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METRO-DADE TRANSIT AGENCY,S MEDICAID METROPASS PROGRAM CASE STUDY

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METRO-DADE TRANSIT AGENCY'S MEDICAID METROPASS PROGRAM Metro-Dade Transit Agency (MDTA), located in Miami, Florida, is the thirteenth largest public transit system in the United States. A department within Dade County Government, MDTA employs 2,700. persons. It is governed by a thirteen-member Board of County Commissioners. MDTA operates within the 600 square miles that comprise the Greater Miami metropolitan area. Its 1996 average weekly ridership of 262,900 represents over 50% of all transit passenger trips in Florida. The fleet consists of 608 buses and 46 minibuses on 70 routes; 136 rail cars; 29 peoplemover cars; and 47 paratransit vehicles. The 1997 operating budget is $204.6 million. ORIGIN OF TEIE: MEDICAID METROPASS PROGRAM Highlights Savings to Medicaid=$503,000/mo. MDTA increased pass sales=3,600/mo. MDTA revenue for adm~n~stration=$4-6/pass MDTA avoided ADA costs= $10 million/year Medicaid is a federal entitlement program that pays for basic health care services for low income people and long-term care for the elderly and persons with disabilities. In 1995 it was a $159 billion program serving one in eight Americans. The federal government pays about 57% of this cost, with the states picking up the rest. Although transportation was not called out in the 1965 authorizing legislation, federal courts have found that people have a right of access to the Medicaid services for which they qualify. Consequently, although states have a great deal of flexibility in designing how that access will be delivered, they are required to assure that clients have some way to get to health care services. The result is that Medicaid non-emergency transportation is the second largest federal expenditure for public transportation, amounting to $~.5 billion.) In keeping with the mandate to provide access for clients, in 1992 the Medicaid Area 11 Program Administrator approached MDTA for transportation a. ~ ~ services to take teenagers to an alter school program for c;n~tc~ren at Risk. The door-to-door tailored bus service would have cost almost $100,000 a year. Noticing that the schools at which the program was offered were along an existing bus route, the manager of MDTA's Transit Mobility Planning Section suggested giving the teenagers bus passes at a cost of about $16,000 a year. Out of this pragmatic solution, the Medicaid Metropass Program was born. 1

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The Medicaid Program Administrator and MDTA staff then discussed expanding the use of monthly bus passes for other transit dependent Medicaid clients who were able to use fixed route services. First, the staffs compared the cost of a Metropass and the cost of paratransit trips. In Florida, Medicaid pays the transit operator for the actual cost of the trip, whereas in some other states Medicaid gives the client a voucher for the fare only. Therefore, Medicaid was paying MDTA $14.10 for the cost of a paratransit trip plus an administrative fee of $~.63 to cover scheduling, dispatching, verification of eligibility, and billing. The cost of a discounted Metropass was $30. The staffs agreed that MDTA would incur similar administrative costs to issue the Metropass to clients, especially since increased monitoring for eligibility would be required. Therefore, the break-even point for Medicaid was the third one-way trip, when the cost of the paratransit trips matched the cost of a monthly pass. Based on this analysis of potential cost savings, MDTA and Florida's Agency for Health Care Administration (AHCA) agreed to conduct a pilot program in June 1993. The program was offered to 1200 eligible individuals who: made six or more one-way trips a month for three consecutive months, and agreed to give up door-to-door paratransit for the free monthly bus pass. Although only 44 persons enrolled in the program that first month, six months later 126 were enrolled. Many of these traveled five days a week to mental health centers. Consequently, the savings to AHCA by November 1993 was $42,000 over the cost of these same trips by paratransit. Because of the success of the pilot program, AHCA decided to greatly enlarge the Medicaid Metropass program. It contracted with MDTA to administer the entire program and increased the administrative fee to $4-6, depending on the volume of passes sold. The program grew rapidly and by Summer of 1997, about 3,600 passes were being sold a month, at an estimated monthly savings of over $503,000. The steps to creating a Medicaid pass program are illustrated in Table 1. A complete packet of documents developed by MDTA to assist others in replicating their program is included in Appendix A. HOW THE MEDICAID METROPASS PROGRAM WORKS When the pilot program was initiated in June 1993, no one foresaw the tremendous growth that would occur. Consequently, passes were mailed to each individual, there was duplication of effort between AHCA and MDTA, and there was no central computerized system. As the staffs learned from experience, the program underwent a number of refinements. For example, although MDTA still 2

