Health and Human Services spokesman Jake Leon said the department does not know yet how many current Doorway clients are insured by Medicaid and thereby eligible for free transportation because the program began fewer than three months ago. For the same reason, Leon said he does not know how many Doorway clients have used public transportation to reach services.
The state also thought about non-Medicaid clients who don’t have their own transportation, can’t afford the bus fare or are uninsured or underinsured.
For this group, the state built a $450,000 “flexible needs fund” into the grant to cover non-reimbursable expenses necessary for recovery such as transportation, housing and medication co-pays. Each of The Doorway’s nine hubs are to receive $50,000, but it’s not clear yet how much spending discretion they will have or whether some portion of the fund must be dedicated to transportation.
That money has not yet been given to the hubs. And Leon said the department is still finalizing a policy for using the flex money.
In reality, there are still significant transportation barriers, said those who rely on public options for themselves or their clients.
Melbourne Moran Jr., director of Integrated Care and Population Health at Harbor Homes, said CTS’s required one- to two-day notice for a ride doesn’t work when he has a client that needs medication-assisted treatment today. That’s when Harbor Homes staff pay a client’s cab fare out of their own pocket. “They are motivated for change while they are here,” Moran said of clients. “Just a five minute delay, then we lose them.”
Alyssa Seidenberg of Rindge used a taxi arranged by CTS to get to counseling and other treatments for several months last year. She said the taxi was unreliable - often late or a no-show - and inflexible if she needed to change her route. Seidenberg had a much better experience after staff at her drug court suggested she contact a nearby church that was offering free rides. Seidenberg said the driver called her over the weekend to set the week’s travel schedule and showed up when she said she would - every time.
But that ride service is limited to only females who have been in the criminal justice system and are working toward their recovery. That’s a small group of Doorway clients. Other local ride services are similarly limited, often to seniors and people with disabilities.
“Overall (buses and taxis) are helpful when they go the way it should,” Seidenberg said. “But at the same time, it’s a huge pain.”
Several treatment providers said the limited hours of public transit services can also be a challenge. Most run Monday through Friday, during the day. Yes, those hours work for most doctor appointments, counseling sessions, and medication-assisted treatment. But those hours don’t work for evening support groups or peer-to-peer sessions. And if a client needs to get to treatment across the state, the local transit services isn’t an option because it can’t leave its designated route.
Asked what would help, Burns of SOS in Rochester and Dover suggested a cooperative system between hubs and other spokes, although he acknowledged creating it would be a “logistical nightmare.”
This story was produced by The Granite State News Collaborative as part of its Granite Solutions reporting project. For more stories, follow us on Twitter @Newsgranite and like us on Facebook @collaborativenh.