October 21, 2008 Presented by: Ken Hosen, KFH Group, Inc. Presented to: 18th National Conference on Rural Public and Intercity Bus Transportation

 Provide more and better service for more people.  With that in mind… THE OVERARCHING GOAL FOR TRANSIT

 For many rural transit systems, Medicaid Transportation is an integral part of their coordinated network of services  Medical Transportation however is not always compatible with public transportation  You are the rural transit experts – in areas where the Medicaid model is not conducive to public transit, you can make change happen.

 The most successful rural transit systems operate as a business  Your profit is your ridership  Your currency is safety and quality  Business opportunities should be sought and assessed for the potential to have a positive impact on your service IT IS A BUSINESS

 Medicaid is the largest funding source for rural transportation  Rural transit has a successful track record in providing quality services to Medicaid  Medicaid transportation may be a great business opportunity… or not!  You may be able to shape the future of Medicaid Transportation

 Medicaid Transportation is a state run program.  There are almost as many approaches to Medicaid Transportation as there are states.  Some of them are pretty wacky  You can effect a change at the state or local level. THE MANY FACES OF MEDICAL TRANSPORTATION

 This not a medical program where everybody is accredited and assumed to meet minimum standards. There is no such thing in transportation.  Premise: Safety should be the Number 1 objective – help Medicaid managers understand and ensure the highest safety and quality standards.

 There are brokerages: ◦ Large statewide or regional (sometimes on a capitated basis – the less trips provided, the more profit is extracted) ◦ State managed ◦ Managed by county  Designated provider at the state or county level  Open system – minimal requirements to become a provider  Use of fixed route – always a winner!  And others…

 Are you running a business?  Do you believe in the power of coordination and economies of scale?  Do you want the safest service possible for all of your constituents?  Do you need local match funding to access all of your Federal dollars?

 Find out why the Medicaid Transportation managers do it that way  Maybe you can help them change to a better, safer model. You are the expert.  Transit is often the solution.  Yet, Medicaid transportation may not be a part of your organizations goals or priorities

 Educating Medicaid management about the need for high standards: ◦ Does it make sense to have two types of service standards– a low one for Medicaid and higher for the public? ◦ The need for safety – training, skilled drivers, standard procedures, proper maintenance ◦ The need for ADA compliant vehicles ◦ The highest standards of safety and quality

 How can you provide safer and better service?  Does it make business sense?  Do you have a business sense?  Have you fostered an atmosphere of trust?  It is a matter of “planting seeds” DEVELOPING A MEDICAID TRANSPORTATION BUSINESS PLAN

 Fixed route usage is easy and very inexpensive  Certify Medicaid clients to ride fixed route through the ADA process  Avoid cost transferring  Safest, best trained drivers available  Safest, best maintained vehicles  Strong operational control  You are a part of the community, Medicaid clients are your customers

 90 PERCENT OF SUCCESS IS JUST SHOWING UP  Develop a brief white paper demonstrating your capabilities and assets ◦ Safety, ◦ Quality ◦ Cost  Seek out the State Medicaid director or other appropriate person and set up a meeting  Present your capabilities and offer your services – even if it is just sharing of knowledge.