Concerns over California's transportation broker model for medical services took center stage during the Joint Hearing of the Health and Budget Subcommittee No. 1 on Health and Human Services on May 30, 2023. Providers voiced urgent worries about low reimbursement rates that are jeopardizing patient access to essential transportation services, particularly for vulnerable populations like dialysis patients.

Since the implementation of the Calam project on February 1, many medical fee-for-service members transitioned to managed care, leading to a significant decline in transportation availability. Providers reported that thousands of dialysis patients have been left without transportation, forcing them to miss critical appointments. The introduction of transportation brokers has exacerbated the issue, as these intermediaries have driven reimbursement rates even lower, making it financially unviable for many providers to continue offering services.

One provider highlighted the dire consequences of this model, stating, "When you look at the cost of providing transportation at a sustainable reimbursement rate compared to acute inpatient hospital stays, it's much cheaper to pay that on the front end." The ongoing crisis not only affects patients but also places additional strain on acute care hospitals, which struggle to discharge patients who lack transportation.

The hearing also addressed the broader implications of the broker model, with providers advocating for a return to in-house management of transportation services. They argued that managed care organizations that handle transportation internally tend to pay higher rates and achieve better patient outcomes. "There's a significant amount of other plans that do that same thing," one provider noted, emphasizing the need for a system that prioritizes direct support for transportation providers.

In addition to transportation issues, the meeting touched on funding gaps in emergency air transportation services due to the expiration of a tax that previously supported these programs. The panelists expressed a commitment to addressing these challenges and ensuring that necessary resources reach the communities that need them most.

As the hearing concluded, the urgency of reforming California's transportation model for medical services was clear. Stakeholders are calling for immediate action to ensure that vulnerable populations receive the care they need without unnecessary barriers. The discussions set the stage for ongoing conversations about improving access and equity in healthcare transportation across the state.