Agencies Raise Concerns About State's New Rule For Medicaid Rides | WGLT

Agencies Raise Concerns About State's New Rule For Medicaid Rides

Jan 4, 2019

UPDATED 3 p.m. | Central Illinois transit and social service agencies say they hope the state will pull back from burdensome new requirements that some fear will prevent low-income and disabled patients from reaching their medical appointments.

The change impacts hundreds of Central Illinoisans on Medicaid who use Connect Transit, Show Bus, and other non-emergency transportation options to go the doctor. The state, through Medicaid, covers the cost of those trips.

But starting Feb. 1, the state will require a new form to be completed by the medical provider for every trip. Officials at local social service and transit agencies say that’s a big increase in paperwork and bureaucracy, pointing to those on dialysis who may require roundtrip rides several times a week.

“Anytime you ask a medical office to fill out a form, it’s a big deal. It’s always difficult,” said Laura Dick, executive director at Show Bus, which provides non-emergency transportation in nine counties, including McLean. “The problem is, they just don’t do it. And then you end up with folks who don’t have the approval for their transportation.”

The new “onerous” requirements are an unnecessary barrier for those who need help getting to their appointments, said Rickielee Benecke, who advocates for the disabled as executive director of Bloomington-based LIFE Center for Independent Living.

There’s also concern that those few doctors who do accept Medicaid will be even less inclined to do so, given the extra paperwork, said Benecke.

“It worries me,” she said. “Because people with disabilities, especially cognitive disabilities, will be unable to get to their appointments.”

"It worries me. Because people with disabilities, especially cognitive disabilities, will be unable to get to their appointments."

Added LIFE Center Program Director Meri Helbig: “Transportation is already a huge barrier.”

The reason for the change is unclear. It’s tied to legislation passed last year in Springfield. The Department of Healthcare and Family Services (HFS) sent a memo Nov. 21 to transportation providers, hospitals, and nursing facilities, explaining the changes.

A spokesperson for HFS did not respond to a request for comment.

HFS officials told the Illinois Public Transportation Association (IPTA) this week that they’re still trying to figure out how to implement the change, said IPTA Executive Director Laura Calderon. It’s unclear whether that new form will just be required to be kept on file, or sent somewhere, or actually approved in advance.

The incoming Pritzker administration (which takes over Jan. 14) may also take a different approach to the issue, she said.

“If they were to require this every-single-trip approval prior to the trip happening, they’re certainly going to reduce the number of Medicaid trips,” Calderon said.

Calderon said she expects the state to roll back the requirement or otherwise make it less burdensome. So do officials at Bloomington-Normal’s Connect Transit, one of the only urban transit systems in Illinois that offers non-emergency medical transportation like this.

Connect Transit only got approved to accept Medicaid riders in fall 2018. Since then it’s provided 1,350 trips to 91 people, said Martin Glaze, interim chief operating officer at Connect Transit. Those riders save $2 each trip by using their Medicaid benefits, and those savings add up quickly, he said. One person has already taken 100 trips.

Even before this change, the process was burdensome and required some hand-holding from Connect Transit staff, Glaze said.

“It’s putting a lot of onus on an individual who may not be capable of making sure that they’re doctor fills this out. They have to call and see if a ride’s available. Then they have to call and get the ride OK’d through First Transit (the state's vendor). Then they have to call the doctor and make sure the doctor has the appointment set up and they’ll fill out this paperwork. Then they have to call us back with a reference code,” Glaze said.

“It’s crazy how burdensome this is for people,” he said.

Show Bus will continue to provide rides to Medicaid clients, Dick said, though it will likely get less money back from the state from those rides because the required paperwork won't be complete. Show Bus got $43,000 from the state for Medicaid riders last year, she said.

"While that is not a tremendous amount of revenue compared to our budget, it is important and can serve as match for other funding streams that require it," Dick said.

Glaze said he's heard from a lobbyist who worked on the issue that the additional burden may have been unintended. It may be tied to original legislative intent aimed at properly reimbursing transportation providers when doctors are the ones making the request for transport, he said.

Regardless, Glaze said Connect Transit’s Medicaid-covered riders will have to abide by the new rules for now.

“We’re pretty confident that this will get changed or modified. But I’m not sure when,” he said. “If we want these trips covered for our riders, we’re going to have to follow it."

Editor's note: This story has been updated to correct comments attributed to Martin Glaze about the possible legislative intent tied to the change.

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