The fiscal 2009 state budget that took effect on July 1 requires the Rhode Island Department of Elderly Affairs (DEA) to charge a co-share to users of its RIde transportation program for the elderly and disabled. The co-share was projected to save the state $319,000. DEA Director Corinne Russo indicated she would propose a co-share of $2 per trip, $4 for a round trip. Two groups of users were exempted from any co-pays: persons traveling to adult daycare services, and seniors or disabled persons eligible for Medicaid.
Therefore the burden of paying this co-share will fall on those using the service to access medical care or food at senior meal sites. This program is not a small one-it provided 276,933 trips for 5,534 individuals during 2007. This fee will not take effect immediately. Prior to implementing it, by law DEA must publish regulations and hold a public hearing to receive comments on those regulations. This process may take up to 60 days.
Recently members of the Senior Agenda Coalition met with DEA Director Corinne Russo to advocate for a method of applying the co-share that would be least burdensome for the most needy. We suggested the following steps: (1) Give low-income seniors a 50% discount per trip, reducing the charge to $1; and (2) Allow a hardship exemption from the co-share for low-income seniors who use the service several times a week to access critical medical treatments such as kidney dialysis, or radiation or chemotherapy for cancer. We believe this relief is particularly important for these persons, who are facing Medicare premiums, drug coverage co-pays, deductibles and other costs due to their illnesses.
Research has shown that even relatively small increases in premiums and co-pays can produce sizable declines in participation in programs. While $2 per one-way trip doesn't sound like much, for someone using RIde for three trips a week to kidney dialysis adds up to $624 per year. We have urged the Department of Elderly Affairs to be creative and compassionate in implementing this cost sharing. No one should miss a critical medical treatment or a nutritious meal because they can't afford this added cost.
The Senior Agenda has pointed out that this cost-sharing is totally inconsistent with the commitment, mandated by law in this same budget, to allocating at least 50% of state long-term care dollars to home and community-based care by December 2012. If the proposed Global Medicaid Waiver is approved, then its promised "flexibility" should be applied immediately to help pay for these critical transportation services for low-income elders who currently don't qualify for Medicaid-funded transportation services.