Office of Transportation Delivery Vickie Bourne, Executive Director KBT January 23, 2015 Medicaid Expansion and Impact on Public Transit

Office of Transportation Delivery Vickie Bourne, Executive Director KBT January 23, 2015 Medicaid Expansion and Impact on Public Transit

Goal for Human Service Transportation Delivery Save Cost/ Cost Containment Eliminate Fraud & Abuse Safer Transportation & Better Quality Service Vehicle Inspections Drug and Alcohol Better Use of Resources Dollar Infrastructure

NEMT-Non-Emergency Medical (Medicaid) Transportation Human Service Transportation Delivery (HSTD) Regions- Geographical Regions- Brokers-Medicaid Cap Rate PMPM-Per Medicaid Member Per Month Count of Medicaid Eligibles for each Region Subcontractor/Transportation Provider-Fee for Service Rate Broker MLR-Medical Loss Ratio 80%+

114 Transportation Contracts 81 Taxi or Day Programs 28 Public Transit Providers 5 Fixed Routes- Para Transit/PTA-TARC- TARC3/LEXTRAN/TANK

True or False Statewide, every Trip a Medicaid Transportation Provider makes results in a break even or a profit? FALSE True or False Transportation Brokers have always made a profit each month? FALSE Before the NEMT Brokerage Network, the Medicaid Voucher System had approximately 7% of the Medicaid Population Utilizing Non-emergency transportation services Today 33% or more of the Medicaid Population utilizes NEMT The Expansion has increased trips but we are finding that more of the Expansion population are just now realizing they have the NEMT benefit.

NEMT Expansion on Public Transit Increase in TRIPS & MILES More vehicles Needed The State recognizes that public transit vehicles are needing to be replaced sooner due to additional NEMT miles More drivers More hours for current drivers New hours paid for new drivers More operating costs Fuel Oil changes/tires/parts Insurance

Expansion IMPACTS by County/Region Increases Miles and Trips

December 2014 Eligibles=46,172 Dec 2013 Monthly Trips=8,474 Dec 2014 Monthly Trips=10,375 (22.4% increase in trips) Dec 2013 miles=121,042 and Dec 2014 miles=155,333 (28.3% increase in miles) Ballard 602 Calloway 2,686 Carlisle 426 Fulton 707 Graves 3,197 Hickman 395 McCracken 5,388 Marshall 2,178 Expansion:15,579

December 2014 Eligibles=52,439 December 2013 Monthly Trips-6,950 December 2014 Monthly Trips=8,868 (27.6% increase in trips) Dec 2013 miles=83,380 and Dec 2014 miles 121,176 (45.3% increase in miles) Christian 4,846 Hopkins 3,787 Caldwell 1,011 Crittenden 643 Lyon 541 Muhlenberg 2,689 Todd 998 Livingston 754 Trigg 1,011 Expansion: 16,280

December 2014 Eligibles=52,400 December 2013 Monthly Trips=7,843 December 2014 Monthly Trips=8,897 (13.4% increase in trips) Dec 2013 Miles=81,102 and Dec 2014 Miles=87,126 (7.4 increase in miles) Daviess 6,861 Hancock 478 Henderson 3,526 McLean 650 Ohio 1,917 Union 1,237 Webster 946 Expansion: 15,615

December 2014 2013 December Monthly Trips=14,248 2014 August Monthly Trips=17,044 (22.4% increase in trips) Dec 2013 miles 148,704/Dec 2014 189,822 (27.7% increase in miles) Breckinridge 1,760 Hardin 7,233 Meade 1,947 Grayson 2,852 Larue 1,199 Marion 1,502 Nelson 3,109 Expansion: 19,602

December 2014 Eligibles-91,562 December 2013 Monthly Trips=24,781 December 2014 Medicaid Trips=28,431 (14.7% increase in trips) Dec 2013 miles=307,909 Dec 2014 miles=364,558 (18.4% increase in miles) Warren 9,396 Adair 2,202 Allen 1,764 Barren 3,740 Butler 1,277 Edmonson 1,214 Green 1,118 Hart 1,997 Logan 2,126 Metcalfe 1,211 Simpson 1,409 Taylor 2,299 Expansion: 29,753

December 2014 Eligibles=221,044 December 2013 Monthly Trips=68,374 December 2014 Monthly Trips=75,782 (25.2% increase in trips) Dec 2013 miles=554,640 Dec 2014 miles=638,449 (15.1% increase miles) Bullitt 4,487 Jefferson 60,964 Oldham 1,792 Henry 1,252 Shelby 2,488 Spencer 936 Trimble 642 Expansion: 72,561

