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24 There are a wide variety of approaches used by the CTCs in provide a subsidy to the program in the face of shifting Florida's counties. Flexibility at the local level is considered funding by AHCA. one of the keys to success. The designated CTC can be a tran- Difficulty of operating in conjunction with ADA-- sit agency, county government, Metropolitan Planning Orga- ADA and NEMT are demanding services that are both nization (MPO), nonprofit agency, or other entity. Typically, (individually) difficult to operate successfully. Adding the transit agency is given an opportunity to participate. additional (and also demanding) service can overwhelm an agency. In this case, the eligibility certification staff (determining the use of fixed-route or paratransit ser- Broward County Transit--Coordination Efforts vice) was not able to conduct NEMT certifications while simultaneously dealing with significant growth in BCT, an arm of county government, is the public transit its ADA certification. operator for the county. BCT is also the designated CTC HIPAA interpretations--There were misperceptions of for the county and between 2002 and 2005 successfully confidentiality issues limiting vital information to the managed and operated the NEMT program in the county as contractors. One interpretation was that certain client well. BCT had integrated ADA paratransit with NEMT. groups cannot mix with others, lest these riders discover Customers called BCT to register for the NEMT program. where the first group is going (confidential information). For rides, customers called their designated contract provider Different service standards--BCT provided an ADA who verified eligibility (monthly) and then determined trip level of service that is higher than the requirements for eligibility before scheduling and providing the trip. Medicaid. The higher level of service costs more money than a service that does not meet these stringent According to BCT management, NEMT was a difficult requirements. This creates two separate agencies with program to operate in conjunction with ADA paratransit. The different standards of safety and quality. programs were separate, but were operated by the same group of contractors who coordinated service at the contrac- tor level. BCT did not have the staff available to certify GEORGIA--NORTH GEORGIA COMMUNITY NEMT customers for paratransit versus fixed-route service. ACTION AGENCY, JASPER Consequently, fixed-route ridership was low (although it increased from 90 passes per month to 1,000). The large Introduction numbers of new riders (averaging 500 per month) were taxing staff ability to keep pace with applications. BCT man- Thirteen transit agencies in Georgia coordinate with Medicaid. agement chose not to expand their ADA eligibility certifica- Several transit agencies have successfully coordinated the tion staff and instead provided paratransit for those who programs of all three state agencies and one of these will be requested the door-to-door service. reviewed here. This agency, the North Georgia Community Action Agency (NGCAA), operates public transportation, Ultimately, at the highest level of county government, has an agreement to provide social service transportation decisions were made to discontinue the county's involve- (Title III--Aging), and also has a contract with one of the ment in the NEMT program. BCT continues to act as the brokers to operate Medicaid service. NGCAA operates in six CTC, coordinating a variety of other human service trans- counties of north Georgia (population--310,000), with its portation services. base in the town of Jasper. They provide a variety of para- transit services, typically within each county, with vehicles infrequently traveling out of county. The FY 200405 rider- Activities That Affect Coordination ship was 240,000 one-way trips. Approximately 40,000 trips are provided for NEMT through the regional broker. Communication with AHCA--BCT cited difficulty in communicating with AHCA and being unable to provide input into the funding changes. The TD Commission Relationship Between Stakeholders echoed those remarks. AHCA is proposing a number of changes, and both AHCA and the TD Commission are Georgia has been working recently to coordinate services on considering termination of the agreement. the state level. The state has three separate transportation pro- Local control and flexibility--Services are brokered at grams in three agencies, two of which are actively engaged in the county level, allowing for significant local control coordination activities. The local level has also seen significant in how services are delivered, the development of stan- coordination of two of the programs. The three major pro- dards, and other functions that allow flexibility and can grams--all administered separately by three agencies--are: encourage coordination. Throughout the state there are many models of local service delivery. Georgia Department of Transportation (GDOT)--pub- Business/financial sense--The county was clear that lic transportation, its primary reason for terminating its participation in Department of Human Resources (DHR)--social ser- the NEMT was financial. The county was unwilling to vice transportation and management of the FTA Section