Minn. Legislators Change Medical Assistance Rules

Feb. 15--WORTHINGTON -- A couple of changes made by state legislators during the 2011 session are just starting to make an impact locally on legal noncitizens and undocumented people who rely on state- and federally-funded medical assistance to cover their healthcare costs.

The Emergency Medical Assistance (EMA) program served undocumented people with serious needs, such as broken limbs or ongoing medical issues like diabetes. As of Jan. 1, the program has changed to cover only emergency services through an emergency room visit or direct hospitalization.

Mike Thies, financial supervisor with Nobles County Community Services (NCCS) said the change means undocumented people requiring ongoing medical care -- such as insulin or dialysis -- have no medical coverage.

"I don't know what's going to pay for it now," he said.

NCCS Director Nicole Names said loss of the state-funded medical coverage may force some individuals to skip necessary medical appointments because they don't have the means to pay for the care.

"If somebody has a chronic illness and they can't see their doctor, at some point they're going to become very sick. It could force them into the hospital or even death," Names told Nobles County Commissioners last week. "My suspicion is it will push a huge demand on the emergency room in the hospital. The hospitals cannot turn anyone in an emergency away, covered or not."

Since the change took effect just seven weeks ago, Sanford Worthington Medical Center has yet to realize just how great the impact will be locally.

Sanford's Chief Nursing Officer Jennifer Weg said the loss of the EMA program further highlights the challenges of healthcare affordability.

"We know that when people don't have adequate insurance, they don't prevent as well as they could," she said. "They enter the ED (Emergency Department) more in crisis or deteriorated health."

Those who don't have insurance are typically directed to the county's family services (NCCS) to meet with a financial worker, Weg said.

"When we see that decline (in people coming in for ongoing care), we may be able to tie it back to insurance," Weg said.

NMED cut

While the new EMA rules took effect Jan. 1, changes to the Noncitizen Medical Assistance (NMED) program will be implemented March 1. Starting on that date, NMED will no longer be available for non-pregnant adult noncitizens who do not have an immigration status that qualifies for federally-funded MA.

Names said the NMED program was established in Minnesota in 1997 as a way to provide coverage for noncitizens who did not qualify for the federal Medical Assistance program. NMED, like the EMA program, was changed by the state legislature in 2011 as a cost-savings measure.

"There are many states in the U.S. that do not cover Medical Assistance costs for nondocumented citizens," she said. "(Minnesota is) following the lead of some other states in the U.S."

The changes made to the NMED program apply to certain noncitizens legally allowed to live in the United States, said Thies, explaining that those affected have resided in the U.S. for less than five years and came here on a diversionary visa through another country's lottery system.

In Nobles County, between 38 and 40 individuals over age 21 fall within those criteria, Thies said.

The elimination of NMED doesn't mean those people will go without health coverage. Thies said they may qualify for MinnesotaCare.

"We have recognized all those people and we are sending out (information) to see if we can get them switched over to MinnesotaCare by March 1," he added. "They may have to pay a monthly fee and there are some other differences in coverage."

The monthly fee could be as low as $4 per month for someone who is unemployed, Thies said, adding that they have a sliding scale fee system in place based on a person's income and ability to pay for coverage.

By moving the impacted individuals to MinnesotaCare, Thies said the state can access some federal funds.

"The state isn't going to pay for everything," he said, adding that the elimination of NMED was done to help reduce the state's overall healthcare budget, yet still allow an option for people who fall into the noncitizen category.

Daily Globe Reporter Julie Buntjer can be reached at 376-7330.

Copyright 2012 - The Daily Globe, Worthington, Minn.