‘What am I going to do?’: Wheelchair user says Medicaid transportation caused her to miss medical visits

Bonnie Griffith of Clinton missed four doctor appointments in June and July because of problems with the transportation company that contracts with the Mississippi Division of Medicaid.

Griffith, who has a chronic nerve damage condition that requires her to use an electric mobility scooter, relies on Medicaid’s non-emergency medical transportation program to see her health care providers.

But on two occasions, she said drivers refused to transport her because they did not feel comfortable securing her scooter in the vehicle. Electric scooters qualify as wheelchairs under the Americans with Disabilities Act.

A third time, she said Modivcare told her there were no drivers available with the capacity to transport a wheelchair. And another time, the driver never showed up to the location she specified.

In July, she ran out of her medication.

“I have no way to get to any medical doctor at all,” said Griffith, who has severe peripheral neuropathy.

There’s no way to know if Griffith’s issues are unique or widespread. Denver-based for-profit Modivcare’s three-year, $96.5 million contract with the Division of Medicaid mandates it submit “monthly reports” containing information about the percent of scheduled trips that are late or missed each day or exceed 45 minutes longer than the average travel time.

The company assumed the state’s non-emergency medical services contract on June 8 of this year.

But two weeks after Mississippi Today submitted a public records request for the reports, the agency told the outlet they have no such reports. Spokesperson Matt Westerfield said the reports are not yet due, though he did note that historically, non-emergency medical transportation contractors have struggled to meet the contractual ceiling of 2% late or missed trips each day.

He did not respond to an inquiry about when the monthly reports are due by the time the story was published.

The federally-required service helps Medicaid beneficiaries with no other means of getting to the doctor make it to their appointments. But some beneficiaries and advocates question whether it properly serves people who use wheelchairs and mobility devices.

People with disabilities – not all of whom use wheelchairs – are some of the most frequent users of the service.

Griffith made it to her first doctor’s appointment since the contract began on July 18.

“I feel so much better today just having gotten to where I was supposed to be,” she told Mississippi Today.

Experts question whether Modivcare’s policy complies with law

Modivcare’s website states that it is the “largest and most experienced broker of non-emergency medical transportation” in the nation. The company provides transportation services in 48 states and reported $118.3 million in profits during the first half of 2024 for non-emergency transportation services alone.

Modivcare contracts with local transportation companies, which give beneficiaries rides to their doctor’s appointments and take them home afterwards.

Advocates argue that the program yields cost savings for states and the federal government by heightening access to preventative medicine and routine health care that helps beneficiaries manage their medical conditions and avoid costly trips to the emergency room.

Griffith said she has relied on non-emergency medical transportation services in Mississippi for over 10 years.

Modivcare spokesperson Melody Lai told Mississippi Today in an email that while the service can transport people who use power carts or mobility scooters, they “will have to either transfer to a wheelchair or ambulate into the seat of the vehicle,” citing concerns about safety while transporting people seated on their mobility device.

Griffith, however, can not walk to a vehicle or push a non-motorized wheelchair by herself.

Her home health aide can accompany her to appointments to push the wheelchair, but Griffith must then give up time with the aide intended to support her personal care needs.

Hunter Robertson, the civil rights team supervising attorney at Disability Rights Mississippi, said he believes Modivcare’s policy is a violation of the Americans with Disabilities Act.

He said drivers can recommend that wheelchair users transfer to a vehicle seat, but can not require them to transfer, according to the latest guidance from the Federal Transit Authority.

“The final decision on whether to transfer is up to the passenger,” reads the agency’s circular.

Robertson said that if a wheelchair fits inside the vehicle and on the lift and can be secured, even if it is not constrained to the comfort of the company, a driver can not refuse to transport a rider.

Scott Crawford, an advocate for people with disabilities and a board member of the Mississippi Coalition for Citizens with Disabilities, disagreed. He said that he believes requiring people using mobility devices to transfer to a seat is an acceptable policy, given concerns that they might tip during hard turns.

However, transportation providers are still required to transport people and their mobility devices, even if the person must transfer to a seat, he said.

“It is vital that transportation providers allow people to bring their ‘legs’ (mobility device) with them when they are transported, assuming they will fit,” he said. “There are plenty of ways of securing a scooter or walker so that they won’t move.”

Robertson said non-emergency medical transportation services are a critical service for people who use wheelchairs.

“There is a limited amount of public transportation or transportation that is accessible when you are a wheelchair user or a power cart user,” he said. “The non-emergency transport is one of the few ways to safely get to doctor’s appointments on time … while using your mobility aid.”

Matt Westerfield, spokesperson for the Mississippi Division of Medicaid, said that Modivcare provided wheelchair securement training to 451 drivers prior to Modivcare’s contract beginning on June 8. He noted that from then to the end of June, there were 4,984 trips completed using wheelchair accessible vehicles.

Modivcare’s contract with the Division of Medicaid specifies that each wheelchair vehicle must have a wheelchair securement device that meets Americans with Disabilities Act guidelines.

In response to questions about the company’s adherence to the Americans with Disabilities Act, Lai wrote in an email, “Modivcare complies with all applicable laws, quality is very important to us and we provide training as may be required by law.”

Modivcare did not respond to specific questions about the contractor’s compliance with the Americans with Disabilities Act and declined Mississippi Today’s request for an interview.

Problems with transportation are not new for Medicaid beneficiaries

Griffith said the challenges she has faced with Medicaid transportation are not specific to Modivcare. She remembered unreliable transportation during the period another company contracted with the state for the service.

On several occasions, her driver did not pick her up from her appointment.

“I was offered a ride … by someone who had seen me still waiting there,” she said.

A 2021 report on non-emergency medical transportation by the federal Medicaid and CHIP Payment and Access Commission cited nationwide concerns about limited supplies of wheelchair vans, late pickups, ill-equipped vehicles and long call center wait times.

Some states have sought to heighten regulation of the companies that provide such services. In 2023, a bill in the New Jersey Legislature to establish performance and reporting standards for Medicaid transportation brokers died in committee. The legislation came after the New Jersey Department of Human Services fined Modivcare $1.7 million between 2017 and 2022 for failing to meet contract requirements, including missing scheduled pickups, according to the Bergen Record.

In Georgia, Modivcare and Southeasttrans, another non-emergency medical transportation company, were fined over $1 million from 2018 to 2020 for picking up patients late, reported KFF.

Over 450 complaints have been lodged against Modivcare in the past three years, according to the Better Business Bureau.

In July, Griffith’s nurse practitioner detected atrial fibrillation, or an irregular heartbeat, during an examination.

She worries about being able to get to visit her cardiologist given the unreliability of Mississippi’s non-emergency medical transportation.

“What am I going to do?” she asked.

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