Dwindling Obamacare funds could hurt regional Medicaid transit program | VailDaily.com

Dwindling Obamacare funds could hurt regional Medicaid transit program

Obamacare has been the law of the land since it was approved by congress and signed by President Barack Obama.

EAGLE — As Medicaid expansion costs increase and Obamacare reimbursements decrease, a regional program providing medical transportation may be on the chopping block, advocates say.

The Northwest Colorado Council of Governments books trips through local transportation companies for a surprising number of Medicaid enrollees and then takes care of the complicated federal Medicaid paperwork for reimbursements.

The Mountain Ride Transportation Resource Center program has grown along with Medicaid enrollment in Colorado's mountain resort region.

"A lot of people you would know in Eagle County take advantage of this program," said Jon Stavney, executive director of the Northwest Colorado Council of Governments. "We want people to use the service. As word gets out and it grows, we feel more people will."

“One of the major gaps in senior care in the mountains is getting transportation to medical care. ... If Medicaid drops in funding, there would be less funding. That means fewer doctors visits and other medical care.”Jon StavneyExecutive director, Northwest Colorado Council of Governments

Mountain Ride patients sometimes travel more than 100 miles to see specialists in Grand Junction or Denver for non-emergency procedures — everything up to kidney dialysis, Stavney said.

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Expanding program

Throughout the three-year Obamacare Medicaid expansion, Mountain Ride trip reimbursements soared from $20,004 in four months during 2014 to more than $220,939 through the first half of this year.

"We were astonished by the first half of 2017 ride numbers," said Karn Stiegelmeier, chair of Northwest Colorado Council of Governments.

Call volume varies widely across the program, from 224 trips in Pitkin County in 2016 to 1,627 in Grand County, according to Northwest Colorado Council of Governments.

Increased Medicaid numbers

Almost 14 percent of Eagle County's 53,000 residents are enrolled in Medicaid, and more than 14 percent in Summit County, according to the Colorado Department of Health Care Policy & Financing.

"When we compiled the information, we were surprised by the number of people being served by Medicaid in our mountain communities," Stiegelmeier said.

The Mountain Ride program started in 2014 following a 2011 analysis of senior services by Northwest Colorado Council of Governments and the Alpine Area Agency on Aging. That analysis was refreshed in 2016 and identified medical transportation as a major hurdle in seniors being able to age in place.

"One of the major gaps in senior care in the mountains is getting transportation to medical care," Stavney said.

Mountain Ride is run by a three-person department and was partially funded through a $210,000 one-time start-up grant from the Colorado Department of Transportation. That grant will be used up this year.

Other funding comes through a separate annual CDOT grant that won't be confirmed until Aug. 4. Northwest Colorado Council of Governments membership dues and contributions also pay some of the costs.

"Regional mobility management in Colorado creates accessibility to basic needs, social interactions and vital appointments for people with disabilities, veterans and older adults," said Moira Moon, CDOT's lead grant coordinator.

Stavney said the increased number of people enrolled in Medicaid parallels the increase in people using this program.

"If Medicaid drops in funding, there would be less funding. That means fewer doctors visits and other medical care," Stavney said.

Into that mix of uncertainty is the Republican effort to repeal and replace Obamacare.

Three free years are finished

In 2014, Obamacare offered to pick up 100 percent of the tab for three years if states would expand their Medicaid eligibility to people earning 138 percent of the federal poverty level. That's $33,948 for a family of four.

Those three years are up, and 32 states jumped on that Medicaid expansion bandwagon, including Colorado.

A new report from the conservative Foundation for Government Accountability finds that enrollment in Medicaid expansion states is far higher than projected:

• 24 states projected that their total Medicaid expansion would be 5.5 million.

• More than 11.5 million people signed up.

The Centers for Medicare and Medicaid Services reports that per-enrollee costs for newly eligible people were 49 percent higher than expected, $6,366 in 2015, above the projected per-person cost of $4,281.

In March 2016, the Congressional Budget Office increased its 10-year cost projection for Obamacare's Medicaid expansion, determining that it will cost the federal government $1.34 trillion during the next decade, an increase of $136 billion from the CBO's predictions in 2015.

To cover that tab, states that expanded Medicaid will see their own Medicaid costs climb almost 6 percent next year, compared with 4 percent for states that didn't expand Medicaid, according to the Kaiser Family Foundation.

By the numbers

The Mountain Ride Transportation Resource Call Center books transportation for Medicaid patients to see medical specialists.

1,085: Medicaid reimbursed non-emergency trips in 2014, its inaugural year.

4,864: Medicaid reimbursed non-emergency trips in 2015.

6,461: Medicaid reimbursed non-emergency trips in 2016.

4,200: Medicaid reimbursed non-emergency trips so far in in 2017, a 30 percent increase in Medicaid usage.

Source: Northwest Colorado Council of Governments

Follow the money

Total reimbursements to individuals for non-emergency medical transportation through Mountain Ride:

• $20,004 in 2014 (4 months)

• $131,633 in 2015

• $193,855 in 2016

• $220,939 through the first half of 2017

Source: Northwest Colorado Council of Governments

Medicaid by county

Percentage of Medicaid enrollees of county populations in the mountain resort region:

Eagle County: 13.90 percent of the population, or 7,450 people, are using Medicaid each month.

Grand County: 15.57 percent of the population, or 2,276 people, are using Medicaid each month

Jackson County: 24.12 percent of the population, or 327 people, are using Medicaid each month

Pitkin County: 8.91 percent of the population, or 1,585 people, are using Medicaid each month

Summit County: 14.14 percent of the population, or 4,278 people, are using Medicaid each month

Source: Colorado Department of Health Care Policy & Financing

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