Dr. Sara Loritz, a resident internist at HCMC, with GAMC patient Natalie Mobley, who said she is trying to stay ahead of several health issues.

Richard Tsong-Taatarii, Star Tribune

Poor face health care change

  • Article by: WARREN WOLFE
  • Star Tribune
  • May 17, 2010 - 9:51 PM

A budget deal and a lawsuit: As the Legislature approved a new budget, two retired public employees sued over pension cuts. Stories on A1, B7

Even as legislators ended a grueling session Monday with a compromise over a contentious health care bill, the state began mailing letters telling 39,000 very poor, childless Minnesotans that their health coverage will change on June 1.

Problem is, nobody knows precisely how it will change -- not doctors, not hospitals where care now will be centered, not legislators or Gov. Tim Pawlenty, who together struck the late-night deal.

"Right now, I don't know how to advise our clients," said Maureen O'Connell, advocacy director for the Legal Services Advocacy Project. "We have so many questions, and so far the [Department of Human Services] hasn't been willing to talk with us."

One reason for confusion is that many details -- including just what care will be covered -- still are being negotiated with the state, said Lawrence Massa, president of the Minnesota Hospital Association. He said hospitals "are in a mad rush" to put the new system in place in two weeks.

They are trying to create systems to care for hard-to-treat patients, about one-fourth of them homeless, more than half with mental illnesses and most with one or more chronic illnesses.

Arguments over the health care bill nearly derailed the legislative session, centered on whether Minnesota should shift the state-financed General Assistance Medical Care (GAMC) program to the state-federal Medicaid program, an option under the new federal health care law.

Under the compromise, the state will apply for the Medicaid coverage but won't implement it unless the governor or his successor orders it by next Jan. 15 -- something Pawlenty said he's unlikely to do.

While many questions remain, here's what is known about how the GAMC program will change June 1.

The state will pay for care delivered only through hospitals. Clinics not affiliated with hospitals still could treat those patients, for free.

Of the state's 148 hospitals, four in the Twin Cities area have signed contracts to provide integrated care through "coordinated care delivery systems." They cover nearly half of the GAMC patients and will be paid $71 million -- less than half of what they were paid last year.

The four are Hennepin County Medical Center and University of Minnesota Hospital Fairview, both in Minneapolis, Regions in St. Paul and North Memorial in Robbinsdale. Each will get a set sum of money, and under a change announced last week, each will have a cap on the number of patients it will see.

The remaining 144 hospitals will share a $30 million pot to care for the remaining 20,000 GAMC patients. They will be required only to give emergency care and stabilize those patients.

"So for those of us outside the Twin Cities, what happens with our clients who need care?" wondered Ralonda Mason, supervising attorney at the Legal Aid office in St. Cloud. "Many of our clients use hospital emergency rooms already, but some are being treated in clinics for complex medical conditions. Do they have to switch to the ER for care?"

The answer in many cities probably is yes, Massa said. "That's not cheap care, but it's the care the state will pay something for -- probably pennies on the dollar, but something."

Pawlenty has said that he expects more hospitals will agree to provide integrated care later, when they see how the revamped GAMC program is working, because "they'll decide that taking the money is better than taking no money."

For GAMC patients, the first question is whether they are close enough to one of the four participating hospitals to enroll in its coordinate care system. If so, the next question is whether that's a good idea.

Some will be better off enrolling in MinnesotaCare, the health plan for lower-income working people, "if they can afford the premium and copays," Mason said. "Somebody with a chronic disease may get better care from a doctor under that program than from an emergency room."

But many GAMC patients won't have a choice, at least for a while. Under state law, people on that program can switch to another state program only every six months, when their period of eligibility expires.

Warren Wolfe • 612-673-7253

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