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Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility (1998)

Chapter: Metro-Dade Transit Agency's Medicaid Metropass Program

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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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Suggested Citation:"Metro-Dade Transit Agency's Medicaid Metropass Program." Transportation Research Board. 1998. Using Public Transportation to Reduce the Economic, Social and Human Costs of Personal Immobility. Washington, DC: The National Academies Press. doi: 10.17226/9438.
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METRO-DADE TRANSIT AGENCY,S MEDICAID METROPASS PROGRAM CASE STUDY

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

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

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

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

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

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

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

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

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

MDTA. Nonetheless, the reimbursement rate for paratransit trips was reduced below MDTA's costs. Other transit agencies which had not started a pass program could do so to save on paratransit costs and, thus, absorb the state's reduction. However, since MDTA had been proactive in moving clients to fixed-route transportation, it could not realize the needed savings by starting a new pass program. Therefore, AHCA raised the administrative fee for the Metropass program not only to cover new monitoring responsibilities MDTA had assumed but also to help offset the paratransit programs costs. How MDTA's experience can be replicated outside of Flor~da's coordinated system depends on each state's specific policies and procedures, which vary widely from state to state. In some states, the Medicaid office only gives clients vouchers for fares and does not pay the actual cost of the paratransit trip. Unless these states take on more of the responsibility for transportation, there is no monetary incentive to participate in a bus pass program. Forming a partnership with the Medicaid agency in these states to share trip costs is a critical first step. Establishing federal guidelines on shared responsibility for non-emergency medical trips has been the subject of lengthy discussions which have not yet resulted in uniform Medicaid transportation practices across the states. The Transit Specialist, located in the Office of the Secretary of the Health and Human Services Agency (HHS) in Washington, D.C., advocates such federal guidelines. She believes that the joint planning guidelines between HHS and the U.S. Department of Transportation, required by Congress in its welfare reform legislation, may spur shared responsibility for medical transportation costs between the two agencies. The bus pass program could then become attractive to Medicaid offices in many more states. Thus, in assessing the transferability of the Medicaid Metropass Program. it is clear from the joint actions and decisions described in the MD'1'A case, that a partnership is an essential component. Both the health care agency and the transit agency must be committed to helping each other and working from a position of trust. Bias Toward Action Starting the Medicaid Metropass Program required energy and commitment to combat bureaucracy. The Area 11 Program Administrator was not particularly encouraged by AHCA; instead she took it upon herself to work through obstacles in order to implement the program. For example, the budget rules did not petit any addition of staff, even if more staff could result in saving the millions of dollars the Medicaid Metropass Program now does. However, AHCA did permit contracting for services. Therefore, the Program Administrator was able to solve the staffing problem by contracting with MDTA to take over the entire program, giving up 10

traditional AHCA duties such as verifying eligibility, dealing directly with the social service agencies, and monitoring for abuse. Not having enough stay limits creativity within the Medicaid program, according to the Program Administrator. More than busy with just their required tasks, the staff doesn't have the skill or the passion to be innovative. What is needed, she said, is an ability to "color outside the lines." However, "staying in the lines," that is, maintaining the status quo, is more the statewide norm, according to the Florida Legislature's Office of Program Policy Analysis and Government Accountability. In reviewing the pass program, their report states, "Notwithstanding such potential savings, some agencies are reluctant to use mass transit systems to transport their clients." They conclude "that some transportation disadvantaged individuals currently receiving paratransit services could be reasonably transported through lower cost mass transit systems as already been accomplished in some counties. However, this will require an agency commitment to closely evaluate their clients' capabilities for using mass transit services."7 Whereas the Area 11 Program Administrator in Florida led the way by taking the initiative, other Medicaid offices around the country have been more cautious. This is evidenced by the guidance issued by the federal Health Care Financing Administration (HCFA) on December 26, 1996, long after the MDTA Medicaid Metropass program was in full swing. In response to inquiries from the states, the guidance indicates that expenditures for bus passes are allowable as a Medicaid administrative cost. The states must find that the bus passes are the most cost-effective alternative by comparing them with other payment methods and modes of transportation and by determining that mass transit is appropriate to the individual client's needs and personal situation. States may pay the full cost of the bus pass even if it is used for other trips: "If the primary use of the bus pass is for transportation to Medicaid providers and the only other use was personal use which did not affect the cost of the bus pass, no cost allocation would be required."8 Perhaps the HCFA guidance would never have been issued if someone had not used common sense and leadership to be a trailblazer. This bias toward action is expressed in the philosophy of the Area 11 Program Administrator: "Don't accept the wall!" Neither would the pass program have been possible if someone at MDTA had not adopted the same attitude. The Deputy Director expressed a similar philosophy by defining the difference between an administrator and a manager: "An administrator tells you what you cannot do-what the rules are," he said. "A manager rewrites the rules to get things done." 11

