Star Tribune
Frustration builds as rural Minnesotans struggle to get to medical appointments
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.”
About 50 Ukrainian refugees have signed up to donate blood on Saturday in Minneapolis as a way to give thanks to Americans for welcoming them to this country and for support in the face of Russia’s military invasion of Ukraine.
The donated blood will then be given to the Children’s Hospital of Minnesota.
The Ukrainian American Community Center, located at 301 NE Main St. in Minneapolis, has organized the event. The blood drive will run from 10 a.m. to 3 p.m. on Saturday, said Iryna Petrus, community outreach manager at the center.
“It’s a sign of gratitude to Americans for supporting Ukraine and saving children’s lives in Ukraine,” said Yosyf Sabir, speaking on behalf of the blood drive.
It’s also a way to say “thank you to the United States for welcoming us so warmly,” said Petrus. She said there will be a program at 10 a.m. Saturday when several leaders of the Ukrainian American Community Center will speak. She said the center is hopeful that Ukrainian groups in other parts of North America will do similar blood drives.
Those who are unable to give blood have been asked to donate cash, which will be used to purchase tourniquets that will sent to Ukraine to be used by persons who have been injured in the war. Every $50 raised will purchase one hemostatic tourniquet, the Ukrainian Center said in a news release.
If approved, that approach would drop the district’s fund balance to 6% of general fund expenditures. The current board policy is to maintain a fund balance of at least 10% of general fund expenditures.
Anoka-Hennepin’s current operating referendum brings in about $1,154 per student, but the state-allowed cap is about $2,200 per student. If increased to the cap amount, a referendum would bring in another $40 million, McIntyre said.
According to community feedback collected through surveys and community meetings over the last month, nearly 90% of respondents said they supported a referendum. Parents and families also expressed concern about growing class sizes as a result of cuts.
The two options have already been revised based on board members’ requests to reduce cuts that would mean fewer teachers at schools, McIntyre said.
At one point in the discussion, the district floated changes to middle and high school class schedules to save money, but that was removed after board member feedback. At the board’s meeting last month, several board members thanked district staff for transparency about potential cuts and responsiveness to board and community feedback.
“I would encourage people to keep asking questions,” Board Member Michelle Langenfeld said at the September board meeting, “because as we unfold more information, the opportunity becomes greater for us to make the most informed decision under these very, very difficult circumstances.”
On Monday morning, contract workers began snipping razor wire and removing it from fencing that was propped atop concrete barriers along the perimeter of the former Third Precinct police station, which was set ablaze during the uprising over George Floyd’s police killing.
Finally, the concrete barricades will come down, after 4.5 years. As private security guards looked on, contractors began removing the security measures put in place to secure the building at 3000 Minnehaha Av. after it became a focal point of protests.
For the past three years, Third Precinct police officers have been based out of a city building in downtown Minneapolis, with plans to eventually bring them back to a south Minneapolis Community Safety Center just down the street at 2633 Minnehaha Av.
What to do with the former police station – home to what has been called a “playground” for renegade cops – has been the subject of heated debate, with the Minneapolis City Council and Mayor Jacob Frey at odds.
While the city debated its future, some conservatives jumped at the chance to use the charred building as a backdrop to hold press conferences and news reports in which they blasted the city and its leaders. Most recently, vice presidential nominee JD Vance made a campaign stop in front of the building earlier this month to blast his opponent, Gov. Tim Walz, for his handling of the 2020 riots and portray Minneapolis as a city overrun with crime.
GOP vice presidential candidate Sen. JD Vance speaks outside the former Minneapolis Police 3rd Precinct building in Minneapolis on Oct. 14. (Leila Navidi)
After that, several council members expressed frustration at the city’s failure to clean up the site. Despite signs saying “cleanup efforts are underway,” concrete barriers, fencing and razor wire remained all summer.
Council Member Aurin Chowdhury said earlier this month that the blight makes people feel uncared for and gives opportunists a backdrop to manipulate the scene for political gain.
Council Member Linea Palmisano blamed some of her council colleagues for the delays, accusing some members of being “desperate for any objection” to Frey’s proposal. The council passed a resolution saying that the building should not be used for any law enforcement functions again. Palmisano called it disgraceful that the building remains, scarred and secured, over four years later.
