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)
March 22, 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, (171,373 $15.72)
FY17 $3,445, (210,913 $16.34)
FY18 $3,456, (202,875 $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
 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

8. 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

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