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By Clay Masters

Living with spina bifida and hydrocephalus, St. Cloud resident Keith Piskur has learned to concisely tell people all the ways that Medicaid helps him live his life.

“It’s not only needing to tell your story, but knowing what wording to use to be listened to,” Piskur said.

Piskur was the only member of the public speaking at a recent roundtable held by the Department of Human Services at the Whitney Senior Center in St. Cloud. It’s part of a series put together by the state Department of Human Service as state and local health officials prepare for potential cuts to Medicaid at the federal level.

The problem could be severe. Minnesota’s Medicaid program, known as Medical Assistance, costs around $18.5 billion per year; just shy of two-thirds of that is propped up by federal dollars.

Piskur, with his trusty service dog Maya by his side, sat in his wheelchair and ran through all the different ways Medicaid affects his life. It has helped absorb the costs of more than 50 surgeries, his in-home care and his service dog.

“My journey is a long one that will be my entire life. Of course, disability is not my entire life, but it affects my entire life,” Piskur told the group.

In Minnesota, about a quarter of the population is on Medicaid. While local and state health care leaders are voicing concerns, solutions at the state level are few and far between. They might have to be figured out in a special session later this year.

Final details might not be known until later this spring, perhaps after the Legislature sets a budget and adjourns for the year. But some state officials have started doing the math, speculating that the state could lose out on $1.6 billion depending how the cuts get spread among the states. John Connolly, Minnesota’s Medicaid director, said that would trickle down to force difficult choices at the state level.

“Limiting who qualifies for the program, who can actually enroll the services we cover in the program, and then, of course, what we can actually pay providers for the services that they’re offering to people in the program,” Connolly said.

Differing impacts

Dr. Kim Tjaden is a family physician and director of community health at CentraCare Health,  which has 10 hospitals and 30 clinics. She spoke at the roundtable in St. Cloud.

“Rural hospitals are already operating in a very thin margin, and any cuts are going to result in decreased services,” Tjaden said. “We’re really looking at this from an emergency preparedness lens. How are we going to keep caring for folks if these cuts come through?”

In Minneapolis, about 75 percent of Hennepin Healthcare’s patients are on some type of public program like Medicaid, said Dr. Thomas Wyatt, the chair of emergency medicine at Hennepin Healthcare.

Wyatt said people tend to use the emergency department more when they have decreased access to care.

“Our emergency departments are already stressed, many times overburdened,” Wyatt said. “That’s going to just increase this amount of stress. Those ED wait times are going to be longer.”

The cuts would also hit the services that people on Medicaid provide.

Amy Gavanda, director of aging and disability services at Twin Cities Catholic Charities, said the human services agency would also feel the pinch.

“If Medicaid goes away, the clients that we serve will have no option for health care,” Gavanda said.

Gavanda said many of the Medicaid recipients they provide services to didn’t plan to be on the program.

“They hit retirement age and thought they had planned. They thought they were all set,” Gavanda said. “Something happens — a medical crisis, losing housing, a spouse passes away — and they can’t afford their living situation anymore.”

Republicans in Washington still haven’t made final decisions on how to achieve the savings they want from Medicaid as they hammer out a budget deal. As much as $880 billion in potential cuts could have a large impact on the program for disabled, elderly and low-income Americans.

Republicans push back on the idea they’ll be stripping coverage, saying they’re looking for was to crack down on fraud and other slack in the program first.