>> Eric: GOOD LUCK WITH YOU IT.

>> Cathy: GOOD TO SEE YOU.

THANK YOU.

>> CATHY: STATE OFFICIALS ARE WAITING FOR NEW RULES ON MEDICAID CUTS FROM THE FEDERAL GOVERNMENT.

THE CHANGES ARE A RESULT OF THE RECONCILIATION BILL THAT PRESIDENT TRUMP SIGNED INTO LAW IN JULY.

REPORTER KAOMI LEE WENT TO COOK COUNTY TO FIND OUT WHAT THIS COULD MEAN FOR ONE NORTHERN COMMUNITY.

>> Kaomi: DAWN DAVISON LIVES ON PASTORAL DOUBLE TRACK LAKE IN GRAND MARAIS, THE VIEW FROM HIS DOCK IS SPECTACULAR, YOU BUT THE 74-YEAR-OLD'S LIFE IS FAR FROM COMFORTABLE.

>> I HAVE A DISEASE CALLED CIPD, WHICH IS CHRONIC INFLAMMATORY DEMILATING, POLYNEUROPATHY.

>> Kaomi: HE SAYS IT'S AN AUAUTOIMMUNE DISEASE WHERE THE LINING OF THE NERVES IS EATEN UP BY HIS OWN BODY'S IMMUNE SYSTEM.

>> IT'S A STRANGE DISEASE, YOU LITERALLY USE THE REFLEXES IN YOUR KNEES.

>> Kaomi: EVEN SIMPLE THINGS LIKE WALKING CAN BE DIFFICULT.

RELIEF IS HE CAN GET TREATMENT AT NEARBY NORTH SHORE HEALTH.

>> I GET IMMUNOGLOB YIN IV HERE AT THE LOCAL HOSPITAL.

THE TREATMENTS TAKE JUST UNDER SEVEN HOURS EACH, IT'S EVERY OTHER WEEK.

>> Kaomi: NOW HE'S WORRIED WILL WHETHER THAT WILL CONTINUE.

CONGRESS PASSED THE RECONCILIATION BILL THIS SUMMER.

SUPPORTERS SAY IT WILL REDUCE MEDICAID SPENDING BY ELIMINATING FRAUD AND ABUSE.

BUT OTHERS ESTIMATE THAT MILLIONS OF PEOPLE WILL LOSE THEIR HEALTH INSURANCE BY 2034, EVEN THOSE WHO QUALIFY.

IN MINNESOTA, STATE OFFICIALS ESTIMATE 140,000 PEOPLE WILL LOSE COVERAGE.

DAVISON ISN'T ON MEDICAID, HE HAS PRIVATE INSURANCE.

STILL, HE FEARS THE CUTS COULD PUT ALL SERVICES AT RISK, INCLUDING HIS TREATMENTS.

>> THEY WOULD HAVE TO CUT BACK ON STAFFING, WHICH WOULD TAKE AWAY SOME PROGRAMS.

>> Kaomi: THE ALTERNATIVE WOULD BE A TWO-1/2-HOUR DRIVE TO DULUTH.

>> IT'S ONE OF THOSE QUESTIONS I THINK A LOT OF PEOPLE ASK, WELL, WHAT KEEPS YOU UP AT NIGHT?

>> Kaomi: THE CEO SAYS SHE'S CONCERNED ABOUT WHAT THE LAW SAYS AND DOESN'T SAY.

ONE THING SHE DOESN'T WANT TO DO IS SCARE THE PUBLIC.

>> THERE'S A LOT IN THERE AND WE JUST DON'T KNOW.

WE HAVE TO BE NIMBLE, WE HAVE TO PAY ATTENTION.

AND WE HAVE TO BE ABLE TO LOOK AT WHAT MIGHT BE HAPPENING, WHAT'S COMING DOWN, AND THEN HOW COULD THAT IMPACT US.

>> Kaomi: NORTH SHORE HEALTH IS A RURAL-BASED CRITICAL ACCESS HOSPITAL WITH 16 BEDS.

IT HAS AN ANNUAL GROSS REVENUE OF $27 MILLION.

MEDICAID ACCOUNTS FOR 15% OF THAT.

