Reworked GAMC a failure, patients sayPatients share their disappointment with a 'fix' they say needs a repair itself.
By: Candace Renalls, Duluth News Tribune
“It’s not working.”
That was the consensus of about 20 people who attended a Duluth forum Tuesday on the reworked General Assistance Medical Care program for the state’s poorest adults.
“The reason the GAMC program is not working,” said Duluth City Councilor Sharla Gardener, a retired St. Louis County Social Services worker, “is the people who are needing health care are told they have to go down to the Twin Cities to take advantage of their medical insurance. These are the poorest people in the state. These folks, for primary medical care, are supposed to go to the Twin Cities, and they can’t get there.”
Samuel Lewis of Duluth, who came to the forum with the aid of a walker, has struggled with the system after a debilitating knee injury.
“This (GAMC) thing is not working,” he told the panel of state legislators. “I was told, ‘we can’t do nothing for you.’ ... They wanted me to go to the Cities. How do you get there?”
The forum was one of several being held around the state to gauge the impact of changes to the state-run medical assistance program.
The program was set to end March 31, after Gov. Tim Pawlenty eliminated its funding. A last-ditch legislative effort saved the program, but with 77 percent of its funding slashed, a different program emerged.
Instead of medical providers paying for the care they provide, the new program shifted costs to designated hospital-based systems. Seventeen such systems around the state were picked as candidates for the program, including Essentia Health (then SMDC) in Duluth.
Only four hospitals in the Twin Cities signed up and are compensated with capped block grants. Essentia opted out as did other outstate providers. Being the only provider in St. Louis County was too much of a financial risk, Essentia officials said.
But designated or not, hospitals and clinics around the state are still providing care for the more then 30,000 of the state’s poorest adults who qualify for GAMC.
“GAMC was aimed at people too sick to work,” said state Rep. Tom Huntley, DFL-Duluth. “Most are living on $203 a month from general assistance. We’re finding people are getting denied care and (hospitals) are starting to find ways to coordinate the care.”
But they’re not getting paid for it.
Since the new GAMC program began June 1, St. Mary’s Medical Center has had 1,000 clinic visits and 1,000 hospital visits from its potential recipients, including 400 emergency room visits, according to Cathy VonRueden,an Essentia Health vice president.
“We do not turn anyone away,” she said. “We could, but we don’t.”
In the program’s first four months, the cost to Essentia has exceeded $2 million, she said. Only two patients had registered with one of the official providers in the Twin Cities. Essentia billed them for the care it provided, but those hospitals refused to pay, VonRueden said.
So why not become a designated provider and get some compensation from the state?
“Right now we’re only getting 60 percent of the GAMC patients,” VanRueden said. “If we signed up, then we’d get them all. At least now all (providers) are getting a share.”
At Lake Superior Community Health Center, a nonprofit clinic in West Duluth, former GAMC patients now are being charged on a sliding scale based on income, the system used for its other patients.
Even giving them a 90 percent discount, they usually can’t pay, said Jessica Crowley, the clinic’s social service department coordinator.
“It’s hard,” she said. “It’s tough financial times anyway for everyone. We probably have a population of 300 GAMC patients that we see. And a lot of those people have chronic health conditions, so they’re coming in quite often for their care.”
The new GAMC program is even having a big impact on the Human Development Center, costing it $25,000 to $30,000 a month in uncompensated mental health care.
“We feel we have to ethically continue to treat these clients,” said Jeff Herman, HDC’s chief operating officer. “We have a commitment to serve them whether they have a payer source or not.”