren't meeting their clients' needs. There's no question that LogistiCare and Coordinated Transportation Services aren't meeting the needs of the people served by the MaineCare ride program.
The only question that remains is: Where is the state going to draw the line and say "Enough"?