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mails out passes to about 800 individuals each month, the bulk of the passes are now distributed through participating agencies. This has greatly streamlined the process and reduced the claims that passes were never received to less than 1%. In addition, a computer program was developed which could interface with Medicaid's system in order to verify eligibility; generate billing to the participating agencies; and block participants from using paratransit. TABLE 1 STEPS TO CREATE A MEDICAID PASS PROGRAM 1. Develop participation criteria and policies for lost passes. 2. Establish administration fee. 3. Create computer program. 1 4. | Develo monitoring system. 5. | Define assignments for transit and Medicaid staffs. 6. Identify and contact agencies with five or more Medicaid clients. 7. Conduct travel training. S. Design materials and mail to eligible clients. , 9. ~ Check eturned applications for completeness and eligibility. ~ 1 10. Call clients to explain rules. 11. Develop pass distribution system through agencies. 12. Call doctors to verify appointments and monitor abuse. 13. Meet monthly with Medicaid to insure coordination. 14. | Report osts and savings monthly to Medicaid. ll In order to enlist participating agencies, MDTA contacts those which have more than five Medicaid clients a day using paratransit. FiRy-two agencies currently participate, including mental health clinics, drug and alcohol abuse centers, AIDS and HIV treatment programs, sheltered workshops for the developmentally disabled, day care programs for the elderly, and family health clinics. These agencies have an incentive to participate, because the pass program maximizes their transportation dollars, enabling them to serve a larger number of clients, and improves their clients' mobility. 3

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MDTA conducts group travel training for the clients, teaching them how to use fixed-route transit. It also trains the agency staff, who can continue the travel training with new clients entering the program later. Clients are given brochures in English, Spanish, and Creole explaining the program. One reason many of the original 1200 persons sent brochures did not enter the program is that they didn't understand the program, because the brochures were initially printed only in English. Now each applicant is also personally contacted by MDTA to explain the program and the requirement to give up travel by paratransit. MDTA has also added several bilingual staff members. Each month a package is prepared for the participating agencies containing the passes for the eligible clients and a sheet which the client signs indicating receipt of the pass. Both the client and the agency representative also sign the sheet to verif y that the client meets the minimum requirements for obtaining a Medicaid Metropass (i.e., the number of medical trips taken). The package also contains a list of those clients who were ~nel~g~ie, either because they did not meet the medical trip requirement or because AHCA's Unysis computer system did not identify them as eligible recipients. Agencies then pick up their packages at MDTA offices and distribute the passes to their own clients. Some agencies require the client to turn in the previous month's pass, in order to insure that the passes aren't being sold illegally. There are about 800 individuals, not affiliated with an agency, who also receive Metropasses. MDTA continues to mail the passes to these people directly and requires that they send back postcards verifying the number of medical trips they take each month. Three MDTA staff call the doctors of each non-agency individual and each new applicant to determine that their medical trips are indeed being made. Each month the staff also calls a random sample of participating agency to verify the trips. Through the mechanism of monitoring transportation expenses, AHCA has become aware of "income mills" run by a few doctors who are enrolling patients in unwarranted services or by agencies that are filling out claim forms but providing no service. Thus, MDTA's strict monitoring for abuse not only ensures the integrity of the Metropass program but also has helped Medicaid identify fraud by doctors and agencies. There are seven staff assigned to the pass program. MDTA estimates that the time to process 1,000 applications for the Medicaid Metropass program is 62 4/z hours for clerical personnel and 47 ]/2 hours for a Transit Planner. This estimate reflects the additional work required when Medicaid began requiring collection of a co-payment from clients. 4

