State Seeks to Speed Up Ride, Shorten Waiting Time for Medicaid Transportation

Andrew Kitchenman | May 4, 2015 | Health Care
Patient opinions in state survey differ from what providers, advocates report

Wayne Vivian is a member of the Medicaid Assistance Advisory Council, a body that advises Medicaid officials.
The state government is planning to improve transportation for Medicaid recipients, which a number of providers and advocates have identified as obstacles preventing some patients receiving the care they need.

State officials plan to require that every van have a geographic tracker that will enable dispatchers to tell patients how far away their ride is when waiting for transport to a healthcare appointment. This requirement will be included in a request for proposals (RFP) expected in the next 10 days for a company to serve as a transportation broker, hiring and dispatching local van providers.

Medicaid recipients receive free transportation for non-emergency medical appointments as part of their benefits. They must receive prior approval from their healthcare provider and use either public transport or van services contracted by LogistiCare, the Atlanta-based company that’s served as the non-emergency transportation broker since 2009.

Medicaid is the primary program delivering medical coverage for low-income residents.

The state is also considering an initiative in which van drivers will be paid at least in part on how well they perform their jobs.

The final RFP comes nearly nine months after the state sought comments for a draft proposal, a move that was hailed by providers and advocates who are concerned with what they describe as chronic delays affecting Medicaid patients. The issue is likely to become particularly important as the state sees an influx of Medicaid recipients as a result of the Affordable Care Act.

State officials are writing the final proposal with a key piece of information that was recently made public — a survey of both patients and providers evaluating how satisfied they are with the work done byLogistiCare. .

The survey was conducted by IPRO, a nonprofit healthcare research organization.

The survey found a big gap between the problems described by providers and advocates and a relatively pleased group of Medicaid recipients — a gap that state officials are at a loss to explain.

For example, only 30 percent of those working at facilities that serve Medicaid patients said they were satisfied or very satisfied with the timeliness of patient pickups after appointments, while 82 percent of patients said they were satisfied with the wait times for pickups.

And while 93 percent of patients who required assistance from their drivers in getting in and out of the vehicle said the driver was willing and able to help, only 58 percent of those who work at provider facilities said the drivers were always or usually able to provide assistance, while 42 percent said they were sometimes, rarely, or never willing and able to provide assistance.

The ratings were even worse from mental-health and substance-abuse providers, who said that drivers were willing and able to help patients get into or out of vehicles sometimes, rarely, or never 62 percent of the time, while they always or usually help 38 percent of the time.

LogistiCare provided its own statistics to the state about the timeliness of the drivers it hires — 80.8 percent of patients were dropped off early or ontime, while 77.3 percent of patients were picked up from appointment early or within 15 minutes of the scheduled pickup time.

Steven Tunney, who oversees Medicaid transportation for the state, noted a problem with LogistiCare failing to provide a reason for 20.4 of the cancellations of trips, listing the reason as “unknown.”

“We’ve told them that we have to have a reason, so we can track that kind of data,” Tunney said. “That number’s way too big.”

But 96 percent of patients whose trips were completed said their trips were good or very good, while only 4 percent said they were poor or very poor.

Crystal McDonald, organizing director for faith-based advocacy organization Faith in New Jersey, said the survey might not have reached a representative sample of Medicaid recipients. She noted that only 17 percent of patients responded to phone calls, adding that many recipients don’t answer their cellphones or are wary of criticizing their transportation provider.

“We know, having worked in the community, that there are several problems,” McDonald said.

Tunney said his office receives many complaints, but they represent a small portion of all 4.5 million Medicaid trips given between July 2012 and June 2013, the period included in the IPRO study.

The complaints “seem overwhelming but, again, when you’re talking … four and a half million trips, you have to expect some of that,” he said.

Faith in New Jersey would like to see the final RFP include provisions to improve quality, accountability, data transparency, and collaborations involving Medicaid transportation.

McDonald said the state’s decision to hire IPRO to do the survey was a good first step toward increasing accountability. IPRO is conducting a followup survey, which will indicate whether changes the state has already made had an effect on providers’ satisfaction. In addition, state officials have said the RFP will require all vans to have global positioning system (GPS) trackers, which McDonald said is another positive step.

The organization, along with the Camden Coalition of Healthcare Providers, would like to see patients be able to choose their transportation providers, as an incentive to improving customer service.

In addition to the improvements planned through the RFP, the state has been taking other steps to improve the transportation service. It’s launched a unit that works at LogistiCare’s New Jersey office to ensure that customer concerns are addressed. And it’s planning to more actively monitor the service, both by having state Medicaid workers visit provider facilities and watch how van drivers treat patients when they drop them off, and by taking “secret rides” in which the drivers won’t know that the workers aren’t patients.

“We can see if they’re being rude,” Tunney said.

The issue was discussed at a recent meeting of the Medicaid Assistance Advisory Council, a body that advises Medicaid officials.

Council member Wayne Vivian said he’s been frustrated that some Medicaid patients have to wait for approval to switch from public transit to the LogistiCare system.

“We’ve had people in our program that have developed cancer and then they could no longer take the bus,” said Vivian, who works as a case manager for a nonprofit organization. “They had to take the (LogistiCare) transportation, and, you know, we couldn’t get them to their chemotherapy and all kinds of things. It was really difficult — we really had to jump through hoops to make those changes.”

Tunney said there shouldn’t be any lag in changing the type of transportation that patients receive.

Vivian suggested that the state allow some flexibility for patients to take a mixture of public transit and vans, depending on how they feel.

Horizon NJ Health official Joseph Manger, whose company manages some Medicaid recipients’ care, said he’s seen real improvements over the past year in addressing transportation problems based on changes that the state has made.