WILLMAR -- Local officials see anxiety, uncertainty and confusion surrounding the restructuring of Minnesota's General Assistance Medical Care program.
Where should these clients go for medical care? Who's going to pay the bill?
"We're fielding phone calls," Mike Schramm, chief executive of Rice Memorial Hospital, said last week. "There are more questions than answers."
Rice Hospital has formally opted out of a coordinated care delivery system that's being crafted to oversee medical care for GAMC enrollees. Hospital officials analyzed the numbers and concluded there was too much uncertainty about the costs, the payment rate and the number of clients, Schramm said.
"We are not alone in that decision," he said. "The financial risk is far too much for us to bear."
Participants in the General Assistance Medical Care program are mainly single, childless adults and among the lowest of low-income clients. About 360 people are enrolled in the program in Kandiyohi County. The publicly funded program has about 36,000 participants statewide.
Local clients will still be seen in Rice Hospital's emergency room if they need medical care, but it's far from clear where they will be able to receive other services, such as ongoing office care from a doctor or prescription drugs from a pharmacy.
Jay Kieft, director of Kandiyohi County Family Services, said his biggest concern is being able to tell these clients how they will be able to access care.
"We're in limbo essentially right now. It is frustrating," he said.
Family Services staff expected a letter Monday from the Minnesota Department of Human Services, outlining the most recent information about the program.
The biggest challenge, Kieft said, is "reinforcing the communication that comes from the state. We want to give a consistent message to our folks."
Even among providers, it's not clear what's happening with the General Assistance Medical Care program or how to deal with current patients who are enrolled.
Bill Fenske, chief financial officer at Rice Hospital, said he's already heard from one local provider who wanted to bill the hospital for services to a GAMC client.
"There's going to be a lot of confusion over this," he said.
Four Minnesota hospitals, all in the metro area, have agreed so far to become part of the coordinated care delivery system -- but only after working out a deal that allows them to cap how many General Assistance Medical Care enrollees they take. Further changes also are likely with the program, which was slated for elimination at the end of March and now is undergoing redesign in an attempt to pare costs.
Hospitals are expected to be given another opportunity to opt into the program later this year. Incentives to encourage more of Minnesota's rural hospitals to join are also a possibility.
All the uncertainty has been hard on clients, many of whom have mental illness, Kieft said.
"That's a whole other consequence to this that people don't pay attention to," he said. "It just adds to the anxiety and angst of these folks who are already struggling to manage their disease. ... Those are the things that pervasively affect our days and our work with customers."