Portland Press Herald

The state of Maine has wide latitude to cancel contracts for the new ride brokers at the center of the MaineCare transportation debacle, but the state official in charge of the program said she’s not ready to broach that topic yet.

“We’re 14 days in. It’s too early to talk about how long we’ll give them,” Stefanie Nadeau, Director of MaineCare Services, told the Press Herald on Wednesday, when asked whether the state was considering canceling the companies’ contracts. “We expect progress to be made.”

However, Nadeau also said that the state “is committed to making this brokerage system succeed.”

The Department of Health and Human Services, which oversees the MaineCare program, reported that it has received more than 2,000 complaints since Aug. 1, when Coordinated Transportation Solutions of Connecticut and Atlanta-based LogistiCare took over coordinating rides for low-income Medicaid patients who need transportation to doctor’s appointments, therapy and other medical services.

CTS is being paid $28 million for winning contracts to serve most of the state, while LogistiCare landed a $5.1 million contract for the York County region.

Previously, the rides were organized by local nonprofit agencies with few problems, numerous patients have said.

The transportation program costs about $40 million a year and serves about 45,000 patients. The federal government reimburses the state for the majority of the costs.

Nadeau said the state is “holding the brokers accountable” to provide much-improved service. She said DHHS has had discussions with company officials to express their concerns.

“Any missed ride is unacceptable,” Nadeau said.

Activists say that the state should cancel contracts and go back to a system that worked.

“The state should put things back the way that they were and give people some peace,” said Rita George-Roux, a volunteer driver in York County. “Let us do what we were doing, and doing very well.”

Pam Lee, of Kennebunkport, an advocate who has been fielding calls from those who have missed rides, said that the state should admit it was wrong and undo the new system.

“It’s been a nightmare, and it’s not getting better,” Lee said. “The state is taking the easy way out.”

Officials with CTS couldn’t be reached for comment Wednesday, while LogistiCare issued a written statement.

“We have increased our capacity since starting operations this month,” LogistiCare spokesman Todd DeFeo wrote. “As a result, the complaint rate has dropped dramatically, even as the number of scheduled trips has increased. We expect the rate will continue to decrease moving forward.”

Rep. Richard Farnsworth, D-Portland, chairman of the Legislature’s Health and Human Services Committee, said after from conversations he’s had with state officials, he believes the contractors will be given at least a month to resolve problems.

Adrienne Bennett, spokeswoman for Gov. Paul LePage, said state officials have been briefing the governor on the problems frequently.

“We acknowledge this is a problem, and we’re doing what we can to fix it up,” Bennett said.

According to the terms of the brokers’ contracts, the contracts can be terminated “whenever for any reason” ending the agreements are “in the best interest of the Department.”

One of the stumbling blocks in the new system has been volunteer drivers quitting in large numbers because of reimbursement problems, state officials have said.

Because of Medicaid reimbursement rules, drivers no longer can be reimbursed for miles driven when a patient is not in the vehicle. So even though the mileage rate increased from 41 cents per mile to 55 cents per mile, it wasn’t enough to make up for not being reimbursed for mileage to and from a patient’s house, especially in more rural areas of the state.

Charlotte England, of Oxford, said she used to be a MaineCare volunteer driver, but she quit this summer when she heard about the pending reduction in reimbursement rates. She said she would have lost money to volunteer because she would often be getting reimbursed for only about 10 miles of a 40-mile trip.

“I don’t mind volunteering, but if I have to pay to volunteer, that’s another story,” England said.

Nadeau noted that under the state contracts, the new ride brokers have the flexibility to increase the reimbursement rate for miles driven with the patient to higher than 55 cents, which would help maintain the volunteer driver force.

Farnsworth said he thinks the contractors were surprised at how much Maine relied on volunteer drivers to provide the MaineCare service.

Switching to a higher reimbursement rate appears to be happening already.

Jack DeBeradinis, executive director of Portland’s Regional Transportation Program ride service, is still providing rides, although the ride coordination is being handled by CTS.

He said he’s been told by CTS that the reimbursement rate is going to increase to 68 cents per mile to retain the volunteer drivers better, and he believes that will apply in all the regions covered by CTS.

George-Roux said she has heard that an improved reimbursement system also will kick in for volunteer drivers in York County, which is served by Logisticare.

Meanwhile, stories of missed rides and other logistical snafus continued to flood into the Press Herald on Wednesday, via dozens of calls and emails.

Valerie Enos, of Freeport, said she’s missed chiropractor appointments to treat fibromyalgia and other medical problems.

“I have a very delicate system,” Enos said. “I have anxiety issues. I thought my anxiety was under control, but when something like this happens, it comes back.”

Adam Adams, of Skowhegan, who suffers from a degenerative disc disease, said he’s missed two appointments and he’s been on hold for several hours trying to set up rides.

“The whole system is a joke,” Adams said.

Nadeau said the state is temporarily helping the brokers by having state employees take overflow calls and email or fax appointments to the brokers.

Ultimately, Nadeau said, the brokers are responsible for making the contract work.

She said even if the contracts eventually were canceled, the state, long-term, could not return to the same system it had previously. For instance, the nonprofit agencies were operating without a formal contract with the state, which was frowned upon by Medicaid.

Medicaid required the state to change the way it structured the ride service to add more transparency and accountability to the system, although the state had flexibility in how to comply with Medicaid rules.

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