The revamped acute medical coverage for Minnesota’s poverty-stricken working poor took a hit this week when it was announced that many greater Minnesota hospitals would not be participating. The state’s governor, Tim Pawlenty (R) initially planned to use his executive powers to nix the entire GAMC program, which guaranteed umbrella coverage by the state for means-tested beneficiaries who fell below a certain income mark, often at poverty levels. An eleventh-hour compromise led to the present legislation which shifted the healthcare cost within the GAMC legislation to acute care hospitals from the state.

Two of the state’s largest providers of care to the indigent — Hennepin Co. Med. Ctr. (Minneapolis) and Regions Hosp. (St. Paul) — will continue to do so, as they will be rewarded with rather large capitated sums to design care models (the thrust of the legislation). For smaller facilities outstate, however, uncertainty surrounding the development of such care models is giving cold feet to wary CEOs.

In Duluth, St. Mary’s hospital is working on ways to better care for its GAMC clients outside of the new program, said CEO Dr. Thomas Patnoe. ”It’s going to hurt us, this new law. Essentially, the state is offering to pay us $2 million where they paid us $8 million, but we’re asked to take on an unknown number of new patients, add some social services, and then redesign it all,” he said. “We simply can’t buy into it.”

The dilemma over how to provide care in fiscally murky situations like this this may prove to be a blessing as smaller hospitals will now have to turn to themselves to try to find acceptable models of care delivery to fulfill their missions admist the steepest drops in state renevue in years, a fledgling healthcare reform law fighting for believers, and in the court of public opinion from those who stand to benefit by or be harmed as a result — the patients. | LINK

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