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Dear Chairman Harkin:
On behalf of millions of Americans with disabilities who rely on Medicaid transportation programs, and the public transit systems which provide essential transit and paratransit services throughout the United States, we write to express support for moratoria on the harmful Medicaid regulations identified in H.R. 5613, the “Protecting the Medicaid Safety Net Act of 2008.” We urge the Senate Appropriations Committee to add the provisions proposed in H.R. 5613 to the War Supplemental Appropriations bill currently under consideration, and to consider additional proposed regulations by the Centers for Medicare and Medicaid Services (CMS) which can have even more devastating impacts on the ability of seniors, children, and people with disabilities to access needed medical services.
This letter is submitted jointly on behalf of the more than 1,500 member organizations of the American Public Transportation Association (APTA), the American Association of People with Disabilities (AAPD), the nation’s largest cross-disability membership organization, The National Council on Independent Living (NCIL) and the Disability Rights Education and Defense Fund (DREDF). It is important to note that we have come together in agreement that Congress must protect these services for people with disabilities.
Transportation is the key to accessing Medicaid services, and these proposals by CMS would turn back the clock on years of mobility improvements for people with disabilities. Nowhere in the Deficit Reduction Act of 2005 (P.L. 109-171), on which CMS relies for its ‘justification’ for the proposed rule-changes, does Congress indicate any intent to modify or reduce transportation to medically necessary services.
In addition to the regulation promulgated as CMS-2287-F (“Medicaid Program; Elimination of Reimbursement Under Medicaid for School Administration Expenditures and Costs Related to Transportation of School-Age Children Between Home and School”) which is currently included in H.R. 5613, we urge you to extend the moratoria to include two other proposed Medicaid regulations, described below, that threaten further harm to Medicaid beneficiaries and the local transit agencies on which many people with disabilities depend.
The first of these proposed regulations was announced August 24, 2007, at 72 FR 48604 (CMS-2234-P), titled “Medicaid Program; State Option to Establish Non-Emergency Medical Transportation Program.” This proposal would limit payments to public agencies for transportation provided to Medicaid beneficiaries, effectively shifting the vast majority of their transportation costs to transit agencies and the state and local governments that fund those agencies. It would also establish new barriers to cost-effective public transportation brokerages for providing Medicaid transportation. The public comment period for that proposal closed September 24, 2007, and a final rule has not yet been published.
The most recent of these proposed regulations was announced February 22, 2008, at 73 FR 9714 (CMS-2232-P), titled “Medicaid Program; State Flexibility for Medicaid Benefit Packages.” This proposal could completely eliminate non-emergency medical transportation benefits for certain Medicaid beneficiaries, once again shifting the financial responsibility to local transit agencies and sponsoring state and local governments. The public comment period for that proposal closed March 24, 2008, and a final rule has not yet been published.
APTA submitted comments on both of these proposed regulations, as well as on the CMS regulations relating to reimbursement for transportation between home and school that were finalized December 28, 2007, and which are included in H.R. 5163. Many local member transit systems, as well as disability advocates and health providers have also expressed concerns about the dangers of reducing or even eliminating funding for such essential programs.
Under the guise of providing ‘flexibility’ to states, these proposed changes to Medicaid regulations amount to an abdication of the Department of Health and Human Services’ long established responsibility to provide vital transportation services to those least able to secure private transportation, and are directly contrary to Congressional intent and the President’s directive, expressed in Executive Order 13330, Human Services Transportation Coordination. In response to coordination mandates enacted under SAFETEA-LU, public transit systems and human services agencies around the country have been cooperatively working to more effectively improve mobility for people with disabilities, seniors, students, and low-income individuals. The CMS proposals would effectively undermine all of those efforts.
These proposed regulations would place a massive financial and operational burden on public transit agencies, local and state governments, and the beneficiaries for whom these services are intended. We thank you for considering our views. If you have questions, please contact Paul Dean of APTA's Government Affairs Department at (202) 496-4887 or email pdean@apta.com, Anne Sommers, Policy Counsel of AAPD at aapdanne@earthlink.net, Justin Chappell, Development & Communications Advisor of NCIL at justin@ncil.org, or Marilyn Golden, Policy Analyst of DREDF at (510) 549-9339.
Sincerely,
William W. Millar
President
John Lancaster
Executive Director, NCIL
/s/ per instruction
Marilyn Golden
Policy Analyst, DREDF