This important article is from Kaiser Health News. Note: I can relate. I've had transportation problems through-out my professional career.
Unable to walk or talk, barely able to see or hear, 5-year-old Maddie Holt waits in her wheelchair for a ride to the hospital.
The 27-pond girl is dressed in polka-dot pants and a flowered shirt for the trip, plus a red headband with a sparkly bow, two wispy blond ponytails poking out on top.
Her parents can't drive her. they both have severe vision problems; and, besides, they can't afford a car. When Maddie was born in 2012 with the rare and usually fatal genetic condition called Zellweger syndrome, Meagan and Brandon Holt., then in their early 20s, were plunged into a world of overwhelming need- and profound poverty.
"We lost everything when Maddie got sick," said Meagan Holt, now 27.
Multiple times each month, Maddie sees a team of specialists at Seattle Children's Hospital who treat her for her condition that has left her nearly blind and deaf, with frequent seizures and life-threatening liver problems.
The only way Maddie can make the trip, more than an hour each way, is through a service provided by Medicaid, the nation's health insurance program started more than 50 years ago as a safety net for the poor.
Called non-emergency medical transportation, or NEMT, the benefit is as old as Medicaid itself. From its inception, in 1966, Medicaid has been required to transport people to and from such medical services as mental health counseling sessions, substance abuse treatment, dialysis, physical therapy, adult day care and, in Maddie's case, visits to specialists.
"This i so important," said Holt. "Now that she's older and more disabled, it's crucial."
More than 1 in 5 Americans- about 74 million people- now rely on Medicaid to pay for their health care. The numbers have grown dramatically since the program expanded in 32 states plus the District of Columbia to cover prescription drugs, health screening for children, breast and cervical cancer treatment and nursing home care.
With a Republican administration vowing to trim Medicaid, Kaiser Health News is examining how the U.S. has evolved into a Medicaid Nation, where millions of Americans rely on the program, directly and indirectly, often unknowingly.
Medicaid's role in transportation is a telling example. Included in the NEMT coverage are nearly 104 million trips each year at a cost of nearly $3 billion according to a 2013 estimate, the most recent, by Texas researchers.
Citing runaway costs and a focus on patients taking responsibility for their health, Republicans have vowed to roll back the benefits, cut federal funding and give states more power to eliminate services they consider unaffordable.
Already, states have wide leeway in how to provide and pay for the transportation.
Proponents of limiting NEMT say the strategy will cut escalating costs and more closely mirror private insurance benefits, which typically don't include transportation.
They also contend that changes will help curb what government investigators in 2016 warned is "a high risk for fraud and abuse " in the program. In recent years, the Centers for Medicare & Medicaid Services ( CMS) reported that a Massachusetts NEMT provider was jailed and fined more than $ 475,000 for billing for rides attributed to dead people. Two ambulance programs in Connecticut paid almost $ 600,000 to settle claims that they provided transportation for dialysis patients who didn't have medical needs for ambulance transportation. And the mother of a Medicaid patient who was authorized to transport her child for treatment billed Medicaid for trips that didn't take place. She was sentenced to 30 days in jail and ordered to pay $ 21,500.
Last March, Rep. Susan Brooks, an Indiana Republican, introduced a resolution that would have revoked the federal requirement to provide NEMT in an effort to provide states with "flexibility." That effort stalled.
Another Republican proposal in 2017 would have reversed the Affordable Care Act's Medicaid expansion and reduced federal funding for the NEMT program. It failed, but other efforts by individual states still stand.
Former Health and Human Services Secretary Tom Price and CMS Administrator Seema Verma encouraged the nation's governors to consider NETM waivers, among other actions, in a March letter to them.
"We wish to empower all states to advance the next wave of innovative solutions to Medicaid challenges," they wrote. The Trump administration has used state waivers to bypass or unravel a number of the Obama administration's more expansive health policies, and has granted some states' requests.
At least three states, Iowa, Indiana and Kentucky, have received federal waivers- and extensions- allowing them to cut Medicaid transportation services. Massachusetts has a waiver pending.
Critics of the cuts worry the trend will accelerate, leaving poor and sick patients with no way to get to medical appointments.
"I wouldn't be surprised to see more of these waivers in the pipeline," said Joan Alker, executive director of the Georgetown University Center for Children and Families.
Because medical transportation isn't typically covered by the commercial insurance plans most Americans use, it's unfamiliar to many people and could be seen as unnecessary, said Eliot Fishman, senior director of health policy for Families USA, a nonprofit, nonpartisan consumer health advicacy group.
Formerly a Medicaid official in the federal government, Fishman called the transportation program "vital" not only for children with severe disabilities, but also for non-elderly, low-income adults.
CMS released results of a 2014 survey of Medicaid users, which found that lack of transportation was the third-greatest barrier to care for adults with disabilities, with 12.2 percent of those patients reporting they couldn't get a ride to a doctor's office.
"This is not something to be trifled with lightly,' Fishman said. "We're talking about a lifesaving aspect of the Medicaid program."
To be continued......
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