Modivcare, Penquis and Waldo Community Action Partners will continue to provide rides to medical appointments in their respective regions for another year amid a court battle over the decision to grant Modivcare a contract for the entire state.
A draft of the new agreement was sent to the MaineCare transportation brokers in early June. It allows the brokers to continue providing non-emergency medical rides in their current regions from July 1, 2025, to June 30, 2026.
Modivcare currently serves half of Maine’s 16 counties, and was slated to begin serving all counties in July 2024. But Penquis sued over the state’s award process, claiming it was “fundamentally unfair,” and Waldo was listed as an interested party.
The Department of Health and Human Services has so far extended the original arrangement as the fight plays out in the courts. The new agreement adds some stipulations but continues to provide service by the three brokers in separate service regions.
In May, the Maine Superior Court upheld the state’s decision to award a 10-year, $750 million contract to Modivcare. DHHS spokesperson Lindsay Hammes wrote in a statement that the state is extending the current arrangement because Penquis submitted an appeal to the Maine Supreme Judicial Court in early June.
Modivcare, the largest non-emergency medical transportation broker in the country, has its corporate headquarters in Denver. Some advocates and MaineCare patients reliant on the service have raised concerns about awarding the contract to the out-of-state company because it has been the subject of numerous complaints, including allegations of drivers missing or being late to appointments and trip requests being denied without proper documentation.
The state claims Modivcare is on time for 91 percent of appointments and has met all performance metrics.
Zoe Miller, executive director of the advocacy group the Moving Maine Network, said awarding the entire state to Modivcare goes against recommendations outlined in the Maine DHHS Transportation Program Evaluation from 2021.
“If you put all your eggs in one basket with one provider, should something happen to that provider, then I would worry the entire state system could fail,” said Kara Hay, the president and CEO of Penquis, a Maine nonprofit that provides rides in Kennebec, Penobscot, Piscataquis and Somerset counties.
Rider complaints
At 9 a.m. on April 2, Ariel Dunn called Modivcare to check on a ride she had scheduled for a 9:30 a.m. medical appointment at St. Mary’s Regional Medical Center in Lewiston, which she had waited months to secure.
She was told bus tickets had been sent to her home instead.
“I’m disabled,” Dunn said to a Modivcare representative on a recorded phone call reviewed by The Maine Monitor. “I am literally unable to take the bus.”
She explained that she could not take the bus because of various medical conditions and opted instead to pay for an Uber.
The bus tickets didn’t arrive until a month later. Dunn said she filed multiple complaints with company representatives and one with the Office of MaineCare Services over the incident. For the next trip she requested, she was sent bus tickets again. And then three of her requests were denied.
“If I don’t get in and get seen, I’ll die,” she pleaded to another representative. “I can’t wait several months. I’m actually dying, like my thyroid is shutting down on me. And if I don’t get into a doctor and get seen, I’m a 33-year-old who will die of complications.”
Dunn was then told that her request for a ride on April 10 was “rejected by an out-of-state agent.”
“This one was definitely rejected by an out-of-state agent that does not understand MaineCare policies,” a representative said to Dunn, according to the recording. “I fixed three already within the last half hour.”
Since March, Dunn has requested seven rides to medical appointments through Modivcare. On three separate occasions, Dunn said she called to check on her ride requests and was informed that they had been denied.
The company’s contract with the state requires denial letters to be sent to riders within 72 hours of a decision, but Dunn said she didn’t receive any. She also said she did not receive any responses to her complaints.
Myra Orifice, senior director of operations for Modivcare in Maine, said that trips are evaluated based on criteria outlined in the state contract.
“When a trip is denied, a formal denial letter is mailed within 72 hours, detailing the reason and the appeal process,” Orifice wrote in an email. “Modivcare follows all complaint resolution protocols outlined in our state contract, including documentation and response timelines. If the member requests a follow-up call, Modivcare follows state guidelines to follow up within two business days using the number on file with MaineCare.”
Alan Balladur, a 75-year-old who lives in Portland, typically uses Modivcare once a week. In the five years he’s used their services, he said drivers arrive late for about one in every three rides, and there have been eight or nine times drivers did not show up at all.
In one instance, an unknown driver showed up, telling Balladur that he was covering a ride for a friend, the original driver. When he got in, Balladur said, the car smelled like marijuana, and he believed the driver was under the influence.
“These (subcontracted driving) companies — they’re fly by night,” Balladur said. “I don’t know how they got their license.”
Orifice said she cannot comment on specific cases due to HIPAA protections, but said that “all subcontracted drivers must meet strict credentialing standards and pass background checks, drug and alcohol screening, and vehicle inspections.”
