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) 50% of MTS costs per trip were reimbursed for eligible Medi-Cal trips 7% of total payment went to SD county for administrative fees

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

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)

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

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

Transportation Brokers  Plan Name Lives Broker Care 1st Partner Plan, LLC 83,583 Call the Car  Molina Healthcare of California Partner Plan, Inc. 227,471 Secure Transportation Kaiser Permanente 51,747 MTM ​Aetna Better Health of California 1,730 Access2Care Community Health Group Partnership Plan 276,376 Internal ​UnitedHealthcare Community Plan 3,481 Nat Med Trans Health Net Community Solutions, Inc. 74,205 Logisticare

Potential Solutions Minimal Success 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

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)

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

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