Audit report on MN Medicaid transportation for persons with disabilities finds problems

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The Department of Human Services uses contractors to help transport about 253,000 Medicaid recipients to and from health care providers as required under federal law at the cost of $38 million in fiscal year 2010. The majority of the recipients covered tend to have more disabilities and are harder to serve than those in managed health care plans.

“Decisions about health and human service programs are some of the most important and challenging decisions being made … human lives, families and communities are directly affected,” Legislative Auditor James Nobles told the House Health and Human Services Finance Committee Feb. 1. These programs are costly and with many government layers it becomes necessary to examine how they operate, he said.

An evaluation report released Feb. 1 shows several areas where the department is failing, including: a duplicative and confusing administrative structure; very few formal and written policies regarding how the program should be administered and how decisions are made; poor program monitoring and oversight; and hiring an outside contractor to determine program eligibility has reduced some costs, but due to data limitations, it couldn’t be determined whether the total savings outweighed the costs of hiring a contractor.

“The department welcomes this recommendation wholeheartedly,” said Christine Reisdorf, a benefits and policy manager at the Human Services Department. “We know that the current system is confusing and inconsistent.” She said a proposal should be presented to the 2012 Legislature to address the issues.

The two major types of non-emergency transportation the state funds include access transportation and special transportation. Both get “people to and from medical appointments using the least expensive type of appropriate transportation,” but people qualify for one or the other depending on their level of need, said Jo Vos, a program evaluation manager with the legislative auditor’s office. Some recipients flip-flop between the two types because needs change within a day, for example if they can wheel themselves into a clinic for surgery but need additional assistance after the appointment.

This can be a particular problem for Greater Minnesota.

“Outstate counties often have problems finding appropriate access transportation providers who can transport people in motorized wheelchairs,” Vos said. But the recipient isn’t eligible for special transportation because they don’t need the assistance of a driver, which would be required, and thus denied service. When Medical Assistance recipients have appealed the service denial, judges have sometimes ruled in favor of the recipient and sometimes for the department, Vos said. Additionally, if guidelines or policies change, the department didn’t notify previously denied recipients that they may now be eligible.

Rep. Patti Fritz (DFL-Faribault) said the report “certainly does tell the story that many of us in Greater Minnesota were trying to relay. I’ve heard so many times from my drivers that would travel great distances to drop a person off, but they are not compensated when a recipient isn’t in the vehicle.”

Vos said Medical Assistance rules don’t allow payment for time a recipient isn’t in the vehicle. “That doesn’t prevent the state or the county from using money from other pots to reimburse for those ‘no load’ miles.” It’s the No. 1 problem Greater Minnesota counties have in finding people willing to drive those unpaid miles, she added.

The report recommends the department develop alternative reimbursement methods to help compensate those in Greater Minnesota where the problem is great.

While contracting has reduced certain transportation costs, the total savings are unclear, Vos said. For example, 11 counties in the Twin Cities metropolitan area took over a contract in 2009 for basically the same services the department was contracting for, resulting in about $2 million less in administrative fees.

“Every dollar is precious when we are trying to deliver these services to people who need them and I just hope we see some real changes,” said Rep. Steve Gottwalt (R-St. Cloud).