Bemidji, Minn. âÄî Health care providers across Minnesota are confused over changes to the state’s General Assistance Medical Care program, which serves more than 30,000 very poor, childless adults. The changes took affect this week, and care givers say there are still lots of unanswered questions, especially in greater Minnesota. During the last legislative session, in a deal between lawmakers and the governor, funding for the General Assistance Medical Care program was slashed by about 75 percent. Now, clinics, hospitals and county agencies are trying to figure out how complex changes will affect health care delivery for some of the state’s most vulnerable residents. “Clients are confused. They don’t understand it,” said Susan Yerhot, a financial assistant supervisor for Beltrami County, which is home to about 1,000 GAMC recipients. “The few providers I talked to, they have a lot of questions, like exactly how does it impact them.” General Assistance recipients used to be able to get health care at any hospital or clinic. Now it’s not so easy. Only four hospitals in the state have signed on to provide care for GAMC patients, and all four are located in the Twin Cities area. For people who live in greater Minnesota, choices are a lot more limited. “If you don’t have access to one of those four sites, you either have to transport yourself there … or you just have to take your chances, and whenever you get sick you go to the ER,” said Joy Johnson, vice president of business development and marketing at North Country Regional Hospital in Bemidji. Hospitals are required by law to treat patients seeking emergency room care. Johnson said there could potentially be a flood of General Assistance recipients visiting emergency rooms in outstate hospitals across Minnesota. Other health care providers in Bemidji are still working to figure out the impact of the GAMC cuts. Officials at the mental health center are concerned about how they’ll be able to continue serving patients on General Assistance. TheyâÄôre confused as to which mental health programs are covered and which aren’t. The same goes for the Northern Dental Access Clinic in Bemidji, which opened last year to serve the low-income population. So far itâÄôs served 300 General Assistance patients, and 200 others are on the waiting list. Jeanne Larson, the center’s director, said that the state no longer reimburses the clinic for GAMC patients and that could put the fledgling center in financial jeopardy. Larson said the state hasn’t provided the dental clinic with much information so far, but it’s clear that General Assistance recipients in greater Minnesota will have a tough time getting service. “What we’ve learned after all our exhaustive efforts, knocking on doors and making phone calls across the state, is that there’s not a categorical solution,” Larson said. “They didn’t provide a solution for rural patients, and we can’t find any way to develop some sort of policy that helps this patient base as a whole.” Many providers, including Larson’s dental clinic and the local mental health center, say they’ll do everything they can to avoid turning General Assistance patients away who can’t pay. Some larger facilities also donâÄôt plan to deny anyone service. Cindy Morrison, vice president of health policy for the newly merged Sanford Health and MeritCare system, said the organization will accept General Assistance Medical Care patients. The system operates hospitals and clinics across Minnesota, including a facility in Bemidji. Morrison said the process is frustrating, because it’s unclear as to what level the state will reimburse providers for General Assistance patient care. It appears the reimbursement will be miniscule compared to the actual costs of services. “The hard part is that there’s so much unknown yet,” she said. “We don’t have enough information, so it makes it a little bit hard to really talk about the impact and what decisions will be made.” Minnesota Public Radio News can be heard in the Twin Cities on 91.1 FM or online at MPRnewsQ.org