The only significant consequence of my meeting with County Legislator Kathy Rapp was that my vendor stopped carrying me. He started kicking my rides back to Medicaid dispatch and saying that he couldn’t provide service in the time frame requested, which I knew to be untrue. Previously, I had talked to him and was scheduling my doctor’s appointments to fit his transportation schedule so I could ride with him.
What I did not understand was the extent of the malicious retribution being engaged in by the Onondaga County government. I was now hearing it from other vendors. Medicaid transportation dispatch was a complete mess that was costing vendors thousands of dollars. Patients would call Medicaid to cancel their appointments but Medicaid wouldn’t send the cancellations on to the vendors.
Say you’re a small business, running maybe ten vehicles. You send a driver in a wheelchair van out to pick up a patient and when the driver gets to destination the patient says she’s not going. You—the vendor—have just paid for gas and the driver, not to mention insurance and registration and vehicle maintenance, and not made a cent on the trip out and back, which could be anywhere from twenty minutes to two hours. Medicaid vendors do not get paid for wasted trips. When dispatch screws up, the vendor has to eat the cost. Likewise, when dispatch does not send the correct home address—or any address—or the room number in an office building with two hundred doctors, the vendor has to absorb the cost of the time the drivers spend hunting for the patients. Additionally, every time the dispatcher fails to properly fill out the paperwork then the state kicks back the billing and the vendor doesn’t get paid.
The vendors were suffering. The county was setting the rate at which the vendors got paid and the county wouldn’t raise it to cover the losses suffered by vendors as a result of the county’s dispatch subcontractor. And the county, in the person of Medicaid Director Kathy Hart, was threatening the vendors. If a vendor tried to talk to Hart about his problems, she would suggest that she would just cancel his contract with the county. So, when my vendor found out that I was calling for Kathy Hart to be fired, he stopped carrying me. Was this an act of cowardice or just good business? None of the vendors would stand up to Hart; she controlled the contracts that covered the majority of their business.
By now I was going absolutely nuts. All I wanted was to get to the doctor. I was really sick and had appointments with my primary care physician, pulmonologist, neurologist, cardiologist, rheumatologist, allergist, gynecologist, psychiatrist and psychologist. (Just about the only specialists I never saw were orthopedic physicians.) I just wanted to see the doctors to try to get my health back. That’s all I wanted and the law said I should have it. Physicians prescribing pharmaceuticals had made me disabled; disability had made me unable to work; unable to work, I had become poor.
Federal law, originally arising out of the Great Depression and the country’s desire to care for its citizens, said that poor people should get medical treatment and transportation to that medical treatment. The law said so.
Onondaga County government said tough noogies, bitch; you get as much nothing as we can arrange.
What does a citizen do when the government is not doing what it’s supposed to do? If you bought a washing machine from Sears and it broke down, you’d call Sears and expect them to fix it, wouldn’t you? And they probably would because they want you to keep coming back to Sears instead of going to JC Penney. But the government is a monopoly. You got no choice. There is no alternate government you can choose if this one doesn’t work. You have to play the government’s game.
Or do you? The executive branch of the government is supposed to abide by the laws passed by the legislative branch. The states have to abide by the laws passed by the federal government and the counties have to abide by the state laws—don’t they? If the county government is legally required to provide your transportation for medical treatment then who do you call when it doesn’t?
You for sure don’t call for a bus—not in Onondaga County. While all this was going on with Medicaid transportation, I also was having trouble with Call-a-Bus. Under the federal Americans with Disabilities Act, bus companies are required to provide paratransit, that is, parallel transportation for people with disabilities. In Onondaga County, Centro is the bus company and Call-a-Bus is the paratransit subsidiary. And it didn’t work any better than did Medicaid transportation.
Medicaid transportation exists solely to transport poor people to and from medical appointments; paratransit is supposed to take people with disabilities anywhere they take people without disabilities. However, Centro’s Call-a-Bus (CAB) was prioritizing; if you were going to a medical appointment then you were more apt to get a ride than if you were going out to lunch. CAB was an appalling and frightening mess. First, you had to apply for the service and then wait about a million years for a response from CAB.
Then you had to call in your ride order at least a day before the date of travel. You only could place your ride order in the morning. What if you were working with your aide and forgot? The women who took ride orders in CAB where bullies who spent most of their time saying “no”—no, you can’t go to that destination, no, you can’t get picked up at that time, no, no, no. Once you actually got your ride order accepted, you then had to call back to find out the time for which your pickup and return had been scheduled, but you only could call and get that information between 3:00 and 5:00. What if you were in a doctor’s office waiting for Medicaid transportation? How were you to find out your travel times?