A bus in Cortland County

Public transit in many rural counties in upstate New York had been heavily reliant on Medicaid for 30 years.

Until 2012, the program designed to provide healthcare to low income Americans was one of the largest contributors to public transportation throughout rural New York. However, due to an overhaul of the way Medicaid is dealt with in the state, rural counties have seen this funding almost entirely dry up, leaving personnel scrambling and residents in danger of losing access to their only source of everyday transportation.

Tompkins County Legislator Dan Klein put it bluntly when he said, in reference to the public transportation in these counties, “They’re going to go out of business.”

Dan Klein

Although West Danby is within Tompkins County, it does not receive TCAT (Tompkins County Area Transit) service, but rather has gotten its public transportation from buses coming in from Tioga County.

However, Legislator Klein indicated that this route would soon no longer be available with the changes that have been made. He worried that this would create a major problem for those who work within the city of Ithaca.

Tim O’Hearn, administrator of Schuyler County, and Russ Barber, of Tioga County’s public transit service, both said that their counties do not receive any of their public transportation funding from local tax sources. The same goes for many other rural counties in upstate New York.

According to Patty Poist, TCAT communications manager, Tompkins County receives the vast majority of its money from Cornell, non-Cornell related fare, and its relatively high ridership.

This has allowed Tompkins County to stay relatively unscathed by changes to Medicaid, according to officials — but its neighbors face different circumstances.

Without Tompkins County’s ridership, a major source of revenue for these outlying counties has been Medicaid. In 2011, it accounted for 32% of public transportation funding in Tioga County, 30% in Schuyler County, 65% in Chenango County and 40% in Cortland County.

A bus in Cortland County

The source of this money is non-emergency transportation, which provides low income residents with a means of transportation to appointments and other non-urgent care. Public dispatchers in each county would determine and dispatch an effective means of transportation for a person, then Medicaid would pick up the bill.

Generally, Klein said, the transportation that was used was public, usually buses, and though patients were occasionally told to walk to a bus stop, most were sent special buses.

He went on to say that the cost of these rides was far higher than the average bus ride, often costing $30 dollars per passenger. Medicaid would therefore run up a high bill, which the counties would collect for the transit system.

The system allowed counties to provide sufficient public transportation for their residents until 2012, when an overhaul of New York State’s Medicaid program, called the Medicaid Redesign, changed the way non-emergency transportation was dealt with, and the money was sucked out of the counties.

Shawn Yetter, commissioner of Tioga County’s Department of Social Services, explained that with the redesign came a shift from many public dispatchers to one, centralized, private dispatcher out of Syracuse. This company is called MAS (Medical Answering Service), and has shifted almost all transportation to private taxi companies.

Yetter characterized the state as being determined to centralize the Medicaid transportation system.

Tioga and Schuyler counties have been forced to reduce their dial-a-ride service, leaving the cheaper fixed route service, according to Barber and O’Hearn, who also worried that this has left many isolated residents of these rural counties with the difficult task of getting to a fixed bus stop. Klein said that every county mentioned, with the exception of Tompkins, has had to make major reductions to their service, in many cases cutting entire routes.

The Medicaid Redesign was the result of an executive order issued by Governor Andrew Cuomo soon after he entered office in 2011. It was in response to the relatively high cost of Medicaid in New York State, according to the department of health.

In 2012, New York paid $53 billion for its Medicaid program, a sum comprising nearly 13% of the total Medicaid spending in the United States (New York only holds 8% of the nation’s Medicaid users, a study by the Kaiser Family Foundation said).

Through the order, the Redesign Team was formed. The goal of the team was to design and implement a plan that would streamline the New York State Medicaid program.
The team was successful in slashing overall costs, with an estimated 2.3 billion dollars saved in 2012 through the 78 initiatives that were implemented.

Counties have worked with the New York State Departments of Transportation and Health in efforts to regain some funding, but the results have not been a similar level of income. According to Barber, of Tioga County’s public transit system, Tioga County was able to regain about 10% of its annual Medicaid riders. That number won’t make a dent in the problem, he said.

Barber went on to say that the state “has failed to go through on its word that public systems would not be harmed.” He also faulted the state for not allowing counties to budget for any loss in funding during their 2014 budget system.

Yetter said he believes that the major effect will be on the residents, saying that “quite frankly, the responsibility [for recovering the lost transportation] will fall on the passengers.”

When asked what he saw the solution to be, Klein, who was the one to bring this issue to the attention of the Tompkins County Legislature in June 2014, said, “What is the alternative to Medicaid [funding]? I don’t know. But the state needs to be aware of the unintended consequences of its actions.”

Jeff Stein

Jeff Stein is the founder and former editor of the Ithaca Voice.