State's poor could face more difficulties after assistance cuts

Advocates for the homeless say that the state's poorest residents could have to resort to panhandling to pay their monthly health insurance premiums if the DFL legislators are not successful in blocking two separate proposals by Gov. Tim Pawlenty.

The debate about state health insurance for low-income residents has grown more complicated after Pawlenty proposed eliminating most welfare payments for single adults.

Pawlenty has said the cuts are needed to help fix the state's $1.2 billion budget deficit, and pay for tax cuts he says will create jobs.

The commissioner of the state's department of human services has also defended the cuts, saying that crisis assistance should replace monthly payments.

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"These are not huge payments, but their continuity for long periods of time is what is what this issue is trying to interrupt, or what the budget proposal is interrupting," said DHS Commissioner Cal Ludeman.

"I can't imagine the governor believes that people can pay MinnesotaCare premiums and co-payments without any income at all."

But social service providers say that, faced with no income, many of the state's poorest residents would be unable to pay the monthly premiums required under their new insurance plan.

"One month he cuts their health care, the next month he cuts their cash assistance," said Liz Kuoppala, executive director of the Minnesota Coalition for the Homeless. "What does he expect these people to do?"

About 30,000 Minnesotans are enrolled in the state's low-income health insurance program, called General Assistance Medical Care.

Pawlenty vetoed funding for the program last year and also vetoed an attempt to extend the program last week. DFL legislators are scrambling to find enough votes to override the governor's veto, but if they fail, the program will end April 1.

Many current enrollees would then be transferred to a different state health insurance program, called MinnesotaCare. The program charges a monthly premium and higher co-payments.

Low-income people were already bracing for the change and worried about affording additional health care expenses, but the new proposal to eliminate most monthly cash assistance payments has left many people distraught.

"It's a crisis," said Robert Fischer, a Minneapolis resident who receives monthly cash assistance and state health insurance.

Fischer and nearly 15,000 other people on General Assistance Medical Care also receive monthly cash assistance payments. That program, called General Assistance, provides up to $203 a month to single adults who cannot work because of a doctor-verified disability. Many are also homeless, and providers say many are struggling with mental illness.

"This is really the bottom rung of the safety net," said Tom Pingatore, human services program manager for Hennepin County.

Pawlenty's proposed budget would eliminate General Assistance on Dec. 1, leaving thousands of disabled Minnesotans without any income other than food support.

Recipients say they will be unable to afford their monthly premiums, about $4 to $5 a month, without panhandling, selling plasma, or resorting to more dangerous and illegal behavior.

"It would put me in dire straits," said Fischer, who receives $203 a month in cash assistance.

Fischer, who is 51, lives in subsidized housing, but he was homeless for three years. He said he hopes to be able to return to work soon, but a few years ago, the situation was different. He said he was depressed, abusing drugs and living under bridges.

"I probably would've gotten into buying and selling something," he said. For many recipients, he added, "it's going to come down to shoplifting and panhandling."

Counties have agreed to pay the monthly premiums for up to six months, but after that, recipients would be responsible for the monthly payments.

If General Assistance Medical Care ends in April, the counties could stop paying for premiums in September--just three months before cash assistance for most single adults would be cut under the governor's budget. Counties could choose to continue paying the premiums, but state law does not require it.

People who switch from General Assistance Medical Care to MinnesotaCare would also face higher co-payments for prescription drugs.

Under General Assistance Medical Care, recipients pay $1 for generics and $3 for name brand medications, with a $7 monthly maximum. The program does not have co-payments for doctor's visits.

In contrast, MinnesotaCare charges a $3 co-payment for all prescription drugs, a $3 co-payment for non-preventive doctor's vists, and does not have a monthly co-payment maximum.

"I can't imagine the governor believes that people can pay MinnesotaCare premiums and co-payments without any income at all," said Liz Doyle, policy director for Take Action Minnesota.

The governor's office did not respond to a request for comment.

Enrollees of either health insurance program can have their co-payments waived, but social service providers say that the state law is confusing, leading many pharmacies to request payment.

A spokesperson for the state's department of human services explained the state law this way: "Enrollees are responsible for copays, but the collection is up to individual providers. Under current state law, if an adult client of state-funded MinnesotaCare can not afford to pay the co-pay at the time of visit, the provider must provide services. They must also inform the client of their debt and give them the opportunity to pay using standard office policies and procedures."

Monica Nilsson, director of street outreach for St. Stephen's Human Services in Minneapolis, says that only a few pharmacies routinely waive the co-payments.

"I'm so tired of people having to scrape by and going across town to find a pharmacy that'll waive the co-pay," she said.

Fischer said that, despite the state law, he still has to pay co-payments to receive his medication. He said that even under the current program, he struggles to afford his medical expenses.

About a year ago, a doctor prescribed a CPAP machine to treat Fischer's sleep apnea. Fischer said his doctor told him to replace the machine's mouth piece every month, but he cannot afford the additional expense.

"They cost about $15 a piece," he said. "I've never replaced one and I've had it for about a year now. I just clean them out really good."

Nilsson, the street outreach director, said she plans to bring General Assistance recipients to the state Capitol to provide testimony on the impact of the proposed cuts.

"What's especially critical this week is to communicate with the House Republicans that if this is their plan with MinnesotaCare, what are they going to do when the General Assistance cash goes away?" Nilsson said. "If they're planning to take their cash, then this whole MinnesotaCare thing is completely a set-up."

The Senate's Health and Human Services Budget Division will hear public testimony on the impact of the budget recommendations starting today.