REFERENCES 1. Community Transportation Association of America, "Medicaid Transportation and Managed Care: An Overview," May 8, 1997, Washington, D.C. 2. "Medicaid Metropass Program," MDTA. 3. "Review of the Transportation Disadvantaged Program," The Florida Leg~slature's Office of Program Policy Analysis and Government Accountability, January 29, 1997. 4. "Review of the Transportation Disadvantaged Program," The Florida Leg~slature's Office of Program Policy Analysis and Government Accountability, January 29, 1997. 5. "Review of the Transportation Disadvantaged Program," The Florida Leg~slature's Office of Program Policy Analysis and Government Accountability, January 29, 1997. 6. Community Transportation Association of America, "Medicaid Transportation and Managed Care: An Overview," May 8, 1997, Washington, D.C. 7. "Review of the Transportation Disadvantaged Program," The Florida Leg~slature's Office of Program Policy Analysis and Government Accountability, January 29, 1997. S. Letter to State Medicaid Directors from Judith D. Moore, Acting Director, Medicaid Bureau, U.S. Department of Health and Human Services, dated Dec. 26, 1996. 12

APPENDIX 1 Mee~icaic! M traps D - I (a joint venture between) District 11 Medicaid Office 8 Metro-Dacte Transit Agency I\II.D.T~A. Transit Mobility Planning Section 3300 N.W. 32 Avenue Miami, F 33142 Ph. {305) 637-3740 Fax (305) 637 3784 Ask For: Sheila Winitzer John Garcia Rev. 8/97

MEDICAID METROPASS PROGRAM Table of Contents I. Program Brochure 2. How to create a Medicaid Metropass Program How to create a computer program for the Medicaid Meiropass Program Operational aspects of a Medicaid Meiropass Program 5. 6. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. Program Task Analysis Application Forms (English, Spanish, Creole) Agency Sign-In-Sheet Manhour PostCard Returned Pass Form Non-Agency Client Eligibility Monitoring Form Agency Fax-Cover Form Agency Pass Handout Non-Agency (Mailout) Letter New Participant (ma. Card) Letters Manhour Rejection (nof eligible) Letter Agency PosiCard Letter Agency Co-Pay Letter Non-Agency (Mailout) Co-Pay Letter (English, Spanish) Non-Agency (Mailout) Late Co-Pay Letter (English, Spanish) Monthly Program Update Monthly Cost Benefits Analysis Medicaid Monthly Savings Estimate Monthly Agency Population Analysis t

5' - to Hi o ~ - ~ ° E as; ~ - ~ JO ~ ' ~ _ . ~1 Cal Cal ~5 ~ _ ~ O ~ A_ ~ ~0 - i,:

To Create a Medicaid Metropass Program a Set criteria for participation in program (Miami, 6 one way trips per month, for 3 consecutive months) o Formulate policy with Medicaid administrator as to reissuing of lost Metropasses, or claims of Metropasses not received in the mail o Establish a reasonable fee for administrating the program o Create computer program to generate all necessary information; create mailing labels; block participants from using paratransit; provide information for billing at appropriate time 0 Create a monitoring system and policy to insure the integrity of the program o Make staff assignments for various responsibilities (to facilitate the program and to eliminate overlap of functions the entire program should be administered by the transit coordinator) o Identify agencies receiving more than 5 Medicaid clients via paratransit a day through an investigation of paratransit service on group multi-load trips to the agencies 0 Contact agency director or program administrator, discuss program and offer to do a travel training program for client group, and an in-service training session for staff (necessary for carry over training, and reinforcement of transit policies and procedures Design brochure, application, and return postcard to be used for re- certification each month Conduct travel training programs, and ask participants how many would be interested in using fixed route transportation in lieu of paratransit if they could have ALL their transportation free Set initial deadlines for receipt of brochures, review of eligibility list, deadlines for mail-out, deadlines for receipt of applications o Generate your first list of eligible Medicaid clients, print mailing labels, mail out brochures - Check applications received against original list of eligible clients to avoid fraud o Review applications to be certain they contain complete info~.~ation o Call each respondent to be certain they understand they cannot have both options

