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When a Medicaid ride to the doctor's office fails to show, others foot the bill

Elisabeth Olden gets into a DART  transportation van from her home Saturday with the help of driver Jake Yousey in Pinellas Park. Medicaid rides are so unreliable that some people are choosing to use PSTA's paratransit instead, even though it costs $4.50 and medicaid is paid for. This has a higher impact on the bus agency, as every paratransit route costs the agency and tax payers $22. [ KASAMBA KOKAYI   |   Special to the Times ]
Elisabeth Olden gets into a DART transportation van from her home Saturday with the help of driver Jake Yousey in Pinellas Park. Medicaid rides are so unreliable that some people are choosing to use PSTA's paratransit instead, even though it costs $4.50 and medicaid is paid for. This has a higher impact on the bus agency, as every paratransit route costs the agency and tax payers $22. [ KASAMBA KOKAYI | Special to the Times ]
Published Mar. 31, 2019

Elisabeth Olden, 53, waited earlier this month for the Medicaid-provided van to take her to a doctor's appointment.

The minutes ticked by, and Olden eyed the clock nervously. The wheelchair-accessible van was supposed to arrive no later than 12:15 p.m. for her 1 p.m. follow-up appointment. At 12:45 p.m., she called.

"They told me they canceled the ride because they couldn't find a contractor to take me," Olden said. "Nobody called me. They didn't tell me. They just cancelled."

The Pinellas Park resident is one of potentially thousands of Medicaid recipients who have been stranded, delayed or forgotten by transportation providers who are supposed to take them to their appointments. And many, like Olden, are choosing to take county paratransit options instead, which costs riders and taxpayers more money.

About 80 percent of the nearly 4 million people enrolled in Florida Medicaid have their non-emergency medical transportation provided as part of their coverage. Officials haven't counted the number of Floridians who have missed appointments or been left waiting for hours, but the problem is so pervasive it has caught the attention of hospitals and transit agencies who are stuck paying the bill.

Officials for the Pinellas Suncoast Transit Authority estimate that the agency spent $1 million in 2018 providing paratransit rides to people who chose the county bus agency instead of relying on a Medicaid-provided trip.

Tampa General Hospital is routinely unable to discharge patients because it takes extra days or even weeks to secure a Medicaid ride, said Peter Chang, vice president of care transitions. That means the hospital is racking up costs and unable to admit others while the patient waiting for the ride is stuck in a care facility they no longer need.

"I'm going into their rooms to say hi to them, and they're saying, 'When can I go? When can I go?" Chang said. "I have to explain to them that I'm trying to arrange transportation services and it's taking time."

Florida Sen. Jeff Brandes, R-St. Petersburg, is sponsoring a bill during the current legislative session after hearing from a number of health care professionals with stories about patients being stranded for hours waiting for a ride.

"We can put a man in the moon in Florida, but we can't pick someone up from a doctor's appointment on time?" Brandes quipped.

Brandes, who has long supported rideshare providers, wants to allow transportation companies like Uber and Lyft to compete with taxi companies and wheelchair-accessible vans to provide Medicaid-sponsored rides. The hope is that providing more options will decrease wait times.

The on-demand service can also be tracked on a smart phone, allowing customers and hospitals to check on the status of a ride.

"We'll have more contact and visibility from the doctor's office," Brandes said. "Today, there's really no ability to track a ride." But if the bill is approved, he said, "we can now call a medical provider and see in real time where people are."

Right now, the paratransit rides provided when Medicaid service falls through are highly-subsidized and are driving up costs for transit agencies already struggling to balance their budgets.

Pinellas County's transit authority provides door-to-door van service for people who can't take a bus because of a disability or other reason. Known as Demand Response Transportation, costs of the program have spiked in recent years. Ridership growth of about 18 percent between 2016 and 2018 has increased expenses almost $2 million, CEO Brad Miller said.

The paratransit service, which often carries a single individual per trip, costs more than $26 per ride. Users pay $4.50 of that, leaving the transit authority — and taxpayers — to cover the remaining $22.

According to Miller, the contractor who provides paratransit rides for the county said a number of people were telling drivers that they were Medicaid recipients, but they either couldn't schedule a trip or it was too frustrating and challenging, so they called the transit agency instead.

"It's one of the main reasons we are seeing shortfalls in our budget," Miller said. "They're trips that should have been paid for by Medicaid, but instead we're paying for it."

Chang has seen a similar situation at Tampa General. Rather than risk waiting for a Medicaid ride, he said the hospital will sometimes cover the cost of a trip for a patient.

"We're not shaving off an hour or two," he said. "We're talking about taking 10, 15, 20 days off a length of stay."

Olden, the Pinellas Park resident, has avoided calling a Medicaid provider again after missing her appointment earlier this month. Fortunately for her, the doctor did not charge her a fee and she was able to rebook for two days later. But that's not always the case.

"What if they couldn't reschedule me and I had to wait six months?" Olden said. "That was just so bad of them to drop me and forget about me."

Contact Caitlin Johnston at cjohnston@tampabay.com or (727) 893-8779. Follow @cljohnst.