COD E R E D

The GAMP program was created after the 1995 closure of Doyne Hospita -- the county’spublic hospital -l- in an effort to redirect the indigent and uninsured population 2 . FroedertMemorial Lutheran Hospital agreed to provide care to uninsured and indigent patients for $60million a year for two years. iii During these two years, Froedert developed a pilot program withfive community-based primary care clinics that would bill for services provided to a limitednumber of GAMP clients. By April 1997 a total of 2,100 GAMP patients were in the pilotprogram and at this time the county voted to expand enrollment in the program and to includeMedical College of Wisconsin clinics in the purchasing model. The program went county-widein July 1997 adding other hospitals besides Froedert as preferred providers and several FQHCsand other local clinics began serving as gate-keepers and primary care providers. ivCurrently, Milwaukee County purchases health care services for all of its uninsured lowincomepopulation through the GAMP. The program places the uninsured into a providernetwork that includes 15 community clinics, 10 local hospitals, 240 specialty providers andapproximately 25 pharmacies. In total there are about 30 sites which include an array offederally qualified health centers (FQHCs), FQHC look-alikes, private practices, communityhealth agencies and community hospitals. GAMP covers primary care, specialty care, inpatienthospitalization, pharmaceuticals, diagnostics and laboratory services. Mental health, routinedental services and substance abuse treatment are not covered. Emergency dental extractionsare covered.Each clinic must have an affiliation with at least one hospital, specialty provider andpharmacy. The program includes integrated patient record-sharing among all network providersand standardized eligibility screening for the GAMP and other public assistance programs.GAMP participants enroll when a medical need arises. They select a participating clinicin which to receive services. The chosen clinic is then required to meet the participant’s primarymedical needs and coordinate all specialty services. When specialty care is needed that is notoffered by the clinic, it is up to the clinic to obtain a provider in the GAMP network to provide theneeded service.EligibilityGAMP serves adult county residents who are not eligible for other public programs(Medicaid, BadgerCare, W-2), have incomes up to 125% FPL, depending on family size, andhave a medical need. The majority of the participants are adults aged 22 to 65 years.Residency is established after 60 days of living in Milwaukee County.In 2003 a total of 24,000 participants were enrolled in the program with 10,000-12,000enrolled at one time. There is an estimated population of 80,000 indigents who may needGAMP services.2 Doyne hospital was closed and was privatized for several reasons only after state legislative approval to do so. Anearby non-profit hospital, Froedert Memorial Lutheran Hospital, was opened in 1980 and consequentially the twohospitals shared medical school staff and services which compromised Doyne’s revenue. In 1995 state fundingtowards the General Assistance funds was capped and reduced thus creating a significant financial deficit. Finally,some of the Doyne facilities were considered obsolete and the hospital generally provided higher cost specialtyservices which created one of the highest cost per person in the state. These were all factors surrounding the closingof Milwaukee county’s public hospital in 1995.(Norton & Lipson, Portraits of the safety net: The market, policyenvironment, and safety net response. Assessing the New Federalism: Occasional Paper Number 19; Nov 1998 (pp.31-32)).D-3