MODELS FOR PRACTICE

FOCUS AREA: ACCESS (PRIMARY CARE)

Program Name: St. Mary’s County Health Department Medical Assistance Transportation Program

Location: St. Mary’s County, Maryland

Problem Addressed: Access to Primary Care

Healthy People 2010 Objective: 1-4, 1-5, 1-6

Web Address: http://www.smchd.org

SNAPSHOT

The St. Mary’s County Health Department Medical Assistance Transportation Program is a safety net program designed to transport medical assistance patients by a variety of methods to their medical appointments in local and semi-local areas. These individuals have no other means of transportation and would not otherwise be able to attend their appointments and receive care. The program also provides transportation to non-medical assistance individuals for a nominal fee if they have an open seat and are traveling in the same direction.

THE MODEL

Blueprint: The Medical Assistance Transportation Program is grant funded by the Maryland State Department of Health and Mental Hygiene and is managed by the St. Mary’s County Health Department. Collaborative efforts and partnerships are relied upon for some areas of service delivery. The primary focus of the Medical Assistance Transportation Program is to get the medical assistance population of St. Mary’s County, Maryland, to their medical appointments if they have no other way to get there. The secondary focus of the program is to assist others in the county who need transportation to medical appointments since transportation is a major issue for the county. St. Mary’s County is a peninsula at the far southern end of Maryland. At 361 square miles, it lies at the confluence of the Potomac River and the Chesapeake Bay, about 40 miles south of Washington D.C. It is a rural county with a population of just under 90,000. The county has a Medicaid population of about 7,000 and a much larger gray zone population (individuals with incomes too high to qualify for Medicaid but who are unable to afford private health insurance), estimated to be in excess of 12 percent of the population. The non-white population consists of 17 percent black and the Hispanic population is growing at 2-3 percent. Approximately 30 percent of the population is under the age of 18.

All individuals who participate or are eligible for the state Medical Assistance Transportation Program qualify to receive the services of this program. The program provides transportation to scheduled and urgent same-day trips to local and tri-county medical appointments as well as trips to the Washington D.C. and Baltimore areas. Out-of-state trips are also occasionally made. Five drivers provide the ambulatory trips using a fleet of public service commissioned inspected vehicles, sedans, station wagons, minivans, 15-passenger van, mini bus, and wheelchair-accessible vehicles. This is a door-to-door service provided approximately 80 hours/week. The local public transportation service is used at the expense of the program if an individual lives on the public bus route and is traveling to a destination on the bus route. In extreme circumstances, taxi services are utilized as a last resort at the program’s expense. The Medical Assistance Transportation Program also issues gasoline vouchers if the person needing care can get someone to take them to their appointments. In addition, the program contracts with ambulance services for 24/7 access.

The St. Mary’s County Health Department Medical Assistance Transportation Program has a reciprocal agreement with a neighboring county (Charles County) transportation system to relay some of the patients to city appointments. They often work in cooperation with each other to schedule appointments for the same day and time if patients from each county must see a physician in the neighboring county. The two county transportation units meet in the middle and then exchange riders to shorten the trip for the drivers and conserve resources.

Making a Difference: The St. Mary’s County Health Department Medical Assistance Transportation Program currently runs approximately 1,500 trips per month, totaling 15,000-20,000 miles. These trips are critical to enabling the medical assistance population to access needed medical care.

Beginnings: The program began providing transportation services to the citizens of St. Mary’s County in fiscal year 1993, and the program was fully implemented in fiscal year 1994. The problem with transportation was identified by examining the high numbers of missed appointments by this medical assistance population. Non-compliance of patients with medical instructions and poor immunization rates for children within this population were also recognized as problems that could be partially attributed to a lack of transportation. In one instance, a vulnerable individual was lost in Baltimore City for six hours when traveling there for a medical appointment. This event and the knowledge that many of the riders have not traveled in the city alone led to developing a "high visibility" card and ID tag with emergency information on it for riders to carry with them while in the city.

Challenges and Solutions: The program has experienced challenges in persuading the local government to extend/expand bus routes to where the lower income individuals live and to where the medical providers are located. In addition, the increased costs of ambulance transports threaten the program’s ability to continue 24/7 access to this service. Helping the riders develop responsibility skills for keeping appointments, calling to cancel, and being on time continue to be important challenges.

PROGRAM CONTACT INFORMATION

Mary C. Wood

St. Mary’s County Health Department Medical Assistance Transportation Program

21580 Peabody Street

P.O. Box 316

Leonardtown, MD 20650

Phone: (301) 475-4330

Fax: (301) 475-4350