I can't get no transportation

Though I've tried, yes I've tried, and I've tried and I've tried, I can't get none-hey hey hey.

That's what I say.

Keith at Digital Doorway has a post about the trials of people at the mercy of Medicaid transportation.

People with Medicaid in my part of Virginia are, by and large (except for certain rare categories), placed in Managed Care Organizations (MCOs). These MCOs contract for transportation. People with Medicaid are entitled to transportation to and from medical appointments (to oversimplify). The problems are so numerous it is hard to know where to start. Read Keith's post for a good example.

Here's my latest example.

Mom with mild mental retardation living in the community with three children (you think this does not happen? There are lots of people with mild cognitive disability falling through the cracks of this society). Appropriately brought her child to the ER on Sunday for a fever and acute exacerbation of asthma. Given med changes and told to follow up with her pediatrician.

Appropriately calls on Monday morning and gets a doctor's appt for Weds morning.

Calls transportation, and is told "you need to call us five days in advance for a ride".

Calls me, her child's person-of-last-resort (case manager, in other words!). I call transportation and attempt to explain the inability to call five days in advance for an urgent appt.

"We show mom on the bus line (meaning they can tell from her address that she lives on a public transport route) so we cannot accept an appt less than 5 days in advance".

But, I say...

"No buts", they say.

There's always a but. I talk to the supervisor and we finally agree for transportation to pick her up in the morning.

Of course, in the morning, they don't show up. She appropriately calls the doctor's office to say her ride is late. OK, they say, just come when they get there.

Two hours later, they are still not there, despite calls to transportation central.

Meantime, the doctor's office calls her back to say the doctor won't be there after noon anyway.

She cancels.

When her mom gets home from work (the sole family transportation), she goes to the ER.

Why don't I transport her? Unlike Keith's program, I am not allowed to transport anyone (no matter where my heart is). Why didn't she take the bus? She had no voucher, and a bus fare for herself and three kids under ten: out of the question.

And she doesn't know how to get to the doctor's office anyway-what bus to take and how to transfer is beyond her ability.

And she doesn't have a car or a driver's license. Or gas money. Or parking money.

Now, before you get the impression that I think Medicaid owes people a way out of their own poor life choices, you are barking up the wrong tree. I'm just trying to show you the complexities we have built into the system we have devised to "help" people. It is complex to be poor in this country. It is even more complex to be poor and raising kids with multiple disabilities.

The next time an exacerbation of asthma shows up in your ER around 7pm, someone who could have been handled easily at the doctor's office, you might remember this post. It's not always as simple as it seems.