Trying to Give Medicaid Patients a Safer, Smoother Ride to Doctor’s Office

Lilo H. Stainton | May 26, 2016 | Health Care
Passengers with some transport services complain of late or skipped pick-ups, rude or abusive drivers

New Jersey residents who depend on a publicly funded network of cars and vans to get to medical appointments have for years complained about poor service. Medicaid patients across the state face delays, missed pickups, and other problems with the drivers — and vehicles — dispatched to take them to the doctor.

A survey released last week by the Mental Health Association in New Jersey, which advocates for thousands of patients who depend on these services, confirmed that the problems are widespread: More than half of the respondents said they had missed appointments, feared for their safety during transit, or suffered harassment, disrespect, or other indignities at the hands of the drivers. The state pays a private company $165 million to deliver the service. The company, LogistiCare, subcontracts the car service to various providers.

On Thursday the state Assembly is scheduled to vote on a measure (A-3616) that advocates hope would help ensure more timely and reliable service when it comes to Medicaid-funded transportation. Developed by Assemblywoman Valerie Vainieri Huttle (D-Bergen), the measure calls for drivers to be no more than 15 minutes late to collect patients and requires that they receive regular training on the needs of the clients they serve, low-income patients with significant mental and physical challenges, like advanced kidney disease.

The measure, which also requires the state to audit and report the service’s performance each year, passed an Assembly committee last week with unanimous support. Sen. Joseph Vitale (D-Middlesex), the chair of the health committee, said Wednesday he would introduce a companion version in the Senate.

“These are people in poverty, they have a serious mental illness, and they have no way to get anywhere,” explained Carolyn Beauchamp, president and CEO of the association. “They can’t get to church, they can’t get to jobs, they can’t get to friends, they can’t get anywhere.”

LogistiCare, an Atlanta-based company, is the national leader in non-emergency medical transportation and provides some 65 million rides each year to clients in 39 states. The state hired LogistiCare in 2009 and has paid them $165 million annually to assist 130,000 Medicaid patients on more than 5 million trips each year, according to Nicole Brossoie, a spokeswoman for the Department of Human Services, which oversees the contract.

A LogistiCare spokesperson said their workload in New Jersey increased drastically when the Medicaid expansion triggered by the Affordable Care Act added some 700,000 patients to the Medicaid rolls. The company welcomes feedback from clients, monitors services in real time, and complies with a host of safety checks, vehicle inspections and sensitivity trainings, the representative said.

Lori Bonderowitz, the general manager for LogistiCare New Jersey, added the company has worked hard over the past seven years to improve patients access to healthcare and also save taxpayer dollars.

“Assertions by MHA are particularly troubling since they do not represent our performance in New Jersey,” she said, adding that the company supports the reform bill and looks forward to working with the Mental Health Association to find solutions.

LogistiCare subcontracts the actual transportation duties to more than a 100 smaller outfits, a mix of medical transport operations, cab companies, and other providers. The service maintains a “Where’s my ride” hotline and will coordinate trips with the doctors, patients, and local transport company, according to the DHS website. The new proposal would require the management company to hold subcontractors to the same state standards.

Brossoie said the state has penalized LogistiCare several times for poor performance when clients missed appointments. Since 2013, the state has withheld more than $550,000 for various infractions. The company’s contract expires in June, and the Treasury Department is currently reviewing bids for a new contract.

Beauchamp, with MHANJ, said she has heard complaints about poor service for years — long before LogistiCare was in charge. The survey, which questioned more than 300 individuals with mental illness who depend on Medicaid transportation, found nearly a third worried about safety concerns en route; a quarter said they were treated rudely or even sexually harassed; and a third filed complaints, although half of them never saw a response. One in four surveyed said they no longer use the service.

“The survey was disturbing and entirely not acceptable, especially when you’re looking at this vulnerable population,” Vainieri Huttle said. “We’re certainly not attacking LogistiCare specifically, but we are concerned with the feedback and we’d like more positive results.”

Vainieri Huttle said she has spoken with LogistiCare and recognized it’s a complex task.

“I understand the challenges, but this is what the service is supposed to do,” she said. “And they assured me they are working on improvements.”

For Beauchamp, the bottom line is clear.

“We’re not delivering wellness and recovery at the level that we could be,” she said. “And we’re not offering enough assistance to people once they come out of a hospital and are dealing with mental illness challenges.”