Good Bye to GAMP

For years Milwaukee County served it obligation to the poor and indigent via the Milwaukee County General Hospital (a.k.a. John Doyne Hospital). Things changed in 1995, however, when Milwaukee County government decided that it no longer wanted to be in the business of running a major hospital, and so closed the doors of John Doyne Hospital. In its stead, it decided that some of the money dedicated to running the hospital could be redirected to community hospital and health care providers. Thus the General Assistance Medical Program (GAMP) was born.

GAMP was intended to be a medical insurance program to cover lower income Milwaukee County residents who did not qualify for any other source of insurance, including Medicaid and Medicare. GAMP has had its share of problems, however. Providing health care has continued to prove to be expensive, especially in Milwaukee, where the cost of providing health care is substantially higher than other cities of similar size. With increasing numbers of enrollees and rising health care costs, the program threated to swamp the County budget. For a number of years, there were threats to totally eliminate the program. In the last budget battle, two years ago, the program was saved when the major hospital systems in Milwaukee county agreed to contribute to the funding of the program. Afterall, the hospitals stood to lose out if GAMP funding disappeared, forcing even more patients to use their emergency departments for unreimbursed care.

GAMP has been a frustration to health care providers because it reimbursed them at inadequately low Medicaid rates. Beyond that, the program attempted to same money by placing many restrictions on the delivery of services, such as using a very strict medication formulary, and eliminating or severely curtailing services such as mental health, dentistry, and elective procedures. To make matters worse, GAMP funding was on a fixed yearly budget. So if funding ran out before the year was over, providers were not reimbursed for care provided beyond that date. This made it difficult for willing primary care providers to find enough specialist to which they could refer needy patients. Lastly, because eligibility rules stated that enrollees could not be eligible for other forms of insurance, if the program found out at a later date that a patient was indeed eligible for another program, GAMP asked the health care provider to return any reimbursement it had already received from the program, dispite the fact that serviced had already been rendered in good faith, a slap in the face to someone already settling for inadequate rates of reimburse.

NEXT: the future of GAMP