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Eric Halstensen goes to bed every night wondering if a tumor is growing in his brain. Every morning, he wakes up wondering if he will finally be able to get the MRI scans he needs.

"I could die in my sleep tonight and not even wake up," said Halstensen, 34. "I think about it all the time."

Until April, the Maple Grove man had no significant medical problems. After a year of being unemployed, he also didn't have health insurance. Then the unthinkable happened.

After falling down at a golf course in northern Minnesota, Halstensen went to St. Cloud Hospital, where doctors removed a large tumor attached to his spinal cord. They diagnosed him with a rare form of cancer that usually starts in the brain.

Facing more than $50,000 in medical bills, Halstensen quickly signed up for General Assistance Medical Care (GAMC), a state program that provides coverage to about 34,000 poor adults without children. But his troubles weren't over. Citing rules that went into effect on June 1, local health care workers told him he couldn't get the scans that might save his life because that kind of care was no longer covered by the state program.

Legislators and health care advocates said Halstensen's quandary demonstrates the shortcomings of the revised program, whose budget shrank more than 50 percent as part of a compromise between state DFLers and Gov. Tim Pawlenty, who originally planned to scrap the program.

"We are seeing real barriers to access and real dilemmas for providers," said state Rep. Erin Murphy, a St. Paul DFLer who led negotiations on the program changes. "I'm worried there will be life and death consequences as a result of the solution we were able to muster."

Since June 1, the state Department of Human Services has received 180 complaints from GAMC clients, with about 25 involving difficulty or delay in getting specialty care, according to state officials.

GAMC enrollees, many of whom suffer from mental illness and chronic illnesses, can sign up for care at one of four metro area hospitals: North Memorial Medical Center, Regions Hospital, Hennepin County Medical Center and University of Minnesota Medical Center, Fairview.

Under the deal, those four hospitals must provide "medically necessary" care to GAMC patients, including specialty care in most cases.

But that's not what North Memorial officials repeatedly told Halstensen in June.

In an interview last week, North Memorial administrators said doctors and other providers were wrong when they told Halstensen he wouldn't be able to see a specialist. They said there was a lot of confusion as employees figured out the rules and hammered out contracts with outside specialists. "You have to understand, we were building this thing from the ground up," said Mike Parrish, a North Memorial vice president.

John Micklick, a GAMC patient from Duluth, said he hasn't been able to get knee surgery because North Memorial doesn't have a contract in place with an orthopedist.

Parrish said the hospital will notify all patients who were denied access to a specialist as soon as administrators finish those contracts.

Brian Osberg, the state's Medicaid director, said hospitals were supposed to have contracts in place by June 1.

Ralonda Mason, supervising attorney at the Legal Aid office in St. Cloud, said the problem isn't limited to North Memorial. Mason said she has heard from at least six GAMC patients who were turned down when they tried to get an appointment with specialists, including psychiatrists and orthopedists.

"They have these doctors, they're just not making them available to this population," Mason said. "They have the ability to contract with whoever they need to contract with to provide this care."

Officials at the other hospitals in the GAMC program said they now have contracts with all the specialists they need, but they warned patients they may be subject to long waits.

Scrambling for a fix

Halstensen never thought he would need government help to obtain medical care. In April, he started a job as a drafting engineer for a family-owned cabinet company, but he isn't eligible for health insurance until September.

Since his fall, he hasn't been able to urinate on his own, which means he has to use catheters.

When he chose North Memorial as his provider, he tried to make appointments with a neurologist and a urologist, but his primary care provider said that wasn't an option for GAMC patients. "I don't know if I still have cancer," Halstensen said. "There's a chance I could be on catheters the rest of my life."

Halstensen's family and friends jumped into action. They created a Facebook page titled "Desperately Seeking Dr. Mc Specialty" and posted a YouTube video about his situation. They tried to find out if he could see a specialist if he transferred to one of the other hospitals, but found out GAMC patients are not allowed to switch to another provider for six months. Because they aren't given advance information about specific services available at each hospital, advocates say it's hard for GAMC patients to make informed decisions.

Murphy said Halstensen's medical treatment "wouldn't be in question" if Pawlenty had accepted $1.48 billion in federal money offered to expand the state's Medicaid program, which would have made up for the cuts to GAMC. Health care providers urged Pawlenty to accept the funds, but he declined, saying that it would cost the state's general fund $430 million. He also said low-income adults without children had access to other state programs.

Halstensen said he is grateful for the assistance he has received, including payment of his surgery bills, but he wants Pawlenty to accept the federal money and is gathering signatures for a petition. The funds are available until Jan. 15, 2011, which means Pawlenty's successor could reverse course.

Since legislators and gubernatorial candidates found out about Halstensen's situation through his family's efforts, state officials and hospital executives have scrambled to ensure his care. State officials said Friday that Halstensen qualifies for expanded treatment through the state's Medicaid program, but family members said no new appointments have been scheduled and no paperwork received.

Halstensen's sister, Sarah Anderson, said government officials need to fix the underlying problems, not just deal with her brother's situation.

"This doesn't do anything for everybody else," she said.

Staff writer Warren Wolfe contributed to this report. Lora Pabst • 612-673-4628