GAMC patients left with few options
When Minnesota lawmakers rushed home from the capitol Monday they left looming political and societal questions: Who should pay the health care costs of the state's poorest citizens?
Hospital emergency rooms could experience a new influx of indigent, mentally ill patients seeking care because legislators and the governor left them few options, especially in outstate Minnesota.
The healthcare compromise hammered out Monday to end the Legislative session provided no concrete answers for outstate providers and agencies charged with the care of 39,000 General Assistance Medical Care patients.
Four Twin Cities hospitals will receive $71 million to become a "Coordinated Care Delivery System," roughly half of what they received last year for treating GAMC patients.
GAMC health coverage as it exists today ends June 1. If patients live in the metro area they can join one of the four CCDS.
The Department of Human Services will not transition GAMC patients to the state-funded MinnesotaCare program. It could bankrupt the fund, many lawmakers worried, moving the chronically sick and mentally ill into it.
Although MinnesotaCare recipients pay premiums, the bulk of the reserve in the insurance program is a fund created in 1992 that derives income from taxes on physicians, hospitals health care providers, premiums and enrollees and gets some federal matching dollars.
And the commission that oversees that Healthcare Access Fund projected it will begin running a deficit in 2011. It simply can't handle the unique expenditures of the GAMC patients, a majority of which have chemical dependency problems or other behavioral health issues, said Hubbard County Social Services Director Daryl Bessler.
Paying for care outstate
"There's a bit of a problem in that there's nothing really outstate," Bessler said. "There are some North Memorial facilities as I understand that are wiling to take on (GAMC patients) but it sounds like the closest one to us will be Elk River."
And that leaves the question of where GAMC patients will go.
The plan leaves 144 of the state's hospitals to apply to a temporary $30 million "uncompensated care pool" for some reimbursement treating the estimated 20,000 GAMC recipients that will not have access to a hospital in the metro area.
Beginning June 1, Minnesota will only pay for hospital treatment unless a clinic is affiliated with a hospital, which most aren't.
If clinics choose to treat the GAMC patients, they'll do it gratis.
"We just learned via a bulletin from the Department of Human Services that for outstate, or at least in our county, we had looked at the possibility of putting these people on MinnesotaCare because there isn't going to be readily available facilities for folks to get the emergency care. Hospitals will have to see the people regardless," Bessler said.
The county's flex funding account could not be accessed to pay the low monthly premiums of the GAMC patients if they transferred to MinnesotaCare, Bessler said DHS told him. He estimated the county could cover annual premiums for 50 people for a mere $3,000 - about the same cost as a two-day mental health stay for one patient.
It would have been a cheap, pro-active option.
And because of state laws determining eligibility periods for GAMC patients, Hubbard County can't switch its GAMC patients to MinnesotaCare until six-months expire for each patient.
"If we would have moved some of these people from GAMC to MinnesotaCare their premiums would not have covered anywhere close to the costs associated" with their care, Bessler said.
Ground Zero for treatment
Although Hubbard County has fewer than 100 GAMC recipients, "if there's an emergency I'm guessing they're going to present themselves to the local hospital and the local hospital will probably end up having to eat it," Bessler said of the cost.
"Our hospitals are going to treat people that come into emergency rooms," said St. Joseph's Area Health Services CEO Ben Koppelman, admitting his emergency room could see a new wave of patients in the wake of the GAMC restructuring.
"They're obligated to, so we'll continue to see them and do our best to care for them that way but there really isn't going to be other access for care for these people, which is very concerning," he said.
Legislators hotly debated whether they should dump the state-funded GAMC and shift to a jointly funded federal Medicaid program, which was estimated to require a $188 million state match to draw down a potential $2 billion in federal funding.
The federal plan has been called, rightly or wrongly, "Obamacare." It was not politically or economically palatable to Gov. Tim Pawlenty.
Minnesota is one of about a dozen states offered an early enrollment option for the Medicaid program but Pawlenty said he wouldn't implement it, so a successor will need to by Jan. 15, 2011.
"Unfortunately, there was an opportunity to enroll these people in Medicaid and the state chose not to do that," Koppelman said. "Essentially the governor chose not to do that.
"There was an option through the federal healthcare reform to early enroll more people into the Medical Assistance program," he said. "It would have required some state match (the $188 million) but it would have covered a lot more people and would have brought in some additional federal dollars, too."
Both Koppelman and Bessler worry about patients, especially those in need of mental health care, going without treatment.
"You 're going to have individuals that don't have access to physicians or other mental health services that need those services and need that preventative care," Koppelman said.
"Medication management is a significant concern and issue and ultimately as a society we could end up dealing with the repercussions of that in another way."
Both Bessler and Koppelman envision a continuing dialog as the state scrambles to get the revamped GAMC ready in a week and figures out what it will do in the future.
Meanwhile Bessler said there are numerous private grants popping up on the state register monthly that creative seekers could access to pay for indigent health care. But he questions whether the state can react quickly enough.
"Can the government afford to be everything for everybody?" he asked. "Personally I don't believe we can. The money isn't there."
But to fund health care at present levels, a politician would have to run on a platform of raising taxes, he maintains. And that would be political suicide.
And suicide isn't covered under any of the state or federal options.