Medicaid cuts imperil rural health links State budget trims $600,000; $1.2 million lost in federal matching funds

It’s no surprise that the lean-and-mean state budget is forcing social service agencies to tighten their belts.

But a $600,000 cut in the MaineCare program – the state umbrella for Medicaid – may mean the end of an important service altogether, some social service providers believe.

Members of the Coalition of Maine Transportation Providers, the social service agencies that run programs that transport low-income people to health care facilities, claim the cut in state funding “will collapse the human service transportation network throughout Maine,” according to a statement issued late last month.

The $600,000 cut means the loss of another $1.2 million in federal matching funds, equaling a $1.8 million cut to the transportation programs.

The Bureau of Medical Services, part of the Department of Human Services, identified the $600,000 cut in response to Gov. John Baldacci’s call for trimming of all state services, said Newell Augur, spokesman for the bureau.

The cut was necessary, he said Friday, to avoid the far more severe consequences of cuts that would remove some from Medicaid rolls, as has been done in Massachusetts.

But transportation program directors fear the cuts will mean an end to the service that many poor rural residents rely on to get to physician and treatment appointments.

Lee Karker, executive director of the Methodist Conference Home in Rockland, said his agency’s Coastal Trans program will see a loss of $100,000 for the year that begins July 1.

“We can’t absorb it,” Karker said. “We can lay off drivers, we can lay off administrative staff, we can take vehicles off the road,” but Coastal Trans will no longer be able to provide service in the same way, he said.

Last year, Coastal Trans provided 900,000 miles of transportation for 65,000 passengers. About 75 percent of those trips are for Medicaid recipients, Karker said. About a third of users are elderly, and another third are disabled, he said.

Coastal Trans operates a fleet that includes mostly minivans, but also 14-passenger vans and wheelchair-accessible vehicles. The service is used regularly by 1,600 people in Knox, Lincoln, Sagadahoc and parts of Cumberland County, Karker said.

Users rely on the service to be taken to hospitals for tests, or to regular treatment appointments, such as dialysis, which is available only in Belfast or Bath.

“These folks are pretty frail,” he said of the service’s users. “If they don’t go [to dialysis] three times a week, then they’re headed toward the end of their life. This is kind of a lifeline service.”

Karker said severing the transportation link for the rural poor makes other services irrelevant.

“It’s kind of pointless to provide these other services,” he said, if people can’t get to them.

Sharon Eaton, transportation director for Penquis CAP, which provides services for residents of Penobscot and Piscataquis counties, said her agency provided 108,520 billable Medicaid trips last year. The loss of funds may threaten that level of service, she said.

“I think the impact is going to be severe,” she said. “It may mean we have to do business differently.”

Instead of agreeing to transport people with 24-hour notice, she said, Penquis may have to switch to one-week notice.

Linda Belfiore, transportation director for the Washington Hancock Community Agency, said her agency provided 128,000 rides last year.

“We may not be able to continue,” with the cuts, she said.

Augur said the MaineCare transportation budget was $15.5 million, and that an earlier proposal to cut $1 million was reduced to $600,000.

“These cuts, as with all the cuts, are difficult,” he said. But Augur disputed the view that programs would collapse.

“We don’t believe this is going to limit access to anyone,” he said.

Augur said the state believes providers can save money on their programs.

“We are still working with the providers to find ways to find efficiencies in scheduling,” he said.

Karker, Eaton and Belfiore all noted that their programs already rely heavily on volunteer drivers, and that cost-cutting would be difficult.

NEWS reporter Liz Chapman contributed to this story.