December 2014 Eligibles=74,828 December 2013 Monthly Trips-13,883 December 2014 Monthly Trips=15,166 (9.2% increase in trips) Dec 2013 miles =125,370 /Dec 2014=140,780 (12.3% in miles) Franklin 3,677 Scott 2,808 Anderson 1,469 Boyle 2,272 Casey 1,853 Garrard 1,471 Jessamine 3,906 Lincoln 2,652 Mercer 1,740 Washington 912 Woodford 1,576 Expansion: 24,336

December 2014 Eligibles=87,331 December 2013 Monthly Trips-10,581 August 2014 Trips =14,324 (35.4% increase in trips) Dec 2013 miles=119,189 to August 2014 miles165,026 (38.5% increase in miles) Boone 5,520 Campbell 5,699 Kenton 11,179 Pendleton 1,117 Gallatin 664 Carroll 990 Grant 2,041 Owen 957 Expansion: 28,167

December 2014 Eligibles=58,817 December 2013 Monthly Trips=11,363 December 2014 Monthly Trips=15,922 (43% increase in trips) Dec 2013 miles=71,240 Dec 2014 miles =111,121 (56% increase in miles) Medicaid Expansion=20,531

December 2014 Eligibles=62,445 December 2013 Monthly Trips-13,953 December 2014 Monthly Trips=15,634 (22.5% increase in trips) Dec 2013 miles 130,906 Dec 2014 miles =153,468 (17.2% increase in miles) Clark 3,038 Bourbon 1,786 Estill 1,946 Harrison 1,578 Madison 7,546 Montgomery 2,701 Nicholas 837 Powell 1,748 Expansion: 21,180

December 2014 Eligibles=127,029 December 2013 Monthly Trips=42,285 December 2014 Trips=47,351 (12% increase in trips) Dec 2013 miles 495,323/April 2014 miles 504,715= (1.9% increase in miles)

Clinton 1,213 Pulaski 6,871 Rockcastle 2,108 Wayne 2,455 Whitley 4,942 Bell 4,059 Cumberland 961 Laurel 6,551 McCreary 2,650 Monroe 1,150 Russell 2,240 Knox 4,506 Expansion: 39,706

December 2014 Eligibles=85,783 December Monthly Trips=13,614 July 2014 Monthly Trips=15,967 (17.3% increase in trips) Dec 2013 miles=252,615/ Dec 2014 miles 318,736 (26.2% increase) Breathitt 2,184 Clay 3,148 Harlan 4,937 Knott 2,239 Letcher 3,720 Perry 5,258 Lee 1,108 Leslie 1,935 Owsley 783 Wolfe 939 Jackson 1,882 Expansion: 28,133

December 2013 Eligibles=40,992 December 2014 Eligibles=60,568 December 2013 Monthly Trips=9,096 December 2014 Monthly Trips=12,801 (28.9% trip increase) Dec 2013 miles=184,231 Dec 2014 miles=198,212 (7.1% increase in miles) Floyd 5,054 Johnson 2,916 Magoffin 1,908 Pike 6,722 Martin 1,494 Expansion: 18,094

December 2014 Eligibles=60,710 December 2013 Monthly Trips=9,087 August 2014 Trips=9,947 (9.5% increase in trips) Dec 2013 miles=108,239 Aug 2014 miles=130,678 (20.7% increase in miles) Carter 3,203 Lawrence 2,001 Menifee 712 Morgan 1,368 Rowan 2,441 Bath 1,424 Boyd 4,473 Elliott 779 Greenup 3,272 Expansion: 19,673

December 2014 Eligibles=18,588 December 2013 Monthly Trips-1,765 December 2014 Monthly Trips=3,601 (104% increase in trips) Dec 2013 miles14,889 Dec 2014 miles=62,515 (319.9 % increase in miles) Fleming 1,669 Lewis 1,866 Mason 1,909 Robertson 220 Bracken 830 Expansion: 6,494

Dec 2013 Dec 2014 Annual Difference Total NEMT Eligibles 716,758 1,161,134 444,376 Total NEMT Trips 246,729 300,112 640,596 Total NEMT Miles 2,798,778 3,341,715 6,515,246

Public Transit Needs Vehicle Replacements Replacement Vehicle Ratio is Higher Some from the NEMT Dollars Some from Transportation Capital Dollars Public Transit has Increased Access for Medicaid Recipients Public Transit increase employees/drivers

GOING FORWARD Due to the Expansion New Medicaid Recipients Learning about NEMT Services New Medicaid Covered Services Additional Medical Facilities Trips/Miles Continue to Grow What Percent of Kentucky s Population is on Medicaid? 25%