In the 34 years since being diagnosed with lupus, an autoimmune disease that affects her skin, joints and organs, Charlotte Watkins has been consistently in and out of the hospital.
Over the years, Watkins’ trips to the hospital for treatment have included everything from weekly check-ins to multiple heart valve replacements. Those visits, in addition to her latest stay at the Hennepin County Medical Center earlier this month, were covered by the state’s Medicaid program.
But after President Donald Trump signed a budget bill featuring about $1 trillion in cuts to Medicaid this summer, Watkins is one of many patients dreading changes that could make it harder to get care and pay for the cost.
“I’m very worried about that because if anything to do with my medical gets cut, I would die,” Watkins said.
Strain from cuts on the horizon
For Minnesota, reductions in federal funding will total $1.4 billion in the first four years of the law, and counties will face hundreds of millions in new administrative costs, according to a July briefing for reporters by Minnesota Department of Human Services officials.
In addition to the funding cuts, the package included new provisions for recipients including a requirement for 80 hours of “community engagement” a month; eligibility renewals every six months, rather than once a year; and cuts in retroactive coverage from three months to a month.
Hennepin Healthcare CEO Dr. Thomas Klemond said the work requirement and the six-month eligibility renewals will have the biggest impact on the health care system’s ability to recoup the costs of care from patients. Those extra steps are a barrier for many, leading fewer to seek preventive care, he said.
“When patients and community members have to do extra steps to apply for Medicaid, many don’t accomplish them, or don’t accomplish them in a quick manner,” Klemond told Sahan Journal. “Good primary care and good preventive care will help people avoid serious trouble, but when they do show up for care they’ll generally be sicker and use emergency services and the reimbursement will be poor.”
Half of Hennepin Healthcare’s patients — nearly 100,000 people annually — rely on Medicaid or would be eligible for Medicaid coverage if they applied. The federal cuts could mean $100 million in lost revenue, or about 6% of the health care system’s total operating budget, officials say.
Klemond said Hennepin Healthcare is still determining how to move forward and blunt the impact of the federal cuts.
“We look at being as efficient as we can, but we also probably can’t operate our health care system the way that we have been able to,” he said. “We’ll have to make some difficult choices, and we’re still working on that because even without the Medicaid cuts, we’ve got significant challenges to that end.”
Local clinics also feel pressure
The People’s Center Clinic, located in the Cedar-Riverside neighborhood of Minneapolis, sees around 6,500 patients per year — 65% to 70% of whom are East African, according to Ann Rogers, the clinic’s CEO.
The clinic offers medical, dental and behavioral health services, in addition to “wraparound” services for patients that include food assistance and delivery, assistance in finding housing and help filling out immigration and other legal paperwork.
Rogers said about 90% of the patients that visit the clinic are on Medicaid, and as a federally qualified health center, they serve any patient that comes into the clinic regardless of lack of health coverage or immigration status. The impending cuts, Rogers said, will dramatically impact the availability of all of their services.
“We know that right now the impact to our clinic is going to be about a 20% reduction in revenue for us. That’s about $1.4 million,” Rogers told Sahan Journal. “That means that about 1,600 patients are going to lose their coverage.”
Rogers echoed Klemond, predicting a decline in how many patients will seek preventive care, which will lead to more patients holding off on seeking health care until conditions become dire. That would then turn into more emergency department visits and longer wait times.
But at the People’s Center Clinic, where the patients are immigrants and people of color, providers already have a hard time getting patients to come in for regular checkups. Rogers said the Medicaid cuts could worsen that problem and lead to larger public health threats, such as the measles outbreak in the predominantly Somali neighborhood in 2017.
“When I think about the patients that we serve here, often they don’t understand why you come to get those preventive checks, so we’re always saying ‘please come back so that we can catch something early,’” she said. “Our patients are already sick so now if they delay that care, they’re going to be even sicker than that.”
As the federal government steps back from how much it pays in health care and more people lose access to health insurance, more health care systems with slim margins like those that take care of many Medicaid patients and systems in rural areas may start to close, said Dr. Nathan Chomilo, the medical director for Minnesota’s Medicaid and MinnesotaCare programs.
Some community health centers, he said, have already met that fate.
“The concern is that we’ll start to see that as we get more detailed information and have to do the work of implementing this policy that unfortunately really is going to cause more harm than good,” Chomilo said.
Rogers said the People’s Center Clinic will try to figure out ways to keep the doors open but, in the meantime, they’ll continue to serve as many patients as they can.
“They trust people here, the providers that they’ve been seeing for years and years,” she said. “They’re going to keep coming here, and of course we’re going to serve them, we will then need to figure out how we’re going to make sure that we keep the lights on.”
