Minnesota House of Representatives

Menu

Public Information Services Menu

At Issue: No access for all

Published (2/4/2011)
By Patty Ostberg
Share on: 



The Department of Human Services uses contractors to help transport about 253,000 Medicaid recipients to and from health care providers as required under federal law at the cost of $38 million in fiscal year 2010. The majority of the recipients covered tend to have more disabilities and are harder to serve than those in managed health care plans.

“Decisions about health and human service programs are some of the most important and challenging decisions being made ... human lives, families and communities are directly affected,” Legislative Auditor James Nobles told the House Health and Human Services Finance Committee Feb. 1. These programs are costly and with many government layers it becomes necessary to examine how they operate, he said.

An evaluation report released Feb. 1 shows several areas where the department is failing, including: a duplicative and confusing administrative structure; very few formal and written policies regarding how the program should be administered and how decisions are made; poor program monitoring and oversight; and hiring an outside contractor to determine program eligibility has reduced some costs, but due to data limitations, it couldn’t be determined whether the total savings outweighed the costs of hiring a contractor.

“The department welcomes this recommendation wholeheartedly,” said Christine Reisdorf, a benefits and policy manager at the Human Services Department. “We know that the current system is confusing and inconsistent.” She said a proposal should be presented to the 2012 Legislature to address the issues.

The two major types of non-emergency transportation the state funds include access transportation and special transportation. Both get “people to and from medical appointments using the least expensive type of appropriate transportation,” but people qualify for one or the other depending on their level of need, said Jo Vos, a program evaluation manager with the legislative auditor’s office. Some recipients flip-flop between the two types because needs change within a day, for example if they can wheel themselves into a clinic for surgery but need additional assistance after the appointment.

This can be a particular problem for Greater Minnesota.

“Outstate counties often have problems finding appropriate access transportation providers who can transport people in motorized wheelchairs,” Vos said. But the recipient isn’t eligible for special transportation because they don’t need the assistance of a driver, which would be required, and thus denied service. When Medical Assistance recipients have appealed the service denial, judges have sometimes ruled in favor of the recipient and sometimes for the department, Vos said. Additionally, if guidelines or policies change, the department didn’t notify previously denied recipients that they may now be eligible.

Rep. Patti Fritz (DFL-Faribault) said the report “certainly does tell the story that many of us in Greater Minnesota were trying to relay. I’ve heard so many times from my drivers that would travel great distances to drop a person off, but they are not compensated when a recipient isn’t in the vehicle.”

Vos said Medical Assistance rules don’t allow payment for time a recipient isn’t in the vehicle. “That doesn’t prevent the state or the county from using money from other pots to reimburse for those ‘no load’ miles.” It’s the No. 1 problem Greater Minnesota counties have in finding people willing to drive those unpaid miles, she added.

The report recommends the department develop alternative reimbursement methods to help compensate those in Greater Minnesota where the problem is great.

While contracting has reduced certain transportation costs, the total savings are unclear, Vos said. For example, 11 counties in the Twin Cities metropolitan area took over a contract in 2009 for basically the same services the department was contracting for, resulting in about $2 million less in administrative fees.

“Every dollar is precious when we are trying to deliver these services to people who need them and I just hope we see some real changes,” said Rep. Steve Gottwalt

(R-St. Cloud).

Session Weekly More...


Session Weekly Home



Related Stories


A positive balance
Omnibus health care law focuses on reform, restoring cuts and delaying pending cuts
(view full story) Published 5/25/2012

Looking out for children and families
Law offers new safe haven option for newborns; addresses adoption and child safety
(view full story) Published 5/25/2012

Caring for those who care for others
Omnibus health and human services bill remains a moving target
(view full story) Published 3/30/2012

Nursing home funding models
Should residents who can afford to, pay more?
(view full story) Published 3/23/2012

Minnesota Index: Smoking in the state
Facts and statistics on tobacco use in Minnesota
(view full story) Published 3/16/2012

Reform measures draw support
Health and human services reductions draw sharp DFL rebuke
(view full story) Published 8/11/2011

Delivery of health and human services
Governor says proposal puts too many people in health care jeopardy
(view full story) Published 7/15/2011

Surgical precision
HHS budget — end-of-session sticking point
(view full story) Published 5/20/2011

Advocating for patients and constituents
Nurses as legislators add their perspective to health care issues
(view full story) Published 5/13/2011

Aiming for reform
House approves omnibus health and human services finance bill
(view full story) Published 4/8/2011

Omnibus game and fish bill approved
Deer hunting, two-line fishing provisions push people’s buttons
(view full story) Published 4/8/2011

Care for underserved communities
Community paramedic program is a ‘first of its kind’ proponents say
(view full story) Published 4/8/2011

A hand up in climb out of poverty
Bipartisan initiative looks to fund expansion of ‘Circles of Support’ program
(view full story) Published 4/1/2011

Feature: A healthier Minnesota
Long-term savings the goal of statewide improvement plan
(view full story) Published 2/4/2011

At Issue: No access for all
Report says more oversight needed of state-funded non-emergency transportation
(view full story) Published 2/4/2011

Public Information Services  ·   175 State Office Building, Saint Paul, MN 55155   ·   Public.Information@house.mn