Sweeping changes to the Medicaid program in Minnesota this month have expanded health coverage for tens of thousands of low-income adults.
For many of those people in Greater Minnesota, the expansion of Medicaid means they'll be able to access health care closer to home.
That's good news to Jacque Morrow, 43, a homeless woman who sometimes seeks shelter at the People's Church in Bemidji.
Morrow and other rural clients who were covered under General Assistance Medical Care — adults without children with incomes at or below 75 percent of the federal poverty guideline — struggled to access health care. That's because under the old program, they could only be treated at one of four hospitals — all in the Twin Cities.
"I have to go all the way to Minneapolis for my medical," Morrow said. "How am I going to get there? I have no way of getting there. And if I go anywhere else, I'm going to be billed for it."
Morrow hadn't heard about the Medicaid expansion — and how it would simplify her heath care access. Because she's homeless, she didn't receive one of the notifications mailed out a few weeks ago by the state Department of Human Services.
That's not unusual, said Audrey Thayer a volunteer advocate at the People's Church. She said people on GAMC and other public programs are some of the most vulnerable people in the state.
"People are in confusion," Thayer said. "They don't get the letters. They don't know that they can receive the care. Many of the people who are receiving the services really don't understand."
Because of the limits on Morrow's old state health care coverage, she didn't receive the care she needed. She recently sought treatment in the emergency room for severe back pain. Because it wasn't at one of the four Twin Cities hospitals, she was billed for the care. It's a bill she can't afford. She lives on food stamps and about $200 a month in public assistance.
Morrow said her life will be easier now that she knows she's been shifted to the Medicaid program — known in Minnesota as Medical Assistance — which is available statewide.
"I'm just glad," she said. "I mean ... I just found it was really frustrating."
The Medicaid expansion in Minnesota is part of the federal health care overhaul. Along with 32,000 GAMC clients, the expansion shifts 51,000 low-income adults from the MinnesotaCare program to Medical Assistance. It also will cover an additional 12,000 people who currently have no insurance.
As word slowly spreads about the changes, health care providers expect more patients will come back for health and dental care they've put off.
Folks who run the Smile Center dental clinic in Deerwood, Minn. turned away hundreds of low-income GAMC patients after their state health program was scaled back last year. The Smile Center specializes in providing care for low-3income people. About 70 percent of its patients are on subsidized health programs.
Moving those patients to the state's version of Medicaid means the clinic will see more patients and be reimbursed at a better rate than before, said Lori Burgstaler, who heads its insurance and billing department.
"Now that those patients are going to be on, enrolled in a straight MA program and be under that reimbursement rate, we'll get paid a little bit more, about double what we were paid before," she said. "Before, it was an unreasonable low amount."
The changes are expected to bring in more than $1 billion in federal money for Minnesota hospitals and clinics to cover uncompensated care. But that gain could be offset by future cuts in federal funding.
The Obama Administration has proposed reducing federal support of Medicaid by about $29 billion over the next decade.
Lawrence Massa, president and CEO of the Minnesota Hospital Association, said big government deficits mean uncertainty for the health care industry.
"The entitlement programs are going to be looked at with a much different eye, I think, going forward, and a realization that we've got to come up with more reforms," Massa said. "That's the critical question that's going to be asked in Washington and in St. Paul."
Minnesota hospital officials expect to release a study this spring compiling their losses because of uncompensated care over the past year. Those losses are expected to be in the millions.