North country medical transport companies plan strike over long-term underpayment to move Medicaid patients

May 10—Nine major medical transportation companies in the north country are planning to go on strike, citing years of underpayment for services they provide for Medicaid recipients and a pattern of disengagement from the company contracted by New York to pay them.

The nine companies, covering the north country from Watertown to Plattsburgh, are protesting the underpayment they say they've received from Medical Answering Services, a Syracuse-based company that has been contracted to run New York's Medicaid medical transportation program since last year.

These companies provide rides to and from nonemergency medical care for people who are unable to get to those appointments themselves, due to age, disability or distance. In New York, patients who have Medicaid coverage don't have to pay anything out of pocket for those trips, but the companies are supposed to be reimbursed for the costs of the trip by Medicaid.

In a letter sent to MAS staff, the nine companies said they plan to strike starting May 24 "if MAS does not take immediate action to raise the reimbursement rates to a fair and sustainable level."

"Oftentimes, the cost for doing the trip out to someone is greater than the cost of reimbursement," said Ryan P. Frary, president of Frary Funeral Homes, which operates a seven-vehicle medical transport service in St. Lawrence County from offices in Massena and Ogdensburg and has signed onto the strike.

Frary said it's now to the point where the reimbursements his company is receiving from MAS are not equal to the costs they are incurring to run the Medicaid transportation service. Frary transportation director Cassandra A. Fobare said Medicaid patients represent about 90% of their entire medical transport patient base.

Jeff Call, general manager at Guilfoyle Ambulance Service in Watertown, said his company is also joining the strike. Guilfoyle runs four medical transport vans in Jefferson County.

Call said a major issue the Guilfoyle medical transportation program has run into is that they are not reimbursed at all when a patient cancels on them, which he said happens frequently and cuts deeply into the company's bottom line.

"If we go to pick up a client and they just canceled, we don't get paid," he said. "We're scheduling trips all day long, and these people just have the right to cancel at the last minute, and we just eat it."

On top of that, the Medicaid reimbursement rate is too low for Guilfoyle to be able to cover costs, as Frary noted.

"Medical Answering Service needs to step up their game," Call said. "We've asked and asked for attempts to negotiate things with them, and they just seem to think that it's a deal, they won't want to do anything."

Call said MAS also requires providers to put drivers through mandatory training programs with a company chosen by MAS, with rates for attendance set by MAS charged to the companies sending the drivers.

"We're saying, these things are going to cost us money on a part of our business that doesn't make enough money to warrant these costs, so they need to step up and negotiate fairly with us," Call said.

A similar move was made earlier this year in Westchester County, when 10 medical transport companies stopped providing services to Medicaid recipients, citing the same concerns over reimbursements and costs required by MAS. Those companies returned to service about two weeks after stopping work, according to Jake Ninan, manager at Premier Ambulette in New Rochelle.

Ninan said the Westchester operators returned to service after MAS boosted their reimbursement rate by about 40%.

"It's still not what we were looking for, but it was better than what we had," Ninan said.

Ninan said that he had heard that just Friday, providers in Nassau and Suffolk counties on Long Island had reached a similar agreement after threatening to strike, and had called off their work stoppage.

Ninan said the problem is long-term, over 30 years of minimal to no increases from Medicaid for medical transport trips, and it had become an unsustainable system.

He said he and his fellow providers were in touch with Assemblywoman Amy Paulin, D-Yonkers, to discuss long-term improvements to the Medicaid system in New York and possible rate increases for providers, and will continue to advocate for more boosts.

A spokesperson for Paulin did not return requests for comment by press time Friday.

Since 2021, under a slate of reforms started under the Gov. Andrew M. Cuomo administration to cut Medicaid costs, the state Department of Health has contracted MAS as a "broker" for medical transportation across New York.

It's a change to the system from previous iterations that had MAS and another competitor provide services as a contractor, paid at a fixed fee. Under the broker model, MAS is the sole provider of transportation facilitation in New York — — and MAS profits are tied to its ability to cut costs for the program while still taking in an agreed-upon payment from the state for services.

Over five years, the contract is for a little more than $5 billion. In fiscal year 2020-21, the original-year MAS contract was worth $98 million, but the DOH only spent about $91 million in total on it.

The company said it could operate its program at a cost of $11.99 per Medicaid patient per month in upstate New York, and $8.10 for downstate patients. That proposal was 40% lower than the next-closest bidder for upstate trips, and 65% lower than the next closest bidder on downstate trips.

A state Department of Health review on "ambulettes," or nonemergency medical transport operations, conducted in 2022 painted an incomplete picture of the real costs of doing business. Most providers did not respond to the department's survey, but it found that in upstate counties the cost of one trip in upstate counties like Livingston County can cost as much as $280, with an upstate average of $90.19 per trip, and a downstate average of $70.24 per trip.

The average payment to ambulette operators in 2021 was $44.26 and $48.47 upstate.

Frary said companies have been paid less than the cost of a trip for many years, and haven't seen a measurable increase in reimbursement rates since 2012.

He used the analogy of minimum wage to explain what that means for companies.

"If you hire someone for $15 in 2012, they're not gonna still work for you in 2020 for $15 an hour," he said.

Frary said that he and his colleagues have only a rough estimate of how many trips in the north country will be impacted by the planned strike. He said he expects it will mean about 1,000 "trip legs," or transit in one direction, get canceled per day, impacting anywhere from 10,000 to 15,000 people.

Drivers will remain on their company payroll.

Call, with Guilfoyle, stressed that this strike will not impact emergency medical services for any company that also provides those services.

"We would never stop providing emergency services to the state, nobody would, because of Medicaid underpayment," he said.

Russ Maxwell, owner and CEO of MAS, did not return requests for comment on the strike from the Watertown Daily Times, nor did Nicolas Corbishley, MAS's regional representative to transportation providers.

In an unrelated press conference in the Capitol on Friday, Gov. Kathleen C. Hochul said she was concerned about the planned strike.

"That's concerning to contemplate the possibility that people in the north country, an area I know very well, it's rural, there aren't a lot of providers, there aren't a lot of options for people, and that's what the challenge is there," she said. "I will be getting a briefing from my team on this and what our options are."

The nine companies planning to participate in the north country strike are Frary Medical Services and Fox and Murray Medical Transportation in Ogdensburg, MacKay-Lawrence Ambulette in Canton, Lundy Services in Carthage, Guilfoyle Ambulance Service in Watertown, WeCare Transport Service, Adirondack Care Plus and Adirondack Assist in Plattsburgh, AllenCare Medical Transportation in Brushton and Northeast Express Medical Transportation in Morrisonville.