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Emergency health care recipients cut off this week

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Signing budget
With Secretary of State Mark Ritchie next to him, Gov. Mark Dayton signs the budget bills at the Capitol in St. Paul, Minn. Wednesday, July 20, 2011. The deal has led to some unforeseen consequences.
MPR Photo/Jeffrey Thompson

Non-U.S. citizens in Minnesota who received emergency medical assistance from a program of last resort will no longer receive health care services such as chemotherapy and dialysis, thanks to the budget deal to end last summer's state government shutdown.

Late last year, the state Department of Human Services mailed letters to 2,300 people informing them that much of their coverage would lapse Jan 1. They learned that they would still receive emergency care in a hospital or emergency room -- including labor and delivery -- but a long list of medical services would not be covered.

Among them are doctor visits, home health care, treatment for chronic conditions and prescriptions from outpatient pharmacies.

So many patients appealed the cutoff -- about 200 by the department's last count -- that state officials pushed back the changes for a week. They took effect on Monday, Jan. 9, but patients who appeal will continue to receive care during the appeals process.

DHS Deputy Commissioner Anne Barry said the department had to make sure the state was still delivering the emergency services required by federal law.

"Not all of those were anticipated in the statute," Barry said. "And the best example is, in a nursing home, we have people on life support, who are living on ventilators. Well, based upon the state statute, we would have removed them and stopped payment to the providers. But we really couldn't do that under the federal requirement."

The Emergency Medical Assistance program served people who can't qualify for Medicare or MinnesotaCare because of their immigration status. Some, such as people seeking asylum, are in the United States legally. But others are not.

Without it, many patients have nowhere to turn, said Michael Scandrett, director of the Minnesota Health Care Safety Net Coalition of clinics, hospitals and non-profits that serve the poor.

"Some are on chemotherapy or dialysis and we really don't want them to stop getting those treatments," Scandrett said. "So appeals were a way to get services longer, and chance to correct unintended consequences that really people didn't have ... in mind when the law was passed. We need to try to reverse that."

Even some who championed the cuts are calling their effect on the poor an unintended consequence of last summer's middle-of-the-night budget deal.

"Parts of it caught us by surprise," said state Rep. Jim Abeler, R-Anoka.

Abeler, chairman of the Health and Human Services Finance Committee, said he doesn't want to see anyone harmed. But he said the cost of the emergency medical assistance program was growing by 10 percent a year, a rate he called unsustainable. 

The budget agreement trimmed 40 percent of the program's costs, or about $22 million. 

Critics of the cuts, including members of Scandrett's Safety Net Coalition, say the state may save some money, but counties will pay the bill when patients wind up in county hospital emergency rooms where they can't be turned away.

Abeler said that's a valid point. To address it, he plans to introduce a bill in the next legislative session that would adopt the coordinated care model that replaced General Assistance Medical Care for the poorest and sickest patients in several large Twin Cities area hospitals.

"They saved 25- to 30 percent just by coordinating the hospital care," Abeler said. "I'm convinced that we can look to that model that's very doable. We can actually get better care, better outcomes for these folks and achieve the savings we need, which might be a blessing in disguise for everybody."

Abeler would like to see community clinics coordinate care for the Emergency Medical Assistance patients instead of the current program, which isn't designed to control health care costs. He will meet with DHS Commissioner Lucinda Jesson to propose his plan on Monday.

If the legislation passes, Abeler said, in May the state could have a new way to serve patients on Emergency Medical Assistance. They could get by on appeals until then, he said.