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MEASURING THE BENEFITS AND COSTS AHCA, MDTA, and individual Medicaid clients all derive benefits from the Medicaid Metropass program. Benefits to the Medicaid System For AHCA, the benefit is the reduced amount spent on transportation. This amount is calculated by subtracting the cost of the Metropasses from the potential cost if the trips had instead been made by paratransit. For example, in August 1997, the participating agencies and individuals reported that 3,629 pass holders had made 41,554 medical trips. AHCA paid $131,675 for 209 full fare passes reimbursed at $50.44 and 3,420 senior, child and disabled discounted passes reimbursed at $30, plus an administrative fee of $18,534. If those same trips had been taken by paratransit and reimbursed at the Medicaid rate of $15.28, the cost would have been $634,945. Thus, the Metropass program resulted in a savings to AHCA of $503,269. TABLE 2 AUGUST 1997 MEDICAID METROPASS PROGRAM* . l Users 13,629 1~ | Estimated Medical Trips l 41,554 1 _ (A) Potential Cost of $634,946.12 Paratransit Trips at $15.28 (includes $1.60 administrative fee/trip) (B) Actual Costs Full Fare Metropasses 209 @ $50.44 $10,541.20 Discounted Metropasses 3,420 @ $30.00 $102,600.00 Administrative Fee** 1-1,500 passes 1,500 @ $ 4.04 $ 6,060.00 1,501-1,800 passes 300 @ $ 5.00 $ 1,500.00 1,801+ passes 1 1,829 @ $ 6 00 1 $10,974 00 Total Actual Cost l | $131,675 96 Estimated Savings (A minus B) l l $603,269 16 Source: MDTA monthly report. ** To simplify the accounting, AHCA and MDTA are negotiating a flat administrative fee for the new fiscal year based on past experience. 5

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Using this methodology, AHCA has realized cumulative savings since the inception of the program in 1993 through August 1997 of $13,380,968. Appendix B is a spreadsheet illustrating the growth of the program and the resulting savings. Benept;s to Met;ro-Dade Transit Agency For MDTA, the benefit of the program is the increased revenue and ridership it brings to the agency. Increased readership on fixed routes boosts MDTA's federal funding. Because the fixed-route system has the capacity to accommodate the 3,629 people enrolled in the program, MDTA can better utilize existing vehicles and avoid higher contract fees for additional paratransit vehicles that might have been needed otherwise. The administrative fee, which was $~S,534 in August 1997, covers the costs of the MDTA staff assigned to the program and helps subsidize the Medicaid paratransit service for those who can't use the axed-route system. As the pass program has grown, there has been a drop in farebox revenues. However, the Metropass program provides a more predictable source of revenue than the farebox. This is especially true when the economy is poor and people cannot afford to take as many bus rides with cash fares. Pass sales also provide MDTA with the revenue up front, instead of being spread out in cash sales over the month. Medicaid reimbursements also expand the sources of funding for MDTA beyond traditional transit appropriations. Since the State can be relied upon for payment, the funding source is also secure and reliable. If MDTA had been unable or unwilling to take on the Medicaid Metropass program, the MDTA Program Administrator estimates that, because the fixed route system is not fully accessible, at least half of the individuals could have qualified for paratransit under the Americans with Disabilities Act (ADA). Under that scenario, MDTA would only have received the individual paratransit fare of $2.50 per trip instead of the $30 monthly pass revenue from Medicaid. According to MDTA's Deputy Director, the result would be a potential $10 million annual cost to MDTA ~ . .. .. .. for ADA paratrans~t rather than the current revenue-enhancing pass program. Benefits to Ricters Individuals benefit from lower cost and increased mobility. After the program was underway, AHCA introduced a co-payment requirement for its clients. Thus, instead of receiving the monthly pass for free, clients now have to pay a $~.00 co-payment. However, $~.00 a month is less expensive than a co-payment of $~.00 6

