Cuts to health care for poor in greater Minn. hit hard

Dental work
A dentist at the non-profit Northern Dental Access Center in Bemidji examines GAMC patient Bruce Lundmark of Bagley. Lundmark had all his teeth extracted a few months ago and he's now being fitted for dentures. But changes to the GAMC program mean the clinic will no longer be reimbursed for the work.
MPR Photo/Tom Robertson

Bruce Lundmark has been coming to a non-profit dental clinic in Bemidji for the past six months. The 54-year-old Vietnam veteran is going through the long process of getting fitted for dentures.

"I've been without teeth for about two-and-a-half, three months," Lundmark said.

Until now, Lundmark's dental work was covered by the General Assistance Medical Care program. But as of June 1, this dental office will no longer get paid to treat Lunkmark. That mean that unless he can find another way to pay for the denture procedure, this may be his last visit.

"I'm halfway through, or just about to the end of getting my teeth, and all the sudden they say they're not going to cover it. I don't have a tooth in my mouth," Lundmark said. "I'll have to have somebody chew my food and spit it in my mouth for me if I don't get them."

Administrators of the dental office say they can't afford to do the work for free. They're helping Lundmark explore other options, and they hope he may qualify for help from the Veterans Administration.

Lundmark has been on GAMC for years. He's bipolar and suffers from anxiety and depression. With the recent changes to GAMC, the program no longer covers the regular treatment he gets from his psychiatrist. Lawmakers cut GAMC funding by nearly 75 percent.

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Lundmark said he isn't sure what he'll do, but his life has become a lot more complicated.

"I really haven't had that much time to dwell on it, but I'm sure it's all going to come up sooner or later," he said.

FOR A STATE-WIDE PROBLEM, ONLY A METRO-BASED SOLUTION

There are roughly 35,000 low income adults on GAMC in Minnesota. When lawmakers and the governor cut the program, they'd envisioned there would be 17 hospitals across the state to manage care for them. In reality, only four hospitals signed on to the voluntary program, and all four are located in the Twin Cities area.

Bruce Lundmark
Bruce Lundmark is a 54-year-old Vietnam veteran from Bagley. Lunkmark has been on General Assistance Medical Care for years. He just found out the program no longer covers his dental and mental health needs through regional providers.
MPR Photo/Tom Robertson

That leaves counties throughout greater Minnesota looking for other options. GAMC recipients who qualify can move into other programs like Medicaid or MinnesotaCare.

Beltrami County has about a thousand people on GAMC. Mary Marchel, director of the county's health and human services division, said her office has been inundated with calls from recipients who are desperate for answers.

"It's a bit concerning and certainly very time consuming for county staff," she said. "[Recipients are] very vulnerable, I think, because of the confusion and the frustration, and of the increased level of anxiety."

MOVING FORWARD

Some in the legal community are accessing whether the changes violate the rights of low-income people. Rolanda Mason, an attorney for St. Cloud Area Legal Services, said her office is analyzing the legal implications, but that it's too early to tell.

"I think the entire advocacy community is very concerned about this program and how it's going to play out for people," Mason said.

Mason said colleagues call her asking what they can do, but added that "We don't always have good answers for that. In fact, we often don't have good answers for that."

Minnesota Department of Human Services officials say the biggest challenge in implementing changes to GAMC has been the swift time line. Billi Jo Zielinski, assistant commissioner for health care administration at the health department, said she hopes over time the program will evolve to better serve out-state GAMC recipients.

"My responsibility is to implement the law that has been enacted," Zielinski said. "We are hopeful that come September 1, the other 13 designated hospitals in the law that are eligible will consider doing so."

So far, hospital administrators in greater Minnesota have said no to the program, partly because reimbursement rates wouldn't cover their cost. So for now, the gaps in service for GAMC recipients in greater Minnesota will likely remain.