Cuts to general assistance medical care alarm mental health advocates in Minnesota

From The Winona Post in Minnesota:

Eliminating General Assistance Medical Care will have devastating effects on thousands of people, mental health advocates agreed Nov. 7, with families, hospitals and taxpayers all in line for the ripple effect the cut will have.

The conversation was part of a community discussion Nov. 7 between legislators, mental health professionals, medical providers and advocacy groups who each explained the far-reaching implications from a cut they believe is ill-conceived.

Governor Tim Pawlenty used a line item veto to eliminate funding for General Assistance Medical Care (GAMC), the medical assistance program used by the state’s most impoverished residents.

Studies show 70% of the people receiving GAMC have a mental illness, and all are at least below 75% of the federal poverty level, meaning they take in no more than $677 per month for a single adult.

The governor’s plan is to automatically move GAMC recipients to MinnesotaCare for one to six months while they go through the formal application process, but Sue Abderholden from the National Association for Mental Illness said it is a bad solution for a number of reasons.

MinnesotaCare has a 14-page application process, a four-month waiting period and significantly higher co-pays than GAMC, she said. People must send in a monthly premium for MinnesotaCare, yet many of the people receiving GAMC don’t even have a checking account, often because they are homeless.

Moreover, Abderholden said, for people not on the program who qualify, GAMC can be applied for and received at the outset of a hospitalization, while MinnesotaCare will not pay for any care retroactive to a person being accepted to the program months later.

GAMC provides mental health drugs free of charge, but on MinnesotaCare people will have to pay for them. Even a $5 co-pay is too much for some of the GAMC recipients to afford, Abderholden said, and the result will likely be that many patients with mental illness stop taking their medication.

That, said Eric Mueller from the Winona Police Department, is where the trouble begins.

“If you’re dealing with someone off their meds it’s a huge, huge safety issue,” he said. “You don’t know how they are going to react. It creates a whirlwind of problems for us as officers on the street.”

But problems for officers are problems for society, most in the group agreed, because people need to be cared for one way or another, whether it is with free mental health drugs or taxpayer-funded jail stays.

Hospitals also suffer, as patients with no ability to pay still must be treated in the emergency room and hospitals will have to eat the cost for caring for the uninsured.

When people are jailed it is the county that must pay for their medication, said Winona County Human Services Director Craig Brooks. When inmates are released, officials try to give them a few days worth of their prescription to get by, but the uninsured and underinsured without access to the drugs that stabilize their behavior will likely be back, Brooks said.

In Winona there are between 200 and 300 people who will be affected by the loss of GAMC, and the collateral damage to their families can be large, said Helen Newell from Project Compass. “I wonder if everyone knows what happens to the family of a person who stops taking their meds for any reason,” she said. “It’s not just that one person in that hell, it’s the whole family and everyone who knows them.”

Taking away the medical assistance program that sustains many of these people will not save money in the long run, Abderholden said, it will just shift the cost for caring for them from the state coffers to local taxpayers. “Their needs don’t go away,” she said.

Representative Gene Pelowski said he does not believe Pawlenty understood the full ramifications of cutting GAMC, but he also does not believe the governor will find new funding for the program without a significant outcry from state residents.

Pelowski said pressure on lawmakers and Pawlenty to deal with a budget shortfall of $6.4 billion dollars prompted this and other cuts, and that more are on the way given the current forecast.

Representative Steve Drazkowski said Legislators need to create better priorities if they want to continue funding programs like GAMC. “The legislature has never had the discipline to set priorities,” he said. As a result, Drazkowski said the state is funding things like land and easement purchases while programs like GAMC suffer.

“We can’t continue to fund everything in a shrunken economy,” he said, citing perpetual bonding requests for civic centers and volleyball courts and a high speed train from Chicago to the Twin Cities. “Who is going to pay for that?” he asked.

But he did call Minnesota’s medical assistance program more generous than other states, and suggested he is not convinced people will fall through the cracks of the current plan.

But Senator Sharon Erickson Ropes disagreed, saying the system is bad and the state needs to fix it. “Our system is like a giant jigsaw puzzle not put together,” she said. “Why don’t we take some of these 14 pages of forms and reduce it to two pages? It’s ridiculous and a waste of time.

“We are cutting away support for the weakest and most vulnerable members of society,” Ropes said, though she acknowledged the budget deficit facing Minnesota is a “massive problem.”

“Everyone at the Capital is looking at their own budgets, but if you squeeze it here it pops out somewhere else,” she said. “We’re trying to do everything we can to work with NAMI and other support providers, but the government is not going to be able to do it by ourselves.”