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New Provider of Rides for Medicaid Sparks Concerns
By Virginia Young, St. Louis Post-Dispatch
Sharon Crown, who is disabled and on oxygen, is helped to a waiting taxi by driver Francis Cartwright in St. Charles on Monday.
(Andrew Cutraro/P-D)
November 1, 2005
Elderly and disabled people in the St. Louis area who depend on Medicaid for rides to medical appointments could find the going rough this week as a new state contractor gears up.
A Georgia-based firm, Logisticare Solutions LLC, is taking over coordination of the rides today. But the firm has signed up only about one-third of the van and cab companies needed to provide services statewide.
Transportation providers say they are balking because they would be paid lower rates and could face stiff fines for late pickups. They say they can't afford to take a hit, especially with volatile gas prices.
"Right now, I'm doing it at break-even," said Bernie Squitieri, president of Express Medical Transporters Inc., one of the largest providers in the St. Louis region. His company ferries people on Medicaid to appointments 9,000 times a month.
Francis Cartwright, owner of St. Charles County Cab, said he won't sign with LogistiCare.
"If you read through their contract, they have so many fines and stipulations, it could be a possibility that we end up owing them more than they owe us," Cartwright said.
LogistiCare is confident that it will be ready to provide rides. The company has four more days to line up its network of vans, cabs and buses. Rides being booked today are for appointments on Saturday and thereafter.
"History shows that most, if not all, providers tend to wait until the last minute to sign their contract," said Ed Domansky, director of corporate communications for LogistiCare.
Though the company has only about 30 of the roughly 100 vendors signed up so far, "We are very confident we'll be ready to go on Nov. 5, when it's time to flip the switch," he said.
Even if all goes smoothly, people booking rides will still get a jolt: a new $3-per-trip co-payment.
The state set the co-payment as part of the new contract. A cab or van driver can't deny rides, initially, to those unable to pay. But under a new state law, the driver can refuse to provide service in the future if there is a pattern of bad debt.
That could spell trouble for low-income people who need crucial services, such as kidney dialysis. Dialysis patients are the largest group using the service, known as non-emergency transportation. Several times a week, they visit a clinic so that a machine can do what their kidneys can't - filter waste products from their blood.
"Sometimes I don't have a dollar," said Jean Webster, 57, of St. Louis. She goes to the dialysis center run by Barnes Jewish Hospital. In addition to kidney failure, she suffers from heart problems and uses oxygen and a cane. The transportation service includes help from her door to the car.
"When I don't have no money, what am I going to do? Miss dialysis? I could wind up in the hospital, and it's more of a cost then," Webster said.
Republicans have been working to control the cost of Medicaid, the state-federal health care program for the poor. Nearly 1 million Missourians are covered by the program.
About half of Missouri households - 475,010 - are covered by the transportation contract. Those affected include low-income families in rural areas and the elderly and disabled statewide. In general, they are the ones outside managed care.
Most know nothing of the changes. The state began mailing notices to them on Monday.
The notices say to call LogistiCare's toll-free number to schedule rides at least three days before a medical appointment. The number is 1-866-269-5927. The call center, in Kansas City, will have operators available 24 hours a day, seven days a week.
Missouri expects to save about $15 million a year under the new contract. The price is coming down because LogistiCare will charge the state a flat rate for each eligible person per month, no matter how many rides the person schedules.
That gives the company an incentive to book the cheapest form of transportation that is appropriate for the person's condition. For example, an able-bodied person might receive bus tokens or gas reimbursement if a relative can drive to the appointment. Vans, taxis, ambulances and airplanes are other options.
Gov. Matt Blunt's administration chose LogistiCare over Medical Transportation Management Inc., or MTM, of Lake Saint Louis, which had held the contract since 1997. The switch was supposed to happen on Nov. 20, but after MTM lost the bid, the firm exercised an option to quit earlier.
LogistiCare will be paid $25.5 million. The company, based in College Park, Ga., provides similar services in 14 states.
Vendors, many of whom lobbied for retention of MTM, say that LogistiCare's rates are too low and that the fines are too stiff. For example, a company could owe $100 if the driver was 15 minutes late getting a patient to a dialysis appointment.
"I'm fed up," said Sondra Smith, owner of J&S Medical in Clinton, Mo. "They refuse to negotiate anything."
Domansky, LogistiCare's spokesman, said the company wants to develop "solid working partnerships" with vendors. Fines would be imposed only if a vendor had persistent problems or if the state fined LogistiCare for late rides.
"It's only the poor providers who have to worry," Domansky said.
Both LogistiCare and MTM have had problems in other states. LogistiCare recently quit providing services for the elderly and disabled in Washington, after a barrage of complaints about poor service. MTM struggled last month to provide rides on time, when it took over a Medicaid service in Philadelphia.
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