Angela Lisa found out she had leukemia as her diabetes was taking her sight.

Now, legally blind and living alone in a Folcroft, Delaware County, rowhouse, Lisa has to travel to a slew of doctors, including an oncologist, an endocrinologist, and a hematologist.

Cab rides cost $70 a round trip, out of reach since cancer treatments forced her to abandon her South Philly chiropractic practice. Her elderly parents and other family members took turns crossing the bridge from their Gloucester County homes to ferry her to appointments.

Then an insurance company told Lisa, 58, about Pennsylvania’s Medical Assistance Transportation Program, the commonwealth’s answer to the federal mandate for states to provide free nonemergency medical transportation for Medicaid patients. Part of a coordinated shared-ride system that one proponent called a “national model" for efficiency, it became a lifeline for Lisa after her 2005 eye surgery.

But after 35 years, a program available to the state’s 2.8 million Medicaid subscribers, used by roughly 55,000, and among the largest of its kind in the nation, could change dramatically — and possibly for the worse, say county officials, who would no longer administer the program.

Now, for example, Delaware County uses program funds to pay Community Transit of Delaware County to transport its residents.

“I like that they assist me from the door to the door. It’s hard to find that,” she said. “I’ve been very lucky.”

But rather than let county governments decide how to run the program, the state plans to turn over the keys to private brokers, each responsible for a region of the state. The state is reviewing vendors’ applications and expects to award contracts by late summer.

Counties and local transit providers say they were caught off guard by the change — embedded in the mammoth 2018-19 budget bill.

Although Pennsylvania would become eligible for millions in federal funds, counties say the state could end up losing money as costs shift.

Pennsylvania has one of the nation’s lowest costs for nonemergency medical transportation, according to a national study. Counties cite other states that switched to this model and saw delayed rides and worse service.

“Many, many years went into developing [Pennsylvania’s] highly coordinated and efficient system,” said Sue Kopystecki, executive director of TransNet, which Montgomery County pays to drive about 3,000 medical-assistance riders. “There are concerns for our consumers that this [new] system will not be as efficient, will not be as user-friendly."

Pennsylvania’s system now

Pennsylvania uses a county-based model. With some exceptions, including Philadelphia, counties administer medical transportation services. Most counties, including Philadelphia’s suburbs, use program funds to pay an agency to provide transportation. A handful transport residents themselves.

The state’s interconnected shared-ride system cuts down on duplicated service. One local transit company’s bus may be carrying riders eligible for various programs: a senior getting groceries, a man headed to dialysis, a woman in a wheelchair going to work. Different programs fund different types of passengers. The fixed costs of transportation, such as driver pay, fuel, and vehicles, are shared among them.

Given the interconnected system, the change to the medical-assistance piece "doesn’t make sense for Pennsylvania,” said David Kilmer, board member for the Pennsylvania Public Transportation Association, who has worked in public transit for 40 years. "We’ve been a national model for how to provide services and be efficient.”

Changing the model

An amendment attached to the current budget started the program’s transition to a “full-risk brokerage model.” The state will pay a set fee per eligible rider to companies that run the three new regional programs — eastern, central, and western — regardless of how many rides the companies provide. Brokers keep the excess or eat the cost if estimates are wrong; reimbursement now is based on trips provided.

Under the new model, the federal government would classify the program as a “service" cost, as opposed to administrative, which reduces the state’s share of the program cost. The Department of Human Services’ Office of Medical Assistance Programs, which runs the program, estimates the change will reduce its need for state funds by roughly $10 million the first year.

But local transit companies say losing program funds could mean higher co-pays for riders or fewer runs for other types of rides. For Montgomery County-based TransNet, the program pays for about 30 percent of its total rides in the area — more than $3 million.

‘None of us knew’

County and transit company officials said the move toward a regional system came out of the blue as one of a bunch of amendments to the Human Services Code.

“None of us knew that it was in there until it was in there and passed,” said Kathi Cozzone, president of the County Commissioners Association of Pennsylvania and a Chester County commissioner.

State program officials also “were not aware of the changes until the last minute, so we didn’t take a position on it,” said Sally Kozak, deputy secretary of the Office of Medical Assistance Programs.

Bills introduced in the state Senate and House a few months ago that have bipartisan support but are stuck in committees would delay the changes to allow for a study of the impacts to riders and taxpayers.

“If there’s any chance it will increase costs for other programs," said the transportation association’s Kilmer, "shouldn’t they at least know that going in?”

Counties’ concerns

County and transport company officials said they worry service could deteriorate; net costs to the state could be higher; and hundreds of people could lose jobs.

Kozak said concerns are overblown. She said the contracts will lay out standards that vendors have to meet. And while the state won’t require them to use local systems, she said, “we believe in order for any of the selected vendors to be successful, they will need to work with the local transit authorities and local transportation providers."

County officials say they have been excluded from the process.

“Frankly,” Cozzone of the county commissioners association said, “I think that shows a lack of understanding of what local needs are and what our resources are.”