Under the change, about 95,000 people will get better medical care, advocates say. But the shift will take months, and critics fear the long-term costs will hurt the state.
With the stroke of a pen, Gov. Mark Dayton on Wednesday will launch the most sweeping changes to Minnesota health care in years, adding 95,000 of the poorest adults to the state's Medicaid rolls.
The expansion, permitted by the federal health overhaul of 2010, was the subject of fierce budget and ideological debate at the Legislature last spring. But many local doctors and hospital executives say it will improve medical care for thousands of people who have lived at the margins of the health care system.
"Under Medicaid, people will be eligible for better care, wherever they live," said Mike Harristhal, vice president for public policy at Hennepin County Medical Center, which treats more than 8,000 patients who will be shifted to the program. "That's a good thing for the patients and a good thing for Minnesota."
Advocates say the change also will bring about $1.4 billion in federal money to the state and help create 25,000 health care jobs.
Republican lawmakers, however, say the shift may benefit the state financially in the short term, but is not good long-term policy.
Under federal law, in 2014 Washington will take over Medicaid costs for people with incomes below 133 percent of the poverty level.
"That's going to be overwhelming," said state Rep. Jim Abeler, R-Anoka, new chairman of the House Health and Human Services Finance Committee. "The country can't afford it, and Congress may come to its senses and change the law.
"We're counting on mythical money -- money that may not exist -- and adding 95,000 people to Medicaid will just make it worse," he added.
Although they oppose it, House Republicans say there's little they can do to stop Dayton from making the shift. The DFL-controlled Legislature last year gave Gov. Tim Pawlenty or his successor the power to move poor childless adults to the Medicaid program, permitted under the federal law to states already using their own money for that health coverage. Pawlenty declined, and Dayton pledged during the election campaign to sign the executive order.
Poor and sick
It will take months to move thousands of patients out of two health care programs financed by the state and onto Medicaid, which receives a 50 percent federal match. When the shift occurs next summer or fall -- it could take that long to change computer programs and train staff, officials say -- the state Medicaid rolls will swell from 650,000 Minnesotans to about 745,000.
All are childless adults under age 65 who earn no more than 75 percent of the federal poverty line, about $8,000 a year. Most cope with multiple chronic diseases, including mental illness and addiction, and many are homeless.
They include about 32,000 from General Assistance Medical Care (GAMC), a 35-year-old state program that will be phased out; 51,000 from the MinnesotaCare program now serving about 155,000 lower-income working people; and about 12,000 who are uninsured, according to state estimates.
Medicaid will represent an improvement over GAMC, which now offers comprehensive care only at four Twin Cities hospitals, experts say. Those shifting from MinnesotaCare will have fewer co-pays and better coverage of large, in-patient hospital bills.
Abeler and other Republicans say that rather than simply expanding Medicaid, the state should restructure its health programs for low-income people, perhaps patterning them after the GAMC program, which was slashed and retooled last year to keep it alive after its funding was vetoed by Pawlenty.
The result was a program begun last May that all sides agree was flawed by inadequate funding and limited access at hospitals.
"But there were some good lessons on how to provide better care in an efficient, cost-effective way," said Rep. Steve Gottwalt, R-St. Cloud, new chairman of the Health and Human Services Reform Committee. "Yes, there were problems, but they learned a lot."
The four hospitals providing care through the GAMC Coordinated Care Delivery System programs agree. "It's been a tremendous learning experience for us," said Annette Anderson, administrator for the clinic seeing GAMC patients at University of Minnesota Medical Center, Fairview.
The same is true at Hennepin County Medical Center, where officials are assessing data they hope will show that they reduced costs but improved the quality of care.
"We think this is a good way to help people with complex medical conditions, and often complex life conditions," Harristhal said. "We're still learning, but we think we can produce better results by applying the right care at the right time."
Warren Wolfe • 612-673-7253
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