Transportation funds for poor cut by state Some free rides end for 346,000 on Medicaid.


Based on incorrect information supplied by the state Department of Health and Mental Hygiene, The Evening Sun on Friday reported the wrong date that the department will stop reimbursing non-emergency transportation costs incurred by Medicaid patients. The correct date for the end of the reimbursements is May 1. The Evening Sun regrets the error.

The state Department of Health and Mental Hygiene has put the brakes on reimbursements for non-emergency transportation costs incurred by Medicaid patients.

The new policy, designed to save $3 million a year, will affect about 346,000 poor, aged, blind or disabled Marylanders, most of them in the Baltimore and Washington metropolitan areas, said Nelson Sabatini, acting department secretary.

Starting Monday, Medicaid patients will find they can no longer call a taxicab for a free ride to their doctor's office.

The state will continue to pay for taxi rides for patients being discharged from in-patient hospital stays, from out-patient surgery involving general anesthesia, and after emergency room treatment for a "true emergency" provided a doctor certifies the taxi is "medically necessary," Sabatini said.

But, for routine trips to or from the doctor's office, the pharmacy or some other health-care provider, patients will have to call a van service or catch the bus.

"In some cases, we had been paying more for taxi service than what we pay the provider for the exam," he said.

Some health-care providers also complain that too many Medicaid patients abused the service.

"We have perfectly healthy adult people coming in to see a physician for routine things, who insist they need taxi service," said a spokesperson for one provider that serves thousands of Medicaid patients.

"They refuse to use bus tokens because they know if they hold out for a taxi, that's an option they have," said the spokesperson, hTC who asked not to be identified. "We've seen them take the taxi from the doctor's office to the grocery store and the dry cleaners before they go home. There's no incentive for them to take the bus."

The department is also working to restructure mileage rate schedules negotiated with van transport contractors.

In some cases, Sabatini said, van companies in remote parts of the state have charged as much as $600 in mileage fees to drive a patient to Baltimore for specialized treatment.

"We can buy a commuter airline ticket for $50," he said.

But van companies, health departments and other providers have testified that state-proposed reductions in mileage rates and rate structures would drive many transportation services out of business. The DHMH subsequently withdrew its original proposal and is working to devise another.

Non-emergency transportation consumes $17 million a year, but only $200,000 of that is spent on bus fares, Sabatini said. The rest -- $16.8 million -- goes to taxi and van services.

"Realistically," he said, "we just have to look at what it is we can afford. . . . We're dealing with a program whose costs are skyrocketing and, if you look in terms of priorities, some of the basic services are the most critical things I'm worried about protecting."

The state's Medicaid costs have tripled, from $450 million to $1.5 billion in the past eight years, and the state faced a $40 million deficit this year.

Transportation costs also have been climbing sharply, Sabatini said, and patient utilization of the transportation services is rising 2 percent a year.

The 346,000 people affected by the latest cutbacks are those eligible for benefits under the portion of the Medicaid program that receives federal matching funds. They include people who meet income and resource limits, and who are aged, blind, disabled or on Aid to Families with dependent Children (AFDC).

Non-emergency transportation services were eliminated last July to about 34,000 other people who receive benefits under that portion of the Medicaid program that is entirely state-funded. They include people who meet the income tests but don't fall into the other categories.

Some health-care advocates have objected to the transportation cutbacks, warning that making it more difficult for poor and disabled people to gain access to medical care will cost more in the long run.

"It's real clear, after years of working with vulnerable people, that if you don't take care of the transportation part of the plan . . . it tends not to work and the costs in the long run are exacerbated," said Jeff Singer, director of community relations at Health Care for the Homeless in Baltimore.

Many Medicaid patients have multiple problems, and often need rides to a variety of services, Singer said, and "having a cab can make the difference in getting access to these services."

Cutting off Medicaid reimbursement will only shift the burden to non-profit organizations like his that can ill-afford it, he said. And, some patients will fall through the cracks.

Singer also warned that taxi services are being curtailed without adequate planning to assure that adequate van services are available to make up for the taxis.

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