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25 5310 program that provides funding for transporta- management. NGCAA has operated NEMT in various ways tion for the elderly and persons with disabilities (the for more than 20 years and as long as it has been providing funding is used to purchase vehicles in support of their transportation it has coordinated its service. Management is programs), and pleased with the current arrangement and appreciates that it · Department of Community Health (DCH)--Medicaid only does trips in its regular service area and does not have transportation, which is managed by one of two brokers. to conduct the intake. Public transit funding is distributed at the county level. There are some regional multicounty transit agencies; however, Activities That Affect Coordination most service is provided and coordinated at the county level. DHR and public transit are coordinated frequently, yet only · Local level initiatives--NEMT coordination, when it 10% of the transit agencies in the state coordinate with NEMT. does happen, is, in large part, a result of activities initiated and successfully implemented by the local participants. There had been little in the way of coordination efforts at There are some fully coordinated agencies in the state the state level in the past. However, this is changing, as (agencies that operate all three major programs for the GDOT and DHR have been discussing further coordination three agencies). The decision to coordinate or not was, in of their services. DCH operates a separate set of brokerages large part, a result of actions taken at the local level. for its service. The NEMT Request for Proposal (RFP) used · Capitated brokerage--By its nature, the large-scale in 2004 by DCH called for coordination of services with pub- capitated brokerage model is dependent on receiving lic transit to the maximum extent feasible. the lowest cost per trip possible. This is compounded by the playing field set by the broker and/or the state Medicaid agency. The broker attempts to contract with State Medicaid Service Delivery Model as many providers in an area as possible, often encour- aging small providers to initiate service. This makes Georgia's DCH uses a capitated brokerage to manage its coordination with public transportation difficult to NEMT program. That is, the brokers are given a set rate achieve, because public transit must compete for service based on the number of Medicaid-eligible clients who reside on price, rather than quality. in their service areas. There are five regions that were avail- · Lack of coordination of NEMT at the state level-- able for firms to place bids using an RFP process, resulting GDOT and DHR have made significant efforts to coor- in two for-profit firms being selected to operate the capitated dinate their services and their models are compatible at brokerage in the five regions. These firms then contracted the local level. DCH has chosen a capitated brokerage with a variety of public and private entities. The service model that does not encourage coordination. model used by at least one of the brokers is designed to · Service standards--The NEMT program maintains a maximize fixed-route usage. high level of standards for drivers and vehicles, ensuring a reasonably level playing field. Clients call the broker who then verifies eligibility for NEMT and determines the most appropriate/lowest cost provider to meet the client's needs. The broker then contacts OREGON--TRIMET, PORTLAND the provider and informs them of the trips for the next day. Introduction North Georgia Community Action Agency TriMet, the large urban transit agency in the Portland, Ore- Activities That Affect Coordination gon, area (population 1.3 million), operates fixed-route bus service, various light-rail lines, ADA paratransit, and NGCAA is under contract to one of Georgia's two brokers. NEMT. Fixed-route and light-rail ridership is approximately The broker takes all trip requests, verifies eligibility and trip 98 million passenger trips, with a paratransit ridership of purpose, and distributes the trips to their providers, one of 920,000 annually. TriMet entered into its brokerage arrange- which is NGCAA. NGCAA's sole responsibility is to pro- ment in 1994 as the first transit agency broker in Oregon and vide the trips as requested by the broker. The broker in the provides one of the best examples of coordination of public NGCAA service area uses them for service in-county during transit and Medicaid in an urban area. It also serves as an NGCAA's operating hours (7:00 a.m. to 4:00 p.m., Monday excellent example of a publicprivate partnership because through Friday). Trips going out of county or during hours the operations are contracted to private providers. that NGCAA does not serve will go to another local provider. The transit agency is paid by the trip with one rate for ambu- Oregon's Office of Medical Assistance Programs latory and a second for nonambulatory riders. (OMAP), in conjunction with the Oregon DOT (ODOT), chose to work directly with a variety of transit agencies that NGCAA operates using its public transit and GDOT stan- serve as brokers of service. This de facto coordination serves dards, which are higher than Medicaid according to NGCAA as an excellent example of how state agencies can work with