Creation of Computer Program Computer Program has several major facets that need to be addressed: - current client files - archiving procedures and pass history files - reporting functions - eligibility functions - defaults set up functions - billing functions o Current client files - staff must be able to navigate files by either Medicaid number or by last name. Information provided must include fields for: - Medicaid number - pass type (In Miami): Discount Metropass: grades 1-12, elderly 65 or older, handicapped All Transit Metropass: all other eligible participants - agency (when applicable) last name, first name, middle initial address phone (daytime) paratransit trip history (average number of trips taken per month over a 3 month period used to establish eligibility) - minimum trip defaults on computer program would protect eligibility requirements (ea. if fewer than trips are entered into the client file, the client would be made ineligible) date of service/eligibility date - program ability to display, change or delete different fields of client information is also needed. - date of last edit to the client data file (ea. change of address, agency etc.) 0 Archiving procedures /pass history - program must provide a procedure Lo allow for current customer files to be stored by month in a history data set file. Requirements inc. rude: - ability to change pass records (pass returns that are tied to billing to Medicaid office) - print history reports by month or by client. o Reporting functions - program must generate different reports for management of the passes distributed. Reports should include: monthly pass summary: report is sent to Finance Dept. for pass order Elements of the report include: - total number of passes ordered (broken down by number of Discount and Full fare passes ) - cost by type of pass - total monthly pass cost - sublunary client list with name, Medicaid number and number of the

estimated paratransit trips which would have been made by the participant in the program. (This figure is used to calculate estimated costs and savings to the Medicaid Office) - complete (full) client list with name, address and Medicaid number of each client rece iving a pas s client list by each agency and non-agency Pullouts (listed as No Agency) client pas s receipt and eligibility Serif ication form by each agency ( s ign- in- shee t by agency ~ mailing labels for mailout (non-agency ~ clients o Eligibility functions - program must compile data to be batch processed for Medicaid eligibility via the Medifax system. - create initial list - prepare list of clients on the computer program to be verified by the Medifax system using a PC based application (Medifax system uses the PC+ software program licensed by The Potomac Group), includes transferring data onto the PC and then transmitting data to the Medifax system via computer modem - process eligibles - after batch processing of Medicaid eligibility by Medifax, would handle the conversion of the of the Medifax PC+ program back into the computer program - includes a printout of eligible clients and ineligible clients for that month. (Note that total number of eligible and ineligible clients should equal the original number of clients submitted to the Medifax system) - additional reports: - print out list of ineligible clients broken down by each agency. This printout would then be distributed to each agency for their own records. Eliminates numerous phone calls between agency staff and CTC staff as to why this client did not receive a pass for that month o Default set-up functions - would allow for changes in the computer program. Includes: - printer defaults for submitting print jobs to different printers (laser page printers for labels and/or line printers for 11" x 14 7/8 n continuous feed paper) - add/change/delete agency information (agency name, address, phone, contact person etc.) - change pass prices for different passes (discount or full fare) o Billing functions - would allow for data to be compiled for the billing of the program on a monthly basis. Should include: number of passes ordered cost per pass by type of pass total monthly cost for passes - name of client, Medicaid number, type and cost of pass ~ so that the Medicaid Office can charge against client's benefits allowance) - administrative fee to be paid per each pass

Operational aspects of a Medicaid Metro~ass Program 1) Processing for the coming month (from 3 sources) a) mailout pass recipients - postcards b) agency sign-in-sheets (Agency Pass Receipt and Eligibility Verification Form) c) new applications 2) Reviewal for completeness a) incomplete applications - Agencies - faxed back with a cover page explaining what is incomplete - Mailouts - handled via phone or returned aria mail with incomplete sections highlighted b ) convert Medicaid Gold Card number into the 10-digit recipient ID number needed to facilitate billing 3) Categorize and key punch new applications and sign-in-sheets from last month and c omb ine all ma il out app 1 ic ations to ge the r 4) Create initial list of clients for batch verification via the Medifax system ( see Eligibility Functions of creating a computer program ) 5) Based on the list generated by the Medifax eligibility program, print out two reports: a) eligible client list b) ineligible client list with reason for their ineligible status 6) Printout mailing labels for non-agency (mailout), eligible pass recipients 7) Order Metropasses from the Finance Department 8) Prepare agency packages. Include: a) Agency Pass Receipt and Eligibility Verification Form (sign-in sheet) b) current client information bulletins c) printout of ineligible client list for each agency 9) Package Metropasses together with agency enclosures and drop off at prearranged office location 10) Notify all agencies that the Metropass packages are available 11) Mailout passes: a) prepare envelopes with labels, appropriate enclosure bulletins, passes and postcards (recertification procedure for the following month) b) mail out the non-agency envelopes