THE PROVIDER ALSO HAS HOME CARE, COUNTY AMBULANCE SERVICES, AND 37 NURSING HOME BEDS.

>> WELL, I KNOW THAT 50% OF OUR HOME CARE PATIENTS ARE COVERED BY MEDICAID.

I KNOW THAT 85% OF OUR NURSING HOME RESIDENTS ARE COVERED BY MEDICAID.

YOU KNOW, WHEN I TALKED ABOUT HOME CARE, IF THERE ARE GREAT IMPACTS, IS THAT A SERVICE LINE THAT WE HAVE TO ELIMINATE?

IS SENIOR SERVICES AND AND OUR NURSING HOME A LINE THAT WE HAVE TO ELIMINATE?

>> Kaomi: UNDER FEDERAL POVERTY GUIDELINES, PEOPLE EARNING JUST OVER $15,000 OR LESS A YEAR ARE ELIGIBLE.

BUT MAIN WILL NOW BE SUBJECT TO NEW WORK REQUIREMENTS.

THE NEW LAW REQUIRES PEOPLE UNDER 65 TO WORK 80 HOURS A MONTH OR BE IN SCHOOL PART TIME.

THERE ARE SOME EXCEPTIONS.

BUT FOR MENTALLY ILL PEOPLE, EXPERTS SAY IT WILL BE HARDER TO GET COVERAGE.

>> THE PROBLEM IS, WHEN YOU'RE NEW IN THIS DIAGNOSIS, 24 YEARS OLD, RIGHT, HAVING THEIR FIRST SCOTT COUNTY EPISODE, YOU'RE NOT -- PSYCHOTIC EPISODE, YOU'RE NOT YET DECLARED ISABLED AND IT TAKES A LONG TIME TO BE DECLARED DISABLED BY THE SOCIAL SECURITY ADMINISTRATION.

>> Kaomi: AND THERE WILL BE NEW PAPERWORK, A LOT OF IT.

SHE SAYS CERTIFICATION AND RECERTIFICATION EVERY IX MONTHS COULD TAKE AN AVERAGE OF EIGHT MONTHS TO EVEN GET A RESPONSE.

MUCH OF THE PROCESSING WORK WILL FALL TO COUNTIES, BUT WITH LITTLE ATTACHED FUNDING.

SUE ABDERHOLDEN SAID SHE FEARS MANY ELIGIBLE PEOPLE WILL FALL THROUGH THE CRACKS.

>> AND THEN YOU KIND OF DESTABLIZE THE WHOLE MENTAL HEALTH SYSTEM BY HAVING PEOPLE WHO DON'T HAVE INSURANCE AND NOW YOU HAVE A LOT OF UNCOMPENSATED CARE.

AND YOU HAVE PEOPLE WHO CAN'T ACCESS CARE, WHICH COULD INCREASE, FRANKLY, PEOPLE WHO ARE HOMELESS, ENDING UP IN OUR CRIMINAL JUSTICE SYSTEM.

>> Kaomi: JOHN CONNOLLY IS THE STATE'S MEDICAID IRECTOR.

HE SAYS, MANY PROVISIONS OF THE LAW ARE NOT GOOD FOR THE STATE.

>> SOME PROVIDERS WILL HAVE LOWER PAYMENTS.

THE STATE WILL HAVE MORE LIMITATIONS ON ITS ABILITY TO RAISE REVENUE FOR THE PROGRAM TO, AGAIN, JUST SUPPORT MEDICAID BROADLY AND ALSO SPECIFICALLY PROVIDER PAYMENT.

SO WE'VE BEEN VERY CLEAR, I THINK, FROM THE BEGINNING OF THE DISCUSSION OF THIS LEGISLATION AND WHAT BECAME LAW THAT WE WERE VERY WORRIED ABOUT ITS IMPACTS.

>> Kaomi: LIKE OTHER STATES, DHS IS NOW WAITING FOR THE NEW RULES FOR IMPLEMENTATION FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.

THE LAW APPROPRIATES $200 MILLION NATIONWIDE FOR STATES TO MAKE THE CHANGES.

HOWEVER, DHS ESTