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JAN 6: GENERAL ASSISTANCE MEDICAL CARE: Nailing the Powerless Again

Is the entire matter of shifting 28,000 General Assistance Medical Care (GAMC) recipients to MinnesotaCare all about Governor Pawlenty's continuing battle with the urban core? Because state-funded GAMC fills the healthcare gap Medicaid (called Medical Assistance in Minnesota) opens for the poorest of the poor (to qualify for GAMC, one must be a childless adult earning no more than 75% of Federal Poverty Guidelines [FPG] - about $11,000 for a single adult), the poorest among us find themselves on the outs once again. Some 41% of GAMC's 35,000 to 40,000 enrollees reside in Hennepin County alone; in Ramsey, 12.6%. Over half, then, in the core cities and counties.

Although it's possible the national healthcare reform measure would relieve the state of some burden starting in 2014, as part of Governor Pawlenty's now-challenged 2009 budget-balancing scheme, the "unallotment" process, the targeted GAMC recipients – at least a quarter of them homeless and over half of them white – are scheduled to lose their coverage unless they qualify for Transitional MinnesotaCare. $138 million from the budget.

Why? Because MinnesotaCare requires copays on hospital stays, non-preventative doctor's office visits and prescription drug - plus a $10,000 yearly cap on hospital stays. Under current cost conditions, that might mean one overnight bed. Moreover, sometime within the six months following GAMC transfers to MinnesotaCare, GAMC eligibility expires and GAMC recipients must re-apply - not for the better guaranteed GAMC coverage, but for regular MinnesotaCare.

No one need remind us that with the poverty represented by GAMC recipients comes a raft of medical and social issues - chemical dependency, mental illness (80%), and, again, homelessness. Core city hospitals like Hennepin County Medical Center and Regions in St. Paul face a severe shortage of funds to cover the healthcare the law mandates for emergency facilities. MinnesotaCare is paid for through the Health Care Access Fund, and the influx of GMAC recipients into this pool will increase costs significantly, given their health needs. The ripple effect includes higher costs and insurance premiums for the entire system.

Legislative leaders have been scrambling to solve this dilemma, despite the Governor's veto of a financing package that included a tax increase last session. A proposal being heard in joint House-Senate committees - they'll hold another another hearing Wednesday, January 13 - is meant to bring at least temporary relief even as the new session promises even more fiscal pain for the state.

TTT's ANDY DRISCOLL and LYNNELL MICKELSEN talk with policymakers, advocates and willing officials in the provider community and the state's Human Services Department to clear up confusion over which program is which and what is likely to happen now that the entire care community is up in arms over this proposed shift to the rolls of a program recipients may no longer qualify for after a few months.

GUESTS:

• STATE SEN. JOHN MARTY - Chair of the Senate Health Housing and Family Security Committee; co-chair of the joint committee hearing GAMC resolution legislation

• SARAH WALKER - Chief Operating Officer, 180 Degrees, a residential post-incarceration program; Founder, Second Chance Coalition.

• ANNA MEYER - Director, Criminal Justice Project, National Alliance on Mental Illness of Minnesota (NAMI)

• MONICA NILSSON - Director of Outreach Services, St. Stephens Human Services, MInneapolis

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