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If you're on Medicaid and need to see the doctor, go to the hospital or attend a therapy session, you can take a taxi.

Or, if you're in poor health, a wheelchair van or ambulance.

In some cases, you might be able to drive your own car -- and get reimbursed for the mileage.

In New York -- unlike many other states -- Medicaid recipients are entitled to receive free transportation or reimbursement for transportation costs for travel related to medical treatment.

In Erie County, taxpayers paid $12.5 million last year to ferry Medicaid recipients to medical visits.

The figure includes $2.5 million for taxi rides alone.

Now, counties around the region are taking a hard look at these transportation costs, which they consider one of the few places in the unwieldy and expensive Medicaid program where they may be able to trim expenditures.

"The frustrating thing is, with Medicaid, there are very few ways we can control anything," said Anthony J. Restaino, Niagara County social services commissioner. "This is an area where we do have a little bit of control."

The federal government makes transportation benefits for Medicaid recipients optional -- meaning states can choose to provide the service or not.

New York, one of the most generous states in the nation in Medicaid benefits, mandates that counties provide transportation for Medicaid enrollees.

Last week in Albany, state lawmakers celebrated a new budget that includes limiting counties' Medicaid expenses in coming years -- but makes no change in major benefits.

The costs of such "opt-in" services as transportation add up. Consider:

Niagara County spent $1.5 million last year on transportation for Medicaid patients, according to Restaino.

In Chautauqua County, a busing system called CARTS cost the county $1.1 million last year, officials said.

Erie County's share of Medicaid enrollees' transportation costs amounted to $2.5 million last year for buses, ambulances, wheelchair vans and the like.

Taxi trips totaled another $2.5 million.

County officials are seeking ways to streamline the program.

Niagara County now requires Medicaid recipients to seek treatment at facilities within a certain distance of their homes, unless they get a waiver.

That change saved the county about $70,000 last year, Restaino said.

In Erie County, positions in the Social Services Department's medical utilization review team have not been eliminated, despite county budget cuts, said Deborah Merrifield, the department's deputy commissioner. That team oversees Medicaid recipients' use of transportation service.

"We have not cut that," she said.

Next, Erie County needs to figure out how to cut down on Medicaid recipients' use of ambulances -- among the most expensive transports -- except in emergencies, Merrifield said.

Whenever a Medicaid patient calls, an ambulance must respond and, once on scene, must transport the patient, Merrifield said.

"That would be something we'd like to tackle," she said.


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