HCMC opts into health program; other bills uncertain

As the 2010 legislative session wound down, things were more uncertain than ever thanks to high-profile disputes between Gov. Tim Pawlenty and state lawmakers, and a groundbreaking Minnesota Supreme Court ruling.

In a 4-3 decision May 5, the court ruled against Pawlenty in the unallotment case that challenged whether Pawlenty’s emergency budget cuts from last year were legal. The decision could mean an even bigger budget deficit. Some State lawmakers indicated it could force the need for a special legislative session.

It wasn’t immediately clear whether the ruling affects all of the $2.7 billion in cuts Pawlenty imposed last summer, or if it is narrowly focused on the nutrition program for the poor that served as the genesis for the case. As Access Press went to press, indications were that the entire cut was back on the table.

Other issues are also in flux. The General Assistance Medical Care (GAMC) compromise crafted by state lawmakers this session took a hit when the Hennepin County Board of Commissioners initially rejected its terms. The County Board oversees Hennepin County Medical Center (HCMC), which sees more GAMC recipients than any other hospital in Minnesota.

GAMC provides coverage to low-income people, many of whom have disabilities. Until recently, this program provided coverage for more than 36,000 people. The program ended this spring but was replaced with a smaller compromised program.

State health officials did negotiate a plan with Hennepin County May 6. But the decision was at a time when there was more instability than ever about health and human services funding.

The 2010 legislative session must end May 17. But as Access Press went to press there  was much uncertainty over an array of health and human services funding. Aid to local governments, some of which funds health, human services and civil rights programs at the city and county levels of government, was also in jeopardy.

Pawlenty declared May 4 that he would make $536 million in budget cuts if state lawmakers failed to do so. He also vowed to veto the health and human services omnibus bill passed May 4 by the House. The House cut $164 million in health and human services spending, but Pawlenty said that wasn’t enough. He also opposes a plan included in the bill to replace GAMC.

The governor said the state cannot count on $408 million in promised federal aid to help balance the state budget, as that money isn’t in hand yet. 

In the meantime, GAMC continues to face a shaky future with the Hennepin County decision. The Hennepin County Board unanimously approved a resolution April 27, offered by Board Chair  Mike Opat, stating that the board does not accept the draft Coordinated Care Delivery System (CCDS) contract presented by Minnesota Department of Human Services (DHS) to HCMC, and will not authorize participation by HCMC as a CCDS under the contract proposed by DHS.

The resolution also states that the board is willing to pursue good faith negotiations with DHS that bases HCMC’s participation as a CCDS on sound financial terms, recognizing the fiscal and physical capacity of HCMC to provide care for the GAMC population.

The resolution passed by the Hennepin County Board states that “if only a few hospitals participate, the financial risk to Hennepin County Medical Center, Hennepin County and Hennepin County taxpayers, in serving the GAMC population, becomes excessive and unquantifiable, thus jeopardizing the ability of HCMC to continue its mission to provide health care and related services to the general public, including the indigent.” HCMC already sees more GAMC patients than any other hospital in the state.  Legislators approved compromise GAMC legislation earlier this year, but it was vetoed by the governor. Another compromise was then worked out and signed into law.

But the revamped GAMC is raising red flags among potential provider hospitals. The Hennepin County Board initially acted after most hospitals in the state chose not to participate in a new program to provide care to GAMC patients.  The compromise bill creates a new care system in which participating hospitals would provide needed care to GAMC enrollees, but would receive greatly reduced funding from the state. The premise of the compromise legislation was that hospitals statewide would participate, thus sharing the risk. But only five of 17 hospitals statewide that could participate in the new plan have indicated they would do so.  All five are in the Twin Cities area; no Greater Minnesota hospitals have opted in. And at least one metro area hospital, North Memorial in Robbinsdale, has indicated it won’t participate if HCMC opts out.

The new program is scheduled to begin June 1.

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