DFL lawmakers aren’t the only ones thinking about a fix for General Assistance Medical Care, the endangered state program that covers impoverished adults without dependent children in Minnesota.

At a packed joint committee hearing Monday in St. Paul, state Rep. Matt Dean, R-Dellwood, suggested tinkering a bit with the Pawlenty administration’s plan to shift GAMC enrollees to MinnesotaCare, a premium-based insurance program for low-income working adults.

While critics have said MinnesotaCare is not suitable for GAMC enrollees for a variety of reasons, Dean said he thinks the focus of legislative efforts should be on "getting the right care at the right time for patients in this population."

Dean wants the Minnesota Department of Human Services to conduct a census of GAMC enrollees over the past two years to get a better sense of who they are, where they seek care and their health-care needs. While 36,000 people are receiving GAMC at any given time, the annual numbers can top 70,000.

"This is a very difficult population," he said, explaining that some enrollees "tend to move in and out of hospital care"and present as "train wrecks" in emergency rooms.

A census also could determine which enrollees would be adequately served by MinnesotaCare, which has a $10,000 cap on inpatient hospitalizations and focuses more on primary care, said Dean, lead-GOP on the House Health Care and Human Services Finance Division.

His plan also would "move away" from the four-month waiting period required by MinnesotaCare before providers are reimbursed for patients’ care, a key sticking point for hospitals and clinics.

Finally, he suggests instituting a county-based "medical care home model," where counties would pick up the MinnesotaCare premiums and determine how best to care for these patients. The medical care home, he said, was suggested by several stakeholders "as not only the cheapest way to deal with this population but it delivers the best care for these folks."

Dean’s proposal comes a few days after DFL House and Senate members presented a plan to restore the GAMC program. Three days before the session ended in May, Gov. Tim Pawlenty used his line-item veto to strike $381 million in second-year funding for GAMC and his unallotment power to cut the program by another $15 million. The House of Representatives was unable to override the veto, with DFL and GOP lawmakers splitting along party lines.

While the next session doesn’t start until Feb. 4, lawmakers are racing to get a solution before March 1 — the date GAMC is projected to run out of money. Last Thursday, DFL lawmakers offered a 16-month plan to restore $292 million in funding for the program by temporarily hiking a surcharge on hospitals and HMOs in order to qualify for more federal matching dollars, seeking a 10 percent share of GAMC costs from counties, setting up county-based accountable care organizations, and eliminating eligibility for certain groups, some of whom might qualify for programs like Medicaid.              

At Monday’s hearing, House Assistant Majority Leader Erin Murphy, DFL-St. Paul, emphasized that while the DFL proposal was a "work in progress" she was "glad to have something "concrete" to discuss. Murphy said she and other lawmakers visited nine safety-net hospitals throughout the state and met with numerous stakeholders before arriving at a proposal.

While some critics have objected to a cost shift to counties, Murphy was sympathetic: "The 10 percent county share is a return to former state policy and is not one I’m in love with, and I understand it is a cause of concern."

The 10 percent share is based on how much was spent on GAMC in a given county during the previous year, she said. "For some counties, it’s small ... for others, it’s substantial." Hennepin and Ramsey counties and their safety-net hospitals serve the largest number of GAMC enrollees.

All in all, Republicans and DFLers seemed to be playing nice at the hearing, complimenting one another on the work they’ve put into each party’s proposals and indicating a willingness to work toward a bipartisan solution.

"I’m here to be part of the solution," said Rep. Jim Abeler, R-Anoka, vice chair of the Health Care and Human Services Finance Division. "I wasn’t a fan of the (Pawlenty’s line-item) veto; it wasn’t my advice. ... But what the MinnesotaCare switchover does do is it pushes people to clinics," where care costs less than in hospital emergency rooms, he said.

A video of the three-hour-plus hearing can be seen here.