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a trip on paratransit, so the client has an economic incentive to enroll in the Medicaid Metropass program.* For those who can ride fixed-route vehicles, the Metropass program provides independence and flexibility. Clients no longer have to schedule trips in advance and include a 30-minute window before and the scheduled time to wait for the paratransit vehicle. They are not segregated in a paratransit system, but enjoy the mobility offered by the public transportation system, using a Metropass that looks no different than anyone else's. No longer is their mobility restricted to medical trips, since they can use the pass to go anywhere-school, shopping, visiting friends going to work. Some, such as a kidney dialysis patient who could qualif y for ADA paratransit, prefer the pass program as a means of staying independent as long as possible. When bad times hit, riders do not have to ration their bus trips to save household income. As MDTA reports, one elderly woman was thankful for the program because "she no longer has to decide whether she should use her limited income to pay for transportation to church or to the grocery store."2 ELEMENTS FOR SUCCESS Coordinated Trar~sportatzon In 1979 the State of Florida created the Transportation Disadvantaged Program "to arrange the provision of transportation services in a manner that is cost effective and efficient and reduce fragmentation and duplication of services."3 Under this program, local Community Transportation Coordinators (CTCs) are responsible for coordinating transportation services within a designated area. MDTA is the CTC for Metropolitan Dade County, acting as a clearinghouse for all trips that qualify for funding from the State's Transportation Disadvantaged Trust Fund. Prior to the implementation of the Transportation Disadvantaged Program, agencies serving Medicaid clients either had to operate their own vehicles or contract with private operators. The ability of AHCA to contract with a single entity MDTA in its role as CTC was important to the success of the Medicaid Metropass Program. The fact that MDTA's service area is contained in only one county also simplifies the contractual relationship. Although MDTA does contract *In order to reduce its paratransit expenses, MDTA also offers an economic ~7 , ~ , incentive to its non-Medicaid, ADA-elig~ble passengers. These individuals, who pay a fare to ride paratransit, are allowed to ride free on fixed routes. 7

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for its paratransit service, it remains the broker for all such trips. Without this single point of coordination, there would not be the necessary control over the client database. For example, some clients have tried to register at more than one agency in order to be eligible for another Metropass. The centralized database has been able to detect this abuse of the program. If other providers competed for clients, monitoring the number of medical trips and insuring that pass holders do not also take paratransit trips would not be possible. In fact, the inability to control the database was a critical factor in the decision of another Florida public transportation agency not to implement a Medicaid pass program. When the Medicaid Program Office in Central Florida attempted to contract for all its transportation disadvantaged needs with Lynx, the CTC in Orlando, the Medicaid office was challenged by a private, for-profit provider. Lynx abandoned its efforts towards a Medicaid pass program when the court ruled against the Medicaid office, according to a former Lynx employee who ran its A+ Link paratransit service. He believes the court ruling could negatively affect Florida's goals of coordination if, as a result, other Medicaid offices or the CTCs are open to {e gel challenges against a single broker for transportation. Nonetheless, other transportation agencies in Florida have successfi~lly implemented a similar Medicaid pass program. AHCA reports that 13 of the 17 mass transit systems have bus pass programs for Medicaid clients.4 Public transportation systems in Jacksonville, Tampa, PinelIas County and Volusia County have all modeled their Medicaid programs after MDTA. In Volusia County alone, $900,000 was saved in one year through their pass progran~.5 Other states, such as Texas, and other countries, such as Japan, have visited MDTA to gather information on how to start a similar program. Maryland, Massachusetts, Oregon, Vermont and Washington have adopted legislation like Florida's for regional or statewide transportation brokerages.6 Still others, such as California, have legislation which facilitates coordination without mandating it. Therefore, it does seem possible to replicate MDTA's Medicaid Metropass Program elsewhere with the centralized database and control over paratransit trips necessary for a successful program. Parinership The Medicaid Metropass Program began when Medicaid had a problem and MDTA had a solution. The solution was unconventional in that it did not involve a paratransit answer. Rather, it involved a program that did not fit the tidy roles that Medicaid and MDTA traditionally played. Representatives of both agencies formed a partnership which required taking risks. For example, when the program grew beyond expectations, MDTA had to be willing to take on the entire program as a contractor. This role meant assuming 8

