AUGUSTA, Maine - The state of Maine has spent an extra $5.4 million on its MaineCare transportation system this past fiscal year. The added expense is raising more questions about the program, which has been criticized ever since it was overhauled by the Department of Health and Human Services a few years ago.
But DHHS officials say the added costs are needed to solve past problems. The transportation program provides MaineCare recipients with rides to health care appointments . According to a recent newsletter by the state Office of Fiscal and Program Review, the service cost the state about $45 million during the last year. But the budget has since increased by 12 percent to more than $50 million.
"We are extremely pleased with the performance of this transportation system that is truly responsive to the needs of Medicaid MaineCare members," says Mary Mayhew, commissioner of the Department of Health and Human Services.
Mayhew says the transportation program costs more because over the past few years it's expanded service to nights and weekends. "We would certainly expect that increased volume would lead to increased expenditures within the program."
The state changed its MaineCare transportation system in 2013 at a point when community agencies scheduled and provided rides. The federal government had raised concerns about the lack of state oversight, and DHHS decided to move to a managed care model, where transportation brokers are paid based on the number of MaineCare recipients they serve versus the number of rides they provide.
"One of the advantages of going to any kind of managed care model is it's supposed to interject predictability and stability," says Drew Gattine, a Democratic representative from Westbrook and co-chair of the Legislature's Health and Human Services Committee. "So it appears is what we have here is the worst of both worlds. We have a system that has provided service that, by all accounts, has not been as good as the previous service, and it costs the taxpayers more."
The switch to the new transportation system in 2013 did get off to a rocky start. MaineCare recipients complained that the major broker at the time - Coordinated Transportation Services - caused them to arrive late to appointments or miss them altogether.
Currently, the largest broker in the state is Atlanta-based Logisticare. Jack Comart of Maine Equal Justice Partners says there has been a positive change. "It's an improvement over a year ago, but there have been some recent issues that clients have brought to our attention."
Issues such as clients getting dropped off for appointments but not being picked up, or vehicles that aren't equipped with car seats for children. Comart says there have always been issues with various transportation providers, and the state shouldn't necessarily ditch Logisticare, as long as the company can meet performance standards and respond to complaints.
"Well, we've layered on this brokerage system and Logisticare is a for-profit, and I think one of the others is for profit," Comart says. "So it's more costly to do it this way."
But according to DHHS Commissioner Mayhew, the increased cost is translating into better service. MaineCare quality metrics provided by DHHS for January through September of this year show that all of the state's eight regions have a complaint rate of less than 1 percent.
"I find some of the questions and inquiries abut this interesting, given that we spent two years talking about this transportation system and responding to concerns that were being raised," Mayhew says.
Rep. Drew Gattine says the Health and Human Services Committee will likely take up the issue in an upcoming meeting. He says he's concerned that lawmakers weren't notified earlier about the extra expense "that was going to cost taxpayers $5 million or $6 million more a year. I don't really understand why that wasn't flagged for us during our budget discussions."
Meanwhile, Jack Comart of Maine Equal Justice Partners says any MaineCare recipients who have complaints about transportation should notify MaineCare Member Services. Comart says the department has taken action on cases brought to its attention.