MEDICAID METROPASS PROGRAM TASK ANALYSIS ( Based on 1,000 applications ) TASK L. Receive bailout eligibility postcards and mailout new applications Determine mailout copays and categorize into paid copay, didn't pay copay, copay exempt groups Research didn't pay copay postcards with the didn't pay copay postcards from the previous month to determine whether clients need to be placed into the disqualified - copay group 4. Receive agency sign-in-sheets and new applications Determine agency copays received and Tog in agency returned passes 5. Group agency applications and alphabetize 7. Read new applications (agency or mailout) for completeness 8. Research all new applications lacking 10-digit # 8-9 Medicaid recipient ID number via HealthNet POS 10 furs. Te~inal 9. Call agency contact/mailout applicant for incomplete information O. Log new mailout applications and distribute to staff 2 furs. and monitor the return of the new applications l. Contact medical facilities to confirm information # il-12 on all new mailout applications 16 furs. 2. Contact medical facilities and program offices to confirm information on on-going postcards - at least a 50% random sampling of all mailout pass recipients . For individuals found not meeting the minimum trip eligibility criteria (new applicant or from postcard), prepare form letter advising that they were found ineligible based on the information provided and deliver via mail 4. For individuals found not having paid the copay from the previous month prepare form letter advising that they are now responsible for paying $2 in copays and TIME ALLOCATED TO TASK BY STAFF Paratransit Transit Support Planner 2 Specialist I # i-3 2 furs. # 4-7 furs. 4 furs. 1/2 hr.

hat if full payment is not received, they will be neiigible to receive a pass for the next month and eliver via mail or individuals found not having paid the copay for consecutive months prepare form letter advising that hey are ineligible to receive a pass based on edicaid policy and deliver via mail or individuals whose copay in check form was returned by he Dade County Finance Dept. for NSF reasons prepare form ester advising that they are ineligible to receive a pass eased on Medicaid policy and deliver via mad! nput on-going agency client eligibility (from sign- 10 furs. e-sheets) and new applications and make changes .n computer file, when necessary Group postcards and alphabetize Input on-going mailout client eligibility (from Postcards) and new applications and all pertinent .nfo~.,ation into computer program Respond to all inquires from the Medicaid office, agencies, and individual clients Create the initial list of applicants to have their Medicaid eligibility verified on computer program Process this list of individuals via PC based iealthNet program Print out list of Medicaid eligible/ineligible individuals Order Metropasses from Finance Dept., identifying the number of Discount and Full Fare Passes Prepare agency packets with current handouts and prepare envelopes with out-going mailout letter Generate mailing labels from computer list of eligible mailout individuals and paste on envelopes Insert Metropass inside every mailout envelope and group agency passes together in the agency packets Bundie agency packages and postal mailout envelopes Deliver agency packets to the Finance Dept. Pass Window and deliver postal mailout envelopes to Mail Dept. Notify agencies to pick up their Metropasses via U group mails fax and call any agencies not on the fax list Respond to calls for Metropasses not received yet (lost in the mail) or to ineligible notification letter individuals (see # 13-16) 1/4 hr. i/4 hr. 1 hr. 6 furs. 4 furs. # 27-29 3 furs. 1/2 hr. 5 furs. ~ hr. 4 furs. ~ hr. i/4 hr. 2 furs. ~ hr.

2. Respond to agency calls regarding clients not receiving passes, clients wanting to be reinstated onto paratransit and for any other questions 3. Compile list of any late orders 4. Check eligibility of late order group thru HealthNet POS terminal . Prepare second/late order for Metropasses and submit to the Finance Dept. before 5th working day of month 6. Prepare envelopes with labels and mail/deliver/or have rider pick up Metropass 7. Collect all undistributed Metropasses from Agencies and mailout returns and deliver to Finance Dept. before the 25th of the month. Include a list with names and Medicaid numbers of individuals not receiving or returning their Metropasses S. Design letters, forms, policies and procedures necessary to meet the needs and to maintain the integrity of the program 9. Provide the Medicaid office a monthly report containing costs and estimated savings in the program and a historical analysis of cost/ savings for the program LO. Maintain communications as needed with the Medicaid staff to discuss success, changes, or problems with the program 11. Supervise and administer the program 2 furs. # 33-36 4 furs. 2 furs. 2 furs. 1 hr. 2 furs. 5 furs. Is. i