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responsibilities unusual for a transit agency and learning the terminology and players of another industry. The following are some illustrations of this non-transit role: MDTA accesses AHCA's Unysis database to verify the Medicaid eligibility of each client. This can occur because of the partnership between Medicaid, which allows that access, and MDTA, which has agreed to perform this atypical task. Staff of the Transit Mobility Planning Section meet weekly with the case managers of the participating social service agencies. This close relationship brings small details to light before they become problems and assists in monitoring the integrity of the program. Clients with HIV, schizophrenia, and personality disorders objected to revealing their disability to obtain a Discount Metrobus Permit. Working with AHCA, MDTA now uses specific Medicaid codes that provide the same information without breaching confidentiality. Whereas the program was originally offered as an option to clients, the two agencies now have a "mass transit first" policy. Clients who are able to take fixed- route transit are placed in the Medicaid Metropass Program. This policy works effectively because AHCA's partner is a public bus operator. The Area 11 Program Administrator explained that a private, for-profit operator would have no incentive to move clients from reimbursable paratransit trips onto the public bus system. Nevertheless, both agencies are cautious about advertising the Medicaid Metropass Program. Although only 1% of the 375,000 Medicaid clients in Dade County are in the pass program, "We don't want it on the front page," said the Program Administrator. Many clients are able to get to medical appointments by riding with a relative or driving their own car. If they all demanded the Metropass as an entitlement, the Medicaid budget would be overwhelmed. Just as MDTA cooperates to keep Medicaid's costs under control, AHCA cooperates by not "dumping" clients onto MDTA's ADA paratransit program. Since at least half of those in the pass program would qualif y for ADA-paratransit, MDTA's budget could also be overwhelmed if it had to transport these additional clients under ADA mandates for only the $2.50 fare instead of Medicaid's reimbursement for the Metropass. One risk in MDTA's commitment to the pass program is the tightening of Medicaid transportation dollars at the state level. For example, in 1996 the Florida Legislature cut non-emergency medical transportation by 32%. However, a lawsuit by mental health advocates forced the state to restore much of the funding for 9

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non Of ROtID. =~ AGES fO! HEATH ME ~710N emery] "~D au ~ ~ my,, > my, R 33~" Dear Medicaid Metropass Participating Agency: You recently received a letter from the State of Florida, Medicaid Office advising you that the 1995 Florida Legislature passed a law Increasing or requiring co-payments on most Medicaid services except prescription drugs, starting July I, 1995'. This means that your Medicaid eligible clients who are now receiving Medicaid transportation are now required to pay a co-payment for Medicaid transportation. The Medicaid office has directed the Metro-Dade Transit Agency to collect a fee of 51.00 per month for each Medicaid Metropass. Please attach an envelope containing the appropriate amount of money (either check or cash) when you return your Client Pass Receipt and Eligibility Verification Form (sign-in-sheet) a . You do not have to collect the Si.00 co-payment, if your client is: o Under 21 years old or o Pregnant or o Receiving family planning services If you do not have to collect the Sl.00 co-payment, please tell us why. Use one of the reasons listed above, and write it down next to your clients name. If you have any questions, please do not hesitate to contact John Garcia or Sheila Winitzer at 637-3754. Sincerely, l Judy Rosenbaum, Ed.D. District Il Medicaid Program Administrator ~ E T S O D ~ D E Transit Mobility Pl"~ng 3300 N.U'. 32 Avenue Second Floor Room 226 Miami, Florida 33142 Danny Alvarez Deputy Director Metro-Dade Transit Agency

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- ~ AG E N CY F0 ~ H ~ lTH C AR E ~ MI N I ~ FAT I O N ~ t~3 "D~D A - ~N Tmmit MobBit, Planning \~,~y DUAL, a 33lbi 3300 MU'. 32 AveDue em::- ~Second Floor Room 226 Miami Florida 33142 Dear Medicaid Metropass Recipient: l Participants in the Medicaid Metropass program receiving a Discount Metropass must be: r' o Permanently disabled, or o Under I~ years of age, or o Over 65 years of age 637-3754 as soon as possible. | you do not fit into any of these categories, please call Participants with permanent disabilities under the age of 65 must obtain a Metrobus seduced Fare Permit. If you do not have one, follow these simple directions: 1 o Obtain a letter from your physician stating what the disability is, and the; the disability is permanent. O Take the letter from your physician to the Transit Information Center at the Government Center Metrorail station, fare gate level, and they will issue you a Metrobus Reduced Fare I.D. Permit with your photo on it. This pe split is good for an indefinite period of time. In addition, the 1995 Florida Legislature passed a law increasing or requiring Or payments on most Medicaid services except prescription drugs, starting July 1, 19;". t.is means that you are now required to pay a copayment for Medicaid transportation. The Medicaid office has directed the Metro-Dade Transit Agency to collect a fee of $ 1.00 ['r month for each Medicaid Metropass, from you, to allow you to remain in the Medicaid L`tropass program. Please send your $ 1.00 Medicaid transportation copayment in cash, check or money order in the enclosed self-addressed envelope. ,,. flu do not have to send the ~ 1.00 copayment, if you are: a. o Lo ~o Under 21 years old, or Pregnant, or Receiving family planning services [' you do not have to send the $ 1.00 copayment, please tell us why. Use one of the Seasons listed above, and write it on the postcard. r ~ yOU have any questions, please do not hesitate to contact John Garcia or Sheila [initzer at 637-3754. - {incerely, r W~ Judy Rosenbaum, Ed.D. District 11 Medicaid Program Administrator Danny Alvarez Deputy Director Metro-Dade Transit Agency

