GAMC will end, but at what price for Minnesotans?

On March 1 General Assistance Medical Care (GAMC) will end, not only putting thousands of Minnesotans at risk, but it could also cause financial problems for the Minne-sotaCare health care program and its participants as well. State lawmakers, health care providers and numerous advocacy groups are scrambling to keep a financial meltdown from happening.

When the 2010 Minnesota Legislature convenes Feb. 4, at least two proposals to address the end of GAMC will be introduced. The goal of many state lawmakers is to have a plan ready to be voted on early in the session.

Until then several groups are working to draw attention to the difficult situation the end of GAMC is creating. In December, activists and GAMC recipients participated in a statewide event meant to draw attention to the cuts. At various locations they read the names of the 30,000-plus GAMC recipients who will be affected by the program’s end.

Many of the roughly 36,000 people covered by GAMC are mentally ill or have other disabilities. Gov. Tim Pawlenty line-item vetoed GAMC funding in 2009 to help balance the state’s budget. At the time Pawlenty said most GAMC clients could be moved into MinnesotaCare, a health care program that provides coverage for many low-income working Minnesotans.

But at a Dec. 14 joint hearing of House committees on health care and human services, Minnesota Department of Human Services Commissioner Cal Ludeman said that moving GAMC participants to MinnesotaCare would put the MinnesotaCare’s funding into deficit by July 2011.

Ludeman said the intent of DHS is to make transitions from GAMC to Minnesota-Care as “seamless” as possible and that DHS is committed to helping GAMC clients with the transition.

But the transition will have costs and not just to MinnesotaCare. At the Dec. 14 hearing, representatives of hospitals, health care providers, health care workers, social workers and county governments spoke of the ripple effect of costs they will be facing.

Lawmakers have many concerns about the transition as well. Rep. Tom Huntley, DFL-Duluth, questioned whether many of the current GAMC clients would be able to make the transition. He also worried aloud that working Minnesotans who have no option other than MinnesotaCare would be kicked off of that program.

Many of those trying to save GAMC see their efforts as interim measures, meant to fill the gap between now and a time when federal health care reform is adopted by Congress. But any federal changes aren’t expected to take effect for a couple of years at the earliest.

Two proposals were reviewed Dec. 14 by the joint committee, before a packed hearing room. Many of those present, from the Save GAMC Coalition, wore red and white stickers in support of the program.

Rep. Erin Murphy, DFL-St. Paul, said the DFL’s proposal is a “work in progress.” That plan would restore $292 million of GAMC’s $396 million budget through a combination of county and federal funds, a hospital surcharge and cuts to reimbursements to hospitals. There would also be a push to get people with disabilities into other programs, such as Medicaid or Supplemental Security Income (SSI).

Murphy said the DFL proposal would continue to provide access for health care to those served by GAMC, while protecting jobs in the health care sector. The proposal, developed with help from DHS, drew from a variety of resources including visits to nine “safety-net” hospitals.

“As a legislator and a nurse I know this is not a perfect solution,” Murphy said. It will not help all who are currently on GAMC. “The cuts are deep and the consequences of those cuts are going to be real.”

A second proposal, introduced by Rep. Matt Dean, R-Dellwood, would put GAMC recipients into Minnesota-Care, but provide coverage specific to their needs. Some current GAMC recipients would be in the current MinnesotaCare program, while others would be in a modified version of Minne-sotaCare. Part of his plan calls for a county-based medical home care model.

But both legislative proposals are raising red flags. Advocates agree that while GAMC may not be the best program, simply shifting clients to MinnesotaCare isn’t an option for a myriad of reasons. Several people who work with the mentally ill, chemically dependent and homeless described the many problems their clients already face in finding health care. “GAMC has truly been a safety net for people who lack housing and live on the margins,” said Maureen O’Connell of Legal Aid.

For Minnesota’s counties, which have already set their 2010 budgets and property tax levies, picking up more health care costs would mean cutting other programs. Keith Carlson, executive director of the Metropolitan Inter-County Association (MICA), questioned whether counties could pick up any additional costs beyond what they are doing now.

Hospitals and health care providers also raised issues. Hennepin County Medical Center and Regions Hospital, and the Minnesota Hospital Association, were on hand too address the issues. HCMC, for example would lose $40 million per year with the end of GAMC. Regions Hospital would lose $24 million and Fairview-University Hospital would lose $14.7 million.

Hospital workers, social workers and advocates for the homeless expressed fears that many GAMC clients would get no care at all after March 1. One outreach workers for St. Stephen’s programs out of Minneapolis brought a two-foot stack of client files. Some questioned how homeless people would be able to pay MinnesotaCare premiums, be able to enroll in programs or even handle basic program details.

Hennepin County Commissioner Mike Opat asked legislators to understand the challenges the county is already facing. Opat said Hennepin County officials have worked hard to deal with state unallotment and to make cuts, and to hold the line on property taxes. “Then after all of that, boom! We’re effectively thrown off of a cliff with the elimination of GAMC,” he said.

David Godfrey, public policy program manager for HCMC, outlined health care management strategies that could be used for current GAMC enrollments, such as medical home or accountable care models. “Doing nothing is not an option,” Godfrey said.

For more information on Save GAMC and on upcoming proposals and events, go to http://www.osjspm.org/savegamc.aspx