Health care plan for the poor limits options for rural patients

A patient gets her teeth worked on by dental hygienists. Dental care is one of the most common unmet health need for children and low-income adults across Minnesota.
MPR file photo/Marisa Helms

There's confusion among some health care providers over changes to the state's General Assistance Medical Care program. That's a program that serves more than 30,000 very poor, childless adults.

The changes took affect this week, and care givers say there are still lots of unanswered questions, especially in greater Minnesota.

The General Assistance Medical Care program took a big hit during the last legislative session. In a deal between lawmakers and the governor, funding for the program was slashed by about 75 percent.

Now, clinics, hospitals and county agencies are trying to figure out how complex changes will affect health care delivery for some of the state's most vulnerable residents.

"Clients are confused. They don't understand it," said Susan Yerhot, a financial assistant supervisor for Beltrami County, which is home to about 1,000 GAMC recipients. "The few providers I talked to, they have a lot of questions, like exactly how does it impact them."

General Assistance recipients used to be able to get health care at any hospital or clinic. Now it's not so easy. Only four hospitals in the state have signed on to provide care for GAMC patients, and all four are located in the Twin Cities area.

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That means if you live in greater Minnesota, your choices are a lot more limited.

North County Regional Hospital
Health care facilities across the state are beginning to assess how they'll be impacted by changes to the state's General Assistance Medical Care program, which went into affect this week. Cuts to the GAMC program may mean many health facilities in greater Minnesota will suffer financial losses. Pictured above are Bemidji's North Country Regional Hospital and neighboring Sandford Health Meritcare Clinic.
MPR Photo/Tom Robertson

"If you don't have access to one of those four sites, you either have to transport yourself there ... or you just have to take your chances, and whenever you get sick you go to the ER," said Joy Johnson, vice president of business development and marketing at North Country Regional Hospital in Bemidji.

Hospitals are required by law to treat patients seeking emergency room care. Johnson says there could potentially be a flood of General Assistance recipients visiting ERs in outstate hospitals across Minnesota.

Other health care providers in Bemidji are still working to figure out the impact of the GAMC cuts. There's concern at the mental health center as to how they'll be able to continue serving patients on General Assistance. And there's confusion as to which mental health programs are covered and which aren't.

The same goes for the Northern Dental Access Clinic in Bemidji, which opened last year to serve the low-income population. So far that's included 300 General Assistance patients, with 200 more on the waiting list.

Joy Johnson
Joy Johnson is vice president of business development and marketing at North Country Regional Hospital in Bemidji. Johnson says the hospital could lose between $1.5 and $2 million because of cuts to reimbursements for the state's General Assistance Medical Care program. Johnson says the hospital will continue to provide emergency care to GAMC patients. Those seeking non-essential medical care will be accepted on a case by case basis based on physician recommendations.
MPR Photo/Tom Robertson

Jeanne Larson, the center's director, says now that the clinic no longer gets reimbursed by the state for GAMC patients, it could put the fledgling center in financial jeopardy.

Larson says the state hasn't provided the dental clinic with much information so far, but it's clear that General Assistance recipients in greater Minnesota will have a tough time getting service.

"What we've learned after all our exhaustive efforts, knocking on doors and making phone calls across the state, is that there's not a categorical solution," Larson said. "They didn't provide a solution for rural patients, and we can't find any way to develop some sort of policy that helps this patient base as a whole."

Many providers, including Larson's dental clinic and the local mental health center, say they'll do everything they can to avoid turning General Assistance patients away who can't pay.

Some larger facilities are saying the same. Cindy Morrison is vice president of health policy for the newly merged Sanford Health and MeritCare system, which operates hospitals and clinics across Minnesota, including a facility in Bemidji. Morrison says for now, the organization will accept General Assistance Medical Care patients.

Morrison says the process is frustrating, because it's unclear as to what level the state will reimburse providers for General Assistance patient care. Right now, it looks like that reimbursement will be miniscule compared to the actual costs of services.

"The hard part is that there's so much unknown yet," she said. "We don't have enough information, so it makes it a little bit hard to really talk about the impact and what decisions will be made."

Morrison and other providers are hoping for some answers at a state-hosted teleconferences planned for Friday afternoon.