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~N S~ ~ ~o~o~ t-~ ~-~ AGEN~ ~! H~TH CARE ADMInI~ItON ~ ~ "D=D ~ EL~~ p~' ~ ass ~ s: snn ~/ - ~. ~ 331" `~ Es.imado receptor de: Medicaid Metropass: It E T R O D ~ D E Transit 5tobilit, Ptanning 3300 N'.U'. 32 Avenue Secood Floor Room 226 Miami, Flonda 33142 Los pa-ticipantes en el programa Metropass de Medicaid que reciban un Metropass con descuento, tendran que ser: o Incapacitados pe~manentemente o Menores de l S anos de edad, o o Mayores de 65 anos de edad Si us ted no esta incluido en al-tuna de estas categories, por favor flame al 637-3754 lo antes posible. Los participantes con incapacicad permanente que tengan menos de 65 anos tend~c-. ~,e obtener un ~Perm~so de Tarifa Reaucida'' de: Metrobus. Si usted no tiene uno, siga estas sencil:as ins.rucciones: o Octeng2 una carte de su medico que declare cue: es su incapacidaa, y ~"e ia mismc es permanente 0 Lle~e la carte de su mecico al "Centro de Informacion de: Transporte" e-. la estacion de Me~rorail de: Government Cen.er, al nivel de en~rada de pas2je'0s, donae le ex~enderan el "Permiso de Tarifa Reducida" de Metrobus con su foto en el. Este permiso tiene valiaez por tiempo indefinido. Acicionalmente, la legi~iatura estatal de 1995 aprobo una fey, ~aumen.ando o requirienao co-pecos en la mayoria de los servicios de Medicaid, excepto en medicinas de prescripcion'' ~ pa~tir de julio I, 1995. Esto significa que ahora Usted esta responsabilizac- con pager una parse de su transporte de Medicaid. La oficina de Medicaid ie ha indicado a la Agencia de Transito del Condado de Dade (~DlA) que cobre a usted una tarifa de $1.00 cada mes, por cada Medicaid Metropass, pa a permitirie que siga participando en el programa de Medicaid Metropass. Favor de envier su parse de: dinero (S1~00) por los servicios de transportacion de Medicaid. Pueae mandar efectivo o envier un cheque o un money order en ei sobre adjunto. Estara exento de pager la tarifa de $1.00 si usted: o es menor de 21 anos de edad, o esta embarazada, o o recibe servicios de planificacion de familia Si usted no tiene que pager e: SI.OO, favor de informarnos por que esta exento. Escoja unas de las rezones mencionadas arriba y escribala en la tarjeta postal. Si tiene alguna pregunta, favor de llamar a John Garcia al numero 637-3754. Le saluda atentamente, S~ Judy Rosenbaum, Ed. D . District 11 Hedicaid Program A~ninistrator - ~- Danny Alvarez Deputy Director Metro-Dade Transit Agency

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;.~ AGED ~t HEATH CAtE ~MINIU"T10N - Dow' W~' ~.~31" Dear Medicaid Metropass Recipient: ~ E T R O D ~ D E Transit Mobility Plaomcg 3340 ~'.~'. 32 Avenue Second Floor Room 226 Miami, Florida 33142 All participants in the Medicaid Metropass program were notified that the Florida Legislature passed a law n increasing or requiring co-payments on mos t Medicaid services except prescription drugs, starting July I, 1995u. A review of our records shows that you did not send in the $~.00 co-payment for the Metropass you received this month. This letter is to notify you that you will have to send $2.00 with your Medicaid eligibility postcard for next month. If you do not send the $2.00, you will be taken off the Metropass program, and put back on the Medicaid door to door paratransit service. Receiving a Medicaid Metropass is a privilege, not a right. If you have any questions, please do not hesitate to contact either John Garcia or Sheila Winitzer at 637-3754. Thank you for your participation in the Medicaid Metropass program. Sincerely, Judy Rosenbaum, Ed.D. District 11 Medicaid Program Administrator Danny Alvarez Deputy Director Metro-Dade Transit Agency

