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Medi-Cal Reimbursement for Complimentary Paratransit

Medi-Cal Reimbursement for Complimentary Paratransit. CalACT Conference - April 2019. Background. MTS was being reimbursed under a MOA with San Diego County HHSA under a program called Medi-Cal Administrative Activities (MAA)

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Medi-Cal Reimbursement for Complimentary Paratransit

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  1. Medi-Cal Reimbursement for Complimentary Paratransit CalACT Conference - April 2019

  2. Background • MTS was being reimbursed under a MOA with San Diego County HHSA under a program called Medi-Cal Administrative Activities (MAA) • 50% of MTS costs per trip were reimbursed for eligible Medi-Cal trips • 7% of total payment went to SD county for administrative fees

  3. Background • As part of the Affordable Care Act (ACA) Medi-Cal implemented Managed Care Programs (MCP’s) • HMO type health plans for Medi-Cal recipients • 99% of SD County Medi-Cal recipients are in one of these plans

  4. Change in Program • In 2016, AB 2394, passed moving the funding for Medi-Cal transportation services to MCP plans, effective 10/1/17 • Medi-Cal communicated to MCP’s in May 2017 through the All Program Letter (APL) 17-010 • March 22, 2018 SD county notifies MTS of change of funding distribution. (Officially XXX)

  5. Financial Impact • Recent increases in Medi-Cal reimbursement/revenue to MTS • FY16 $2,694,443.43 (171,373 trips @ $15.72) • FY17 $3,445,971.55 (210,913 trips @ $16.34) • FY18 $3,456,792.00 (202,875 trips @ $16.61) • 40% of Access trips are Medi-Cal approved trips • 84% of these trips are San Diego Regional Center and Adult Day Care Centers

  6. Financial Impacts • Medi-Cal reimbursement was $16.25 per trip • Loss of reimbursement on 200,000 trips annually $3,250,000 • Potential to recoup some dollars for reservation/dispatch costs

  7. Transportation Brokers

  8. Potential Solutions • Option 1: • Attempt to redirect Medi-Cal riders to MCP services- Focus on SDRC and ADC’s (benefits) • No out of pocket cost – saves customer $4.50 per trip • MCP’s provide direct service not a shared ride • Multiple letters mailed to clients • Take Ones on vehicles • Personal calls to clients • Dispatch script • Minimal Success

  9. Advantages to Option 1 • Decrease in ridership • Shift 50% of Medi-Cal trips to MCP’s • 100,000 trips @ $28.00 per trip, $2,800,000 contract savings • Additional $400,000 in fuel savings • Fleet size reduction of 10% - 20% (17 - 34 buses)

  10. Potential Solutions • Option 2: • Contract with MCP’s for payment for trips we continue to provide • Become approved Medi-Cal provider • As of March 2019 • 4 contracted • 2 declined • 2 no response • Working on legislative relief to address issues in originating legislation

  11. Questions/Comments

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