“Any incident reported to Modivcare is documented, reviewed by our Quality and Provider Relations teams, and investigated promptly. Subcontractors who do not meet expectations may be placed on corrective action plans or removed from the network,” Orifice wrote in an email.
Balladur said he handles the hiccups pretty well, but it can be frustrating to deal with. In January, when his ride didn’t show up after an appointment in Biddeford, he said he was left waiting in the cold for more than forty minutes after his scheduled pickup time, since his doctor’s office had already closed.
In another instance, he said he was left at Greater Portland Health and ended up having to get a ride home from an employee who was closing up.
He said he has left roughly twenty complaints with call center representatives — to little effect.
“I’ve tried complaining for five years now,” Balladur said. “No one is answerable.”
Getting a ride
Will Gerrish, a driver for Modivcare based in the Lewiston area, said the system works similarly to a rideshare model, where drivers choose the rides they want and skip trips they don’t want to take.
Riders can view their scheduled rides on their Modivcare app. They also receive text messages about their trip. The day before a trip, if a rider is matched with a driver, the name of the subcontractor will show up.
Gerrish said his schedule is completely full, taking eight to 20 patients to appointments a day, and that the way trips are scheduled often means he is late.
“It just seems like as long as they get a ride, they don’t (care) what time,” Gerrish said of Modivcare. “(I) show up … 15, 20 minutes late because they overload the schedules. They don’t have enough people to do it.”
Gerrish is paid $20 an hour by the subcontractor he works for, Care Way Express LLC.
“Subcontracted drivers can choose to accept or decline the trip based on their availability, empowering local small businesses with the flexibility to grow sustainably while participating in a statewide network,” Orifice said in an email. “When coverage is limited or a trip is declined by a subcontracted driver, Modivcare-employed fleets step in to ensure members still receive the care they need without disruption.”
Gerrish said he is skeptical that rides are arranged by Modivcare representatives based in Maine because his schedule rarely accounts for the entire drive time, the rural nature of certain communities or the full drive back from each location.
Gerrish, Dunn and Balladur each said they had interacted with call center representatives who said they were based in other states, including Massachusetts, New Jersey and Virginia.
Orifice said that MaineCare calls are routed to state-based representatives, who are “specifically trained and authorized to access the systems used to serve Maine members,” and that all calls, even after business hours, will be handled by in-state representatives as of July 1.
Riders also raised concerns about Modivcare’s physical presence in Maine. The company has one listed address in the state, which is a lower-level office in a South Portland business park.
During a visit to the office in mid-June, a Monitor reporter observed one person working, Susan Taylor, Modivcare Maine’s fleet manager. She said only a few of the company’s 113 in-state employees come into the call center because “everybody started working remote” during the pandemic.
The company’s state contract requires the call center to have “adequate capacity” to “conveniently schedule needed transportation” to the eight counties it serves.
“I would worry about not having a real storefront presence, a real presence in the community,” said Hay, from Penquis. “To be embedded in a community … really matters to those we serve.”
Modivcare did not respond to questions about these concerns.
Tracking performance metrics
According to figures provided by the state, Modivcare received approximately 58 complaints a month from January to March, up from 52 on average from January to September 2024. Modivcare had the highest complaint rate of all brokers last year, at .07 percent a month.
DHHS figures show 80 complaints in 2024 for all three transportation brokers, down from 157 in 2023. From January through September 2024, Modivcare reported missing less than 0.1 percent of all trips, or 79 a month on average. From January to March of this year, Modivcare drivers missed an average of 154 trips a month, according to state data. DHHS did not provide documentation to support these figures.
Riders and advocates said the state’s metrics might not capture the full scope of concerns, as the complaint process deters many from speaking up. A bill introduced earlier this year, L.D. 1835, would require DHHS to post data on the number of rides and complaints, among other things, on a public website, as well as create an independent ombudsman to review the performance metrics.
The bill saw a lot of support, with over 60 pieces of testimony, many of which described the challenges patients in rural areas have getting to medical appointments.
“While we appreciate the transportation provided through MaineCare, we have witnessed barriers for our patients such as late drop-offs, so they miss an appointment, or late pickups, so they are waiting for hours for their ride. There are patients who have difficulty booking rides as well,” wrote Anne Conners of Cushing in submitted testimony. “If patients and community members cannot access transportation in a low-barrier (manner), they will not be able to receive care in our facilities, postponing care until there is a crisis. Lives are literally on the line.”
The bill was carried over to the next session for further consideration.
The state’s contract for the next year added language to clarify that trip scheduling and complaints should be handled by employees in Maine and added additional reporting requirements for the brokers.
