I started using Medicaid transportation sometime in the 1990’s. I had regular appointments with a doctor whose office was on the seventh floor of a downtown building, and there was no seating in the lobby. I had been on Social Security Disability since 1991, which meant that I was too poor to own a car. I also was too sick to stand inside the building and wait for a taxi.
Nobody knew what was wrong with me. The symptoms most nearly resembled relapsing/remitting multiple sclerosis so I was frequently tested for that but the results came up negative, however, there came a time when I no longer could stand up and wait for a taxi. The way it works is that you call Medicaid dispatch at the end of your doctor’s appointment, they call a cab, and the taxi company puts Medicaid calls as their lowest priority. Among other things, the drivers know that Medicaid patients are too poor to tip them.
If you think that poor people get the same service as middle-class people, you are dead wrong. The same dollars that the taxi company gets paid by Medicaid and by the middle-class customer do not buy the same level of service. Taxi companies always lie to everybody about when the taxi will arrive—there’s equality in that—so you never know if you’re going to stand and wait a short time or a long time and if you’re not there when the taxi arrives then it takes off without you. And taxi drivers will not come inside to get you, nor can you hear the taxi’s horn beep inside a seventh floor downtown office building.
So the day came when I left the front door where I’d been standing, went back up to Dr. Ghaly’s office in tears, and sobbed, “I just can’t stand up any longer!” Dr. Ghaly said, “Then we will get you wheelchair transportation.” I did not, at that time, need wheelchair service; I needed escort service but neither Dr. Ghaly nor I knew such a thing existed. Medicaid transportation does not tell people what their options are. In nearly fifteen years of using Medicaid transportation, not once have I seen any brochure that explains how to use Medicaid transportation. Information is power; if you deprive people of information then it is so much easier to control them.
So I started using a wheelchair—except that I didn’t always need it. Some days I could walk and stand. Anybody with multiple sclerosis or any other autoimmune disease will tell you that this is the way it is—you never know from one day to the next how you’ll be doing. There are too many variables and most of them are unknown. So some days I needed a wheelchair and some days I didn’t, but it was not acceptable to Medicaid transportation dispatch, as administered by Kathy Hart and Wayne Freeman, for me to choose. Choice, i.e., freedom, is something that is explicitly denied by government officials to people receiving government services. We are deemed to be immoral people who are just waiting for the opportunity to commit acts of thievery. I think this is because government officials are immoral people who have found the opportunity to commit acts of thievery.
So I went back to the doctor and got an order saying I could travel either by wheelchair van or escort service. (During the years since I started using Medicaid transportation, I had learned a thing or two.) Nevertheless, Wayne Freeman told me I had to continue to travel by wheelchair because there was no way to code either/or on his computer program. I was being forced to become a cripple in a wheelchair because Freeman couldn’t change a computer code—not to mention that it was costing the taxpayers more money.
Then in March 2004 I had a bright idea: why have any Medicaid dispatch?
In reflecting upon the continuing difficulties with Medicaid dispatch, I got to wondering why Medicaid dispatch exists at all. To the best of my knowledge, all they do is take orders in from clients, verify Medicaid, and mis-send the orders to vendors.
Why not cut out the middleman and put the Medicaid verification and scheduling in the hands of the vendor?
If I need a pharmacy, lab, or doctor, I choose one, make a direct call, and the pharmacy, lab or doctor verifies my Medicaid and schedules an appointment. Why not do the same with medical transportation?
Shut down the dispatch center and reallocate the funds to the vendors so they can hire their own personnel to do the job. Pro-rate the funding to hire new people based on the number of rides each vendor has carried in the previous contract year.
Every time data is handled, you increase the probability that mistakes will be made. Cut out a step and put the verification and scheduling in the hands of the vendor. The vendors will eagerly supervise the new personnel, and the new personnel will work better as a part of a team in which they get firsthand feedback on the effects of their work.
Among other things, it probably will save the county a lot of money to put the verifiers and schedulers with the vendors rather than maintain a separate shop for them. Also, this new method will give the clients the freedom of choice that they are supposed to have, and it will ensure that orders don’t go to the “wrong” vendor. The vendors and clients will have a much higher level of satisfaction, and your time will be freed up for more constructive work than putting out fires.
We’ve all spent years dealing with the awful frustrations of the existing system, which apparently began with the medical society and the idea that doctors should control everything. It seems that no matter who takes the dispatch contract, they can’t make the system work. Can you think of any reasons why this new proposed system wouldn’t work?