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ran non ~ nOtlDA I; AC~ FOR HEALTH CARE ~MtHlSI"710N "D~nn' y is ~ ~ ~ ?~' ~,R]31" '_: :&~' Estimado receptor del Medicaid Metropass: Todos los participances del programa de Medicaid Metropass fueron notificados ac3~rirtiendoles clue la legislatura estatal del Estado de la Florida ha pasado una ley ~ aumentando o requirienclo co-pagos en la mayoria de los servicios de Medicaid, lo cual excluye medicinas recetadas. Esta ley fue efecti~ra el lo cJe Julio de 1995". Al es tudiar su expediente nos hemos dado cuenta que us ted no mando el co-pago de un $ i. 00 cubriendo el Metropass que us ted recibi6 este mes. Por ~ria c3e esta carte le est anos notificanclo gue usted tendra que mandar $ 2.00 con su postal c3e Meclicaid la cual nos clice c~ue us ted califica pare el pr6ximo mes. Si us ted no nos manda los $ 2.00 requiridos, nos ~reremos forzados a quitarlo cJel programa de Metropass y de nue~ro ponerio en el servicio paratransito de puerta a puerta de Medicaid. Dese cuenta que recibir un Metropass de Medicaid es un privilegio, no un derecho. Si tiene alguna pregunta, favor de llamar a John Garcia al numero 637-3754. Gracias por su participacidn en el programa Metropass del Medicaid. Le saluda atentamente, Judy Rosenbaum, Ed.D. District ll Medicaid Program Administrator ~ E t ~ O D ~ D E Tr~sit Mobility Pl"ning 3300 ~'.W. 32 Avecue Socood Ploor Room 226 Miami, Flonda 33142 . ~_ Danny Alvarez Deputy Director Metro-Dade Transit Agency

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- MID ~ non ~S3 MAY, R 331" ~n ~ R - 04 AGES ~t HEALTH ME LION Dear Medicaid Recipient: m ~ ET ~ O D ~ D E 0~ Transit Mobility Plsoning 3300 N.W. 32 Avenue Second Floor Room 226 Miami, Florida 33142 This letter is to advise you that you are not eligible to receive a Medicaid Metropass for next month. The Medicaid Metropass program is designed to offer unlimited free transportation on Metrobus, Metrorail and Metromover, to individuals meeting very Specific Medic-~d transportation criteria. Each month we review the eligibility of all Medicaid participants. We have not received your Medicaid Metropass co-payment for two consecutive months. This is to advise you that if you need Medicaid transportation for next month, call 263-7301 to schedule your trip. If you have any Questions regarding this matter, please do not hesitate to contact John Garcia or Sheila Winitzer at 637-3754. Sincerely, Judy Rosenbaum, Ed.D. District 11 Medicaid Program Administrator Danny Alvarez Deputy Director Metro-Dade Transit Agency

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epoch= 2 A 11 ~ BODICE AS PR0 ~0~ COST BENEFITS HIS

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1993 , . 3 Totals _ ~. r 1994 -~4 Totals f I f995 1995 Totals r tJ996 -996 Totals , 1997 r~u~ bruary March [^ jril 1, tY June -f ~y . i_'gust September {~.tober vember ~cember - r ;, Totals , L_ ;93-97 Totals - AREA 11 ~ MEDICAID METROPASS PROGRAM MONTHLY COST BENEFITS AbJALYSIS PARATRANSIT I~EDICAID METROPASS No. I Avg. of | Actual Users |~Trip~ l Cost ot Paratransit Trips at S 1 5.28* Full | Cost . Fare at Passes S 50.44~. Disc. Cost ~ Admin. ~ Total 1 Passes at ~ Fee'.. Metropass S 30 Costs : Savings . . Cumulative ~ Savings | 1 564173,738 r 7,929 134,352 == ~ 16,876 - 240,820 ~ 1 27,4531 356,687, : 1 1 1 1 3,057135,920 3 13 ~37,C'OO .~ I 3,268138,286 3,214137,046 .~3~96T~ ~ 37,m . 3,404139,232 3J366138,904 ~ 1 3,629141,554 - 1 l ~1~ ~-~_1 T I 26369: 305,714' 11 ~, 7g,13111,051,311, S216, 099 - S2,115,027 - S3,729, 163 S5, 450, 1n S548, 858 sses,36a 1 1 ssss,ola S566, 063 1 S577, 156 S599,46S S594,4s3 1 1S634,94S |SG |SG 1sc t 1sc 'S4,671,31C ,'81,77d 1 11 75 281S1,4561 ~ 11 I 11 r' 86|S4,472| ~ IT 71 488S24, 39) ~ I~ 1 ~ ~ ~ 376TS69, 405 1 1 ~173T S8, 726 . 191 t S9, 634 2IS1 S10,845 7741 s8,m 2031 St0,239 2141 S10,794 1 I7851 S9,331 12091 S10,542 ~1 1 so 11 so 10 ~ SO {7! ~ T I ,5641 S78,888 ~ 1 13,5421 S179,178 536 7,84: '- - 1 76328T S489, 84{ ' 1 1 26,05/ S781,77t 1 2,8841 1 2,944 3,0531 1 3,,040 3,093 39fsol 1 3Jl8l1 1 3J4 1 1 24,805 75,569 1 1 1 1 1 S16,08G 1 1 1 1 31S235,2901 ll S86,5201S1S,702 S88, 3201SI5,570 sSl,59o1S16,368 1 S91,2001SI6,062 sg2,79olS16,536 1 S95, 7001S17,184 S95, 4301S16,956 1 S102,6001Sf8,534 S01 - - Sf32,312 S354, 619 S2,267, 070 ~1 r1 S919 1 1 1I S26,'461 S26S, 908 I T ~, 1I S~1 S~230 1 1 r I .~c 7AO: ,976.864 S18,455 SI97,6431 St97,643 ~ ~ 1 St,849,?798 S2,046,7621 1 1 ~S3, 144,9335 SS, 191,69g 1 I : S110,3" S173,524 S118,803 S116,039 - S119,565 S123,678 S121,717 S13f,676 1 SO 1 SO 1 so 1 so S438,509 S451,836 S466,207 S450, 024 S457, 591 S475, 787 S4 72, 736 S503,265 SG SC SC SC S10,103J517 510, 55S,3s3 S11,02f,561 S1 1,471,58S S1 1,929, 176 . 512,404,sB3 S12,8~7,69S . S13,380,966 S13,380,96& S13,380,968! S13,380,gS' s~59 1 IS95S,350 S3,715,g608S13,380, 968; i ~1 1 S2,800,807 S13,380, 968 BSI3,380,g68; S13,380, 966 Prlor to July 1, 1994, cost ot Paratran..it trips was S 15.73. From July 1, 1994 to June 30, t995 the cost ot a paratransit trip was S 15.75 per trip. Etfective July 1, 1995, the cost of a one way paratransit trip was adjusted to S 15~8 per trip. rhm change is based on the 3 % reductTon tnstituted In the FY 95t96 Medicaid contract. Enective July 1, 1995, the cost of a Full Fare (AII Transit) Metropass was adjusted to S 50.44. This change is based on the 3 % reduction instituted in the FY 95lg6 Medicaid contract. Prior to July 1, 1994, administratiYe fe~e was S 1.63 per pass. From July 1, 1994 to June 30, 1g95, admini~ratnre fe. was Increased to S 4.00 for 1 - 750 Metropasses and to S 4.17 for 1 - 750+ Metropasse~. Eftective July t, 1995, the adminls~tive fe. was adjusted to S 4.04 tor 1 - 1,SW Metropasses, S 5.00 tor t,50t - t ,800, and to S 6.X tor 1,801 Metropasses or more. Increa~e is necessary to provide for needed monitoring and accountability. P~. OUO7l97

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