It’s often a hassle getting to a doctor’s appointment and back in a timely way.
It’s even worse if you’re sick and poor. You might not have a car. Your medical condition might prevent you from driving.
It’s a dilemma faced by many of the 3.87 million Floridians who rely on Medicaid, the state-federal health care program for the sick and disabled. Under Medicaid, health-care companies are required to provide transportation for patients.
But the system doesn’t always work perfectly.
State Sen. Jeff Brandes says he learned about the problems from a woman who worked in a cancer center in his Pinellas County district.
“She would come in and tell me stories about (Medicaid) cancer patients waiting sometimes for hours in their lobby, or just outside their lobby. Or sometimes the vehicle would pull up and not see the person sitting outside and drive off without them,” Brandes said.
“If we can put a man on the moon, we should be able to get people to and from their appointments timely and using all the best options,” he said.
Brandes, a St. Petersburg Republican, has a solution to make medical appointments easier for Medicaid patients. He is advancing a bill (SB 302) in the 2019 Legislature that would allow companies like Uber and Lyft to participate in the Medicaid non-emergency medical transportation program. Drivers involved would have to undergo background checks.
It’s a relatively straightforward idea. But the state Agency for Health Care Administration, which oversees the Medicaid program, says it is not aware of any other state that transports patients by Uber or similar services.
Brandes says one of the problems with the current system is that it can take up to 24 hours for someone to pre-arrange a trip to the doctor via taxi or a wheelchair van.
“If something goes wrong, now they’re left in a bind,” Brandes said.
Under his proposal, transportation brokers who arrange rides for Medicaid patients would be able to contract with Uber, Lyft or other “transportation network companies.”
“This would provide them the ability to get on an app working with the industry and provide maybe six or seven minutes of lead time, which is radically better,” Brandes said.
The problem for most Medicaid patients is being picked up in a timely manner, according to a 2016 study by University of South Florida researchers.
The USF report looked at transportation services being provided by two brokers across the state for Medicaid patients who aren’t enrolled in managed-care programs.
The study found the majority of patients (64.5 percent) were usually picked up on time for their appointments. But more than half (56.77 percent) reported they waited a half-hour or more to be picked up after their appointments.
“The biggest problem is being picked up from appointment,” one Medicaid patient said. “I usually wait one hour if not longer.”
Brandes’s Uber provision appears to have wide support, including backing from the health care companies that provide services under Medicaid. But he has added another provision to the bill that could complicate the legislation’s passage this spring.
The second proposal would let ambulances cross county lines to transport non-emergency Medicaid patients who might need medical assistance during the trip.
Under current state law, the ambulances are licensed and generally restricted to service in a single county.
Audrey Brown, head of the Florida Association of Health Plans, which represents health care companies that handle Medicaid patients, said over a three-year period ending in 2018 about 4,500 of 113,000 non-emergency ambulance trips for Medicaid patients had to be canceled because a vehicle was not available.
Like his Uber provision, Brandes says the ambulance measure is designed to help the Medicaid patients.
“There should never be a time when we say that an artificial line in the road creates a prohibition against somebody getting health care,” he said. “And that (state law) doesn’t stand in the way of some child with a (tracheotomy) tube getting moved from his house to the hospital.”
But Sen. Ed Hooper, a Clearwater Republican, says he is concerned that letting ambulances leave a county for non-emergency trips could cause delays or problems if the vehicle was needed in its home county for emergency services.
Cari Roth, a lobbyist for the Florida Ambulance Association, said her organization opposes the measure. She says the problems facing Medicaid patients who need ambulance transportation could be resolved without “blowing up” the current regulatory scheme for ambulance services.