SIAR ~ HONDA AG£~ FOR H~LTH CARE ~MINIU"TION "l)ICMO ~ ~fUN SASS low S3 S=E1 ~4, Ft 331" APPLICATION M E T ~ O - D ~ D E Transit Mobility Plowing 3300 NeWe 32 Avenue Second F loor Room 226 Miami, Florida 33142 MEDICAID METROPASS PROGRAM If you, or someone you know is a Medicaid recipient, and are interested in enrolling in the Medicaid Metropass Program, please fill out this form and return ~ to the MDTA Transit Mobility Planning Section. You will be notified by mail within 30 days if you are eligible to participate in this program. You will be required to fill out and mail to MDTA each month a post card and a $ 1.00 copayment to establish eligibil ty for the following month. PLEASE REMEMBER THAT WHEN YOU ACCEPT A MEDICAID METROPASS, YOU CANNOT ALSO USE MEDICAID DOOR-TO-DOOR TRANSPORTATION. 1. NAME 2. MEDICAID NUMBER 3. SOCIAL SECURITY NUMBER 4. DATE OF BIRTH 5. Are you currently enrolled in an HMO ? Name of Plan 6. Do you have any other means of transportation including family or fnends? Yes No 7. Are you able to use public transportation for your medical appointments? Yes No 8. How many appointments do you have each month that would qualify for Medicaid transportation? 9. Do you have a disability? (If yes ~ please identify) _ 10. HOME ADDRESS 11. DAYTlt~E TELEPHONE NUMBER 12. NAt~lE OF AGENCY I understand that I cannot use PARATRANS[T while I am receiving the Medicaid Metropass. If I have difficulty using public transportation, I may return my Metropass and be re-instated on Medicaid Paratransit transportation. SIGNED SUBMITTED BY 10ff DATE

~ sr4T' OF ~o~o ~M E T ~ O D A D E F=r ~ AGfNCY FO! H~TH CARE ADMINIU"T10N ~ "~D~ ~T~itMobBi~P~mag ~,`' - ~e ~ 333" ~ N.W. 32 Avecue `° ~Second Fl<~r Room 226 Miami Flonda 33142 SOLICITUD PARA EL METROPASS DEL MEDICAID Si usted o alquien que usted conoce recibe Medicaid y esta interesado en pertenecer al programa MEDICAID METROPASS, por favor llene esta planilIa y devueIvela a la oficina de MDTA Transit Mobility Planning Section. Se le informara por correo dentro de 30 dies si caldica pare participar en este programa. Si fuera aprobado se le enviara una tar~eta cada mes pare que la llene y nos la envie con un dolar de c~pago por correo pare venficar su eligibilidad. POR FAVOR, TENGA EN CUENTA QUE CUANDO USTED ACEPTE EL METROPASS DEL MEDICAID, NO PODRi REaUERIR LOS SERVIClOS DEL TRANSPORTE DEL MEDICAID A DOMICILlO PARA SUS VISITAS AL MEDICO. 1. NOMBRE 2. NUMERO DE MEDICAID 3. NUMERO DE SEGURO SOCIAL 4. FECHA DE NACIMIENTO 5.<,Esta actualmente inscnto en alqun HMO ? si Nombre del plan HMO no 6. <,Cuenta usted con otros medios de transporte incluyendo familiares o amistades? St no 7. <,Puede usted usar el transporte publico para acudir a sus citas medicas? si no 8. <,Cuantas citas con el medico tiene usted mensualmente que le acrediten para recibir transportacion del Medicaid? 9. `,Tiene usted alqun impedimento? (Explique..) 10. SU DOMICILIO ~1. TELEFONO DURANTE EL DiA 12. Nombre de Agencia . Yo entiendo que no puedo usar PARATRANSiT mientras este recibiendo el Metropass del Medicaid. Si yo tuviera dificultad en usar el transporte publico, yo puedo devolver mi METROPASS y continuar utilizando el Medicaid Paratransit. FIRMA PRESENTADO POR 1~ff FECHA

S14H ~ FLOlIDA AGEN~ FOR H~LTH CARE ADMINIST"T10N hIfDlCUO "£A [ 13S5 NW S3 STtEll hUh~l, Ft 33166 APLIKASYON M E ~ R O D ~ D E ~ ~7 Transit Mobility Planning 3300 N.W. 32 Avenue Second Floor Room 226 Miami, Flonda 33142 MEDICAID METROPASS PROGRAM Si ou mem'm, ou bien yon moune ke ou konnen ap recevoi MEDICAID, e ke ou interesse fait parti de Program Metropass pou moune ki genyen MEDICAID, rempli form sa'a epui retounen li nan omce MDTA ye. Yap infome ou par laposte nan environ 30 jou si'ou kalifie pou'ou paticipe nan program nan. Si ou kalifie pou entre nan progran nan, yap mande'ou pou'ou rempli chak mods yon ti carte ke wap voye nan Medicaid offlice la. Infomasyon sou carte sa'a ap permete Medicaid omce la detemine si ou toujou qualifie pou moi prochain. PA BLlE KE Sl OU ACCEPTE METROPASS GRATIS SA'A, OU PA KAPAB EN MEM'M TAN BENEFIClE DE MEDICAID TRANPOTATION Kl VIN'N CHECHE'OU DEVAN PORTE'OU E K' MENNIN'OU TOUNEN DEVAN PORTE OU A. 1. NOM ' OU 2. NUMtRO MEDiCAiD OU 3. NUMEtRO SOCIAL SECURiTE'OU 4. DATE NESSANS OU 5. Esk. ou fait parti de you HMO ? Ki non plan 'en 6. Eske ou genyen lote moyen pou ou deplace, fanmi ou bien zanmi? Oui Non 7. Eske ou kapab monte transpo publik pou ald ka docte? Oui Non 8. Combien rendez-vous par mods ou genyen ki kapab kalifie' ou pou Medicaid transportation? 9. ADDDRESS LACAILLE 'OU 10. TEtLEtFONE OU LAJOUNEN 11. Nom Agence Ki Ba'Ou Midicaid La Moin kompran~n ke moin pa kapab beneficie de service PARATRANSIT ou STS pendan ke map recevoi Medicaid Metropass la. Si toutefoi moin ta gen difikilte servi avek transport public la, moin kapab retournen IYletropass e yap retounen moin nan Medicaid Paratransit Transportation. SIGNE PREPARE PAR DATE

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No: Ml:DICAID ID No. To qualify for Our Medicaid Mctropass for next month, you must pronde the date of your medical appointments fi-om last month and the doctor s name, addrms, and phone number. Date Doctor's Appointment None 1. 2. 3. 4. Office Phone Address Number Your continued eligibility ~ the Medicaid Mctropass Progrmn depends iD paw OD. hmTA receiving this card and your S1 co payment by the 15th of the month. Nombre Numero de identificacion de! Medicaid Para cuatificar pare obtener un Metropass de! Medicaid pare e! proximo mes, apunte las fechas de sus cites m~icas de! mes pasado junto con e! nombre, la direccion, y e! cumero de telefono de su medico. Fecha Nombre de la Cita de! Medico 1. 2. 3. 4. Direccion Numero ale la Oficina de Telefono Lee cont~uidad de so cligibilidad en el Hogrnma del Mc~opass del Medicaid depends en pow en que MDTA mciba esta targets ~ un co page de S1 en o ~tes del ~5 del mes.

- i 5 ·o o to U] U: o ·d ·4 _ _ _ _ - 8 a 3 ~

MEDICAID METROPASS PROGRAM Client's Eligibility Monitoring nts Name Date of Survey Medicaid # intment #l Date ors Name Phone, intment verified yes no intment #2 firs Name ointment verified yes no Date Phone ~intment #3 :ors Name ~intment verified yes no. reyed by Date Phone Date

TO: DATE: FAX # ~flOtIO~ AGENT FOR HEALTH CARE ADMINISTRATION D~IDA~A El~N S5NWi3 -~,fi331" Number of pages ( including cover page 51 E ~ R O ~ D .` D E ~ ~-~ Transit Mobility Planning 3300 N.W. 32 Avenue Second Floor Room 226 Miami, Florida 33142 A ~C O V E R ~ E ~ O FROM: PHONE # FAX # John Garcia M.D.T.A. 637-3754 637-3784 This application cannot be processed because it is incomplete. To guarantee that this client receives transportation services for next month, please complete the areaks) indicated on this form and return to this office before the 20th of this month. Incomplete name: Unable to read name Application not signed: Enrolled in a transport compensatory HMO Other: Incomplete Medicaid number: (10 digit number only) Unable to read Medicaid number: Medicaid appts. from last month: Incomplete S.S. # or D.O.B.: ***~*t*******~**~********~**~***********t*******t********ttt***tatat*tttatt*t** Comments: TI~TrF5L = idol ~ all pages or have any problems with this tacslmlle please call me at 637-3754. 1

STA~ ~ flOlID~ AGENCY FOR HEALTH CARE ADMINISTRATION _ . MfDlCAID 4~A CHIN t3SS HW S] ~E! hU"U, Ft 331" 51 E T R O - D ~ D E |---I Transit Mobility Planning 3300 N.W. 32 Avenue Second Floor Room 226 Miami, Florida 33142 S P E C I A L A T T E N T I O N Just a reminder that as of May 15, 1994 all new applications, re- certifications, and signed receipt lists (sign-in-sheets) of eligible agency participants are to be sent to: Mr. John Garcia Metro-Dade Transit Agency Transit Mobility Planning Section 3300 N.W. 32 Avenue Miami, FL 33i42 Telephone: 637-3754 Fax: 637-3784 Ask for Mr. John Garcia or Ms. Sheila Winitzer All applications and sign-in-sheets (eligibility lists) are due by the ~ _ of the month. Applications received after the 15th of the month, will be held and processed for the following month. All applications must be complete and legible. Incomplete applications Will be returned. Agencies will be notified as soon as the passes are available. Pick-up will continue to be at the Stephen P. Clark Center, lll N.W. ist Street, 9th Floor, window X 2. Agencies returning Netropasses must do so before the 15th day of the month. In order for the Medicaid Netropass program to continue to grow and be both effective and efficiently administered, your cooperation is necessary. Both the staff of the Metro-Dade Transit Agency (MDTA) and the Agency for Health Care Administration (AHCA) are available to answer any questions or to resolve any problems that may arise.

~ S14R ~ ,tOt1D~ t-~.~-) ACENO ~! HEATH CARE ADMINI~710N i "D - D - 4 EL~ 9~' SASS ~ 53 =Et] \~ / - At, AL 331" Dear Medicaid Metropass Recipient: ~ £ T R O · D ~ D E ~-~ Transit Mobility Planning 3300 ~'.~'. 32 Avenue Second 1700r Room 226 Miami, Florida 33142 Thank you for participating in the Medicaid Metropass Program. If you are eligible and wish to continue to receive your free Medicaid Metropass, you must do the following: 1. Complete the enclosed postcard. rist a ~in;- ~ of three medical aPpoinhmonts. * Please note, because of the increased interest and participation in the Medicaid Metropass Program, the response date for the return of your eligibility card is now the ~ h of the month. Failure to copy could result in not receiving a free Medicaid He~ropass for the following month. If you are having difficulty in completing the postcard, please ask you' social worker, counselor or a f e-. ly member to assist you. Do no. leave t~.'s p~c~ca-c With. you doctor to complete. 4. Please note, the mailing address on the postcard has been ch.2ngec. bets-.. the completed pcs.card and address all future correspondence by ma~1 to M: ^'s Tra..si Mobility Pla~r.ing Section. 5. To avoid late receipt of your Medicaid Metropass, please check your mailing lapel for apartment number and correct mailing address. Notify fir. John Garcia or M_. Sheila Winitzer at 6;7-3754 of any corrections and/o' changes. Failu e to properly notify MAYA could result in a delay in receiving your Hetropass. If you receive medical services at Jackson Memorial Bospital (ape), please include your Jan patient identification number. ANY RECIPIENT OF A MEDICAID 2~0PASS HOT MEDICAID ALIGN FOR '1~ ANN IXI)ICA=D ON THEIR I~ROPASS IS RESPONSIBLE FOR REIN TEE ~I'ROPASS TO A'S TRANSIT MOBILITY PIN SECTION AT 3300 N.W. 32 AVENUE, 2nd FLOOR; MIAMI, EI~ORIDA 33142. If you have any questions regarding this program, please call the Metro-Dade Transit Agency office at 637-3754. Sincerely, Judy Rosenbaum, Ea.D. District 11 Medicaid Program Administrator Danny Alvarez Deputy Director Hetro-Dade Transit Agency

3 out U,~31" sail ~ ~ - oA AGES ~! Hats ME ~1~710N FOR 1~ CLIENrS/APPLICa=S l ~ E ~ ~ O D A D E Those Mobility PJ~mog 3300 N.~'. 32 Avenue Second Floor Room 226 Miami Flonda 33142 Congratulations, because of your medical needs you have been designated eligible to participate in the Medicaid Metropass program. Participants with permanent disabilities under the age of 65 must obtain a Metrobus Reduced Fare Permit. If you do not have one, follow these simple directions: o Obtain a letter from your physician or this agency stating what the disability is, and that 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 Hetrobus Reduced Fare I.D. Pe~,~it with your photo on it. This permit is good for an indefinite period of time. For transit route and schedule information, call the Metro-Dade Transit Agency's Information Jepartment at 638-6700. Transit information agents are available from 6:00 a.m. to 10:00 p.m. Monday - Friday, and from 9:00 a.m. to 5:00 p.m. Saturday and Sunday. If you have any other questions regarding the Medicaid Metropass Program do not hesitate to contact John Garcia or Sheila Winitzer at 637-3754. Enjoy the opportunity to travel anywhere at anytime, by using your free Medicaid Metropass. Sincerely, l Judy Rosenbaum, Ed.D. District Il Medicaid Program Administrator . - l Danny Alvarez Deputy Director Metro-Dade Transit Agency

~ slam ~ flOtIOA 6~] AGENCY FOR HEALTH CARE ADMINISTRATION ~ ~ ~ "D~lD ~ ELAN ~ ~ ~J~ usi ~ S3 =££T \~' "~,~331" Dear Medicaid Metropass Participating Agency: m M ET R 0- D ~ D E ·--~7 Transit Mobility Planning 3300 N.W. 32 Avenue Second Floor Room 226 Miami, Florida 3314' On November 6, 1995, the Metro-Dade Transit Agency (MDTA), hosted a meeting for representatives of all agencies participating in the Medicaid Metropass program. The purpose of the meeting was to resolve problems that were being experienced by the staff of MDTA, Medicaid eligible individuals, and agencies participating in the Medicaid Metropass program. A matter of primary concern to everyone, is the reluctance of disabled individuals to obtain a Discount Metrobus Permit. We understand the need for confidentiality in regard to identifying disabilities. However, we were unaware of the fact that there are specific Medicaid codes that provide the same information, without breaching confidentiality. Effective immediately, all physicians letters certifying permanent disabilities for HIV, dual diagnosis, and various mental disorders will be accepted if they contain the appropriate Medicaid code. The codes are as follows: 0 HIV 759.8 o Mood disorders 296.99 o Bipolar disorders 296.7 o Dual diagnosis 304 0 Schizophrenia 295.0 o Anxiety Disorders 300.02 0 Personality disorders 301.9 If there are any other medical diagnosis that require confidentiality, I would appreciate your providing me with the appropriate Medicaid code as soon as possible. Thank you for your cooperation in providing your clients with the appropriate medical documentation, so that they can be approved for a Metrobus Discount Permit prior to receiving their first Medicaid Metropass. If you have any questions, please do not hesitate to contact John Garcia or Sheila Winitzer at 637-3754.

( O ~Y O ~ R C O ~ P A N Y L E T T ~ R H E A D ) Date: To: Prom: Metro-Dade Transit Agency Staff Physician's Name Please assist , ss # with a Reduced Fare ID Card, so that he/she can use his/her Discount Metropass to get to his/her medical appointments at our facility . Mr/Ms is currently receiving treatment at . Mr/Ms meets requirements for the Reduced Fare ID Card under Medicaid code # Should you have any further questions, please contact us at Thank you, Staff Physician's Signature the eligibility '

,~] AGED ~t HOLD ME LION ~ ~ ~.R331" MY Dear Medicaid Recipient: 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 Medicaid transportation criteria. Each month we review the elig wilily of all Medicaid participants. A survey of the medical appointment information provided by you, revealed that you do not meet the minimum requirements to participate in this program f or next month. However, Medicaid policy requires that we of f er you alternative transportation f or your medical appointments. Once you have scheduled a doctor's appointment, please call 2 6 3 - 7 3 0 ~ f or a one day transit pass for that day. 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 Il Medicaid Program Administrator - ~ ~ T ~ O D ~ D E Transit Mobility Plying 3300 N.W. 32 Avenue Second floor Room 226 Miami, Florida 33142 Danny Alvarez Deputy Director Metro-Dade Transit Agency

~ son Of ROWDY AC£~ ~! H~lTH C"£ =~1~710N "DICED ~ Elf~N SASS low S3 SR£D ~4,~31" Dear Medicaid Recipient: ~ E ~ I O D ~ D E i-~] Tnos~t Mobility Placing 3300 N.W. 32 Avenue Secood Floor Room 226 Miami, Flonds 33142 The Medicaid Metropass program is designed to offer unlimited free transportation on Metrobus, Metrorail and Metromover, to individuals meeting very specific Medicaid transportation criteria. To limit the possibility of fraud in the Medicaid Metropass program, the Metro-Dade Transit Agency has been charged with the task of monitoring the eligibility of all Medicaid participants. Beg inning thi s month , pa stcards will be distributed together with your Metropass. Your postcard mus t be completed and returned to the Metro-Dade Transit Agency (METAL before the 15th o f the man th, so that your me di c a ~ appo intment s c an be verified. Failure to complete and return this postcard could result in your not receiving a l§edicaic! Metropass for next month. ~ f you have any que s t i ons r eg arcing this matter, ple as e do no t 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 Trans it Agency

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

- ~ 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

~N S~ ~ ~o~o~ t-~ ~-~ AGEN~ ~! H~TH CARE ADMInI~ItON ~ ~ "D=D ~ EL~~ p~' ~ ass ~ s: sn£n ~/ - ~. ~ 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

;.~ 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

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

- 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

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

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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