TRANSPORTING

person uses the services. The approach is similar to how Ohio Medicaid pays for most medical services through managed-care organizations.

States are federally required to provide Medicaid recipients with transportation for non-emergency medical services. Most states use third-party brokers to coordinate that and pay them a set amount, said MaryBeth Musumeci, an associate director at the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.

Whether run by a statewide broker or at the county level, providing Medicaid-insured people with non-emergency transportation is generally cost-effective for states because it helps avoid more expensive treatment later if that person requires an emergency room visit or hospitalization, Musumeci said. Paying a fixed amount per person also provides states with cost predictability, she said.

The Ohio Department of Medicaid hasn’t hired a company yet. The department issued a request for information in October, a precursor to seeking requests for proposals, asking potential vendors about their ability to serve Ohio’s approximately 3 million Medicaid recipients. Officials also are seeking community input.

Unique challenges

State Rep. Jay Edwards, a Nelsonville Republican, said Athens County and other counties in the region do a good job of getting Medicaid-insured people back and forth for medical care, and questions whether one state broker could do it better.

“We think people here know the area better and can devise a plan specifically for what the people here need,” Edwards said.

Nelsonville resident Elizabeth Nelson said she relies on transportation arranged by Athens County Job and Family Services to take her to medical appointments in Athens, Logan and Lancaster. Nelson, 62, who has had surgery and radiation for breast cancer, is being treated for pneumonia. She doesn’t drive and her husband, Tim, 65, can no longer drive because he is disabled from a stroke.

“It’s really a help,” Nelson said. “I do use it. I hope they keep it.”

The change is needed because the current system is inconsistent from county to county, and has limited accountability for what is provided and how the money is spent, Ohio Medicaid spokeswoman Melissa Ayers said.

“The goal is to provide consistent transportation services for all Ohioans covered by Medicaid, and more efficiently arrange for their transportation needs,” Ayers said.

Details on potential savings to the state are not yet known, she said.

Rural, southeastern and southern Ohio counties have unique challenges, said Jack Frech, who advises the Appalachian Ohio advocacy group Mayors’ Partnership for Progress, a consortium of mayors from 13 counties in the region.

“We have a higher percentage of poor people; poor people are less likely to have their own transportation, and people have to travel farther to get medical services,” he said.

Metropolitan counties, he noted, have medical professionals closer to where people live, and people there have better access to public transportation. That means the average cost for non-emergency transportation for a Medicaid patient is typically lower in metro areas than in the rural, Appalachian counties.

Frech is concerned that a statewide broker who is paid a set amount per person for transportation could wind up making money in the urban counties and losing money in rural ones. He fears that could lead to reductions in the transportation services available in his region.

Unanswered questions

Texas, Colorado and Michigan, like Ohio, have concentrated urban areas and sparsely populated rural regions. Those states use a system that pays the transportation broker a “capitated” —or fixed — amount per person for rides in densely populated areas, and a fee-for-service cost for rides in rural areas, says a report by the National Conference of State Legislatures.

Reports by the U.S. Government Accountability Office and the older-adult advocacy organization Justice in Aging have cited the general, inherent challenges in running non-emergency medical transportation in rural areas of the country.

“By definition, ‘capitated’ means you get to keep more money the less you spend providing services,”said Georgia Burke, an attorney with Justice in Aging.

Uncertainty about Ohio’s proposed system is prompting questions.

Jody Walker, director of South Central Job and Family Services, which includes Hocking, Ross and Vinton counties, said it’s unclear, for example, whether people have to call two days ahead or two weeks ahead to arrange rides to a doctor’s office, or whether there will be enough transportation service to accommodate the demand.

Among a total combined population of about 120,000 in Hocking, Ross and Vinton counties, about 40,000 people use Medicaid, including about 10,000 added under Ohio’s Medicaid expansion, Walker said.

His agency has contracts with 15 transit services, including Chillicothe Transit System and private companies, to provide nonemergency transportation.

Athens County Job and Family Services uses the Corporation for Ohio Appalachian Development, a nonprofit agency that uses seniorcitizen volunteers to drive Medicaid patients to appointments; locally operated Green Cab; and others to provide transportation, agency Director Scott Zielinski said.

“In our part of the state, where transportation is such a barrier for low-income people, it is imperative that systems to address the issue are created with as much local input and decision-making capability as possible,” Zielinski said. “We do not believe that a statewide, or even regional, system will be able to individually address all of the unique challenges our part of the state faces.”

Ohio Medicaid currently spends approximately $71 million from the total annual budget of about $27 billion on non-emergency medical transportation, Ayers said.

Ohio Medicaid officials will continue to seek community input in developing a new system, she said. When it will start has not been established.