Danny Heskett’s ride to the doctor to check his hearing had been arranged weeks in advance.

But on a recent Tuesday, the staff at Good Samaritan Society nursing home in Albert Lea got a familiar call from the transportation provider. They weren’t able to pick up Heskett.

“What can you do? You can’t get upset. You can get disgusted because you can’t get a ride. But that’s something I’m used to,” said Heskett, 69, who estimated that he can’t get transportation to one in every three medical appointments.

Rides to the doctor or home from the hospital can be difficult to find in greater Minnesota for people who can’t drive and don’t have family or friends who are able to help. Transportation companies, county officials and health care providers are calling for state action, saying that in many corners of the state, the system is failing to meet the demand.

The result? Minnesotans are having to delay or miss oncology and dialysis appointments, dentist visits and substance abuse treatment. Those who need a ride from the hospital to their home or another site remain stuck in emergency rooms or rely on an ambulance to transport them, unnecessarily costing taxpayers hundreds of additional dollars and further burdening ambulance services that are already stretched thin.

Federal law requires states to provide Medicaid recipients with transportation if they need it. Nonemergency medical transportation providers contract with the government and managed care organizations to handle rides. But companies in rural areas said staffing struggles, inflation in operating costs, insufficient state reimbursements and administrative hurdles have made it increasingly difficult to stay in business.

Scott Isaacson estimates his Pine City-based company, Lifts Transportation, turns down 80 to 100 trips every day because they don’t have enough vehicles and drivers. He said people who need a ride include older adults, children, people with disabilities and Minnesotans who can’t afford a car.

“It’s a huge issue, and it’s very detrimental to the health of the people who live in rural Minnesota,” Minnesota Rural Health Association Executive Director Mark Jones said. “If we can’t get people to their appointments … They will forgo that care.”

For Heskett, who has prostate cancer, missed appointments can be stressful. Emily Boone, a social worker at Good Samaritan Society in Albert Lea, said the majority of their residents have struggled to get transportation to a medical appointment.

‘Can’t make ends meet’

After a pandemic-era dip in nonemergency medical transportation providers, Minnesota Department of Transportation data shows an increase last year in providers and vehicles inspected. However, people doing the work said that’s not reflected in many corners of the state.

“When you get into super rural Minnesota, there’s just not a consistent service model in place,” said Mike Pinske, CEO of the transportation company Amvan. “I’m just shaking my head right now, because it just seems counterintuitive that we have a federally mandated program and we don’t seem to have the saturation, or the coverage, necessary out there to move people.”

Amvan, located in Mankato, reduced the number of counties it serves from 10 to six since COVID-19 and is planning to cut back to four, he said.

“We can’t make ends meet,” Pinkse said. He said businesses like his are part of a rural Minnesota health care infrastructure that is collapsing.

Transportation providers in the metro area can fit in multiple appointments in a day, said Beth Ringer, executive director of the Minnesota Social Service Association. That is more financially sustainable than doing the work in greater Minnesota, where providers travel long distances to bring people to appointments and often need to wait to bring them home, she said.

Leaders with that association, which represents thousands of health and human service professionals, said they have been hearing more about the issue in the past few years. They are among the groups pushing for a funding increase.

In January, nonemergency medical transportation companies saw their first reimbursement rate bump since 2015. Lawmakers agreed last session to raise the per mile rate from $1.30 to $1.43. For rides in which a client has a wheelchair and needs a lift or ramp, the rate ticked up from $1.55 to $1.77.

Several greater Minnesota providers said the increase was dramatically less than what they need.

“Before the ink even dried on the signatures on the bill, that had already been eaten up by inflation,” said Isaacson, who owns the Pine City-based company.

Protected transport hard to find

Another growing group of Minnesotans need a specific type of nonemergency medical transportation: protected transport.

Protected transport providers generally serve riders who may pose a danger to themselves or others or who might run away, said Erich Doehling, who opened Alexandria-based ASAP Secured Transport last year. He has one of just six such companies in the state, according to MnDOT data.

Doehling started the business after seeing the need in his previous work as a police officer and an emergency medical technician. He regularly works with hospitals and sheriff’s offices to bring people to mental health facilities and addiction treatment centers.

Without protected transport companies the work often falls to law enforcement or ambulances, who are short-staffed.

“ER beds in rural Minnesota are tough to get,” he said, and people often take up beds far longer than they need to simply because they don’t have a ride.

Despite the need for protected transport, Doehling said it’s difficult to start and sustain a business in the field.

Many insurers don’t cover protected transportation. And Doehling said companies like his must have expensive specialized vehicles and sometimes need two staff members in the car with a client. While protected transport gets a higher reimbursement rate than other types of nonemergency transportation providers, he contended the rates are still too low.

Mental health advocates are pushing state lawmakers this year to boost protected transportation reimbursement rates and help cover some of the providers’ start-up costs.

Unmarked cars staffed by people trained in mental health first aid often are a better option for people in crisis than law enforcement vehicles or ambulances, said Sue Abderholden, executive director of the National Alliance on Mental Illness Minnesota. Plus, she added, they are “just a heck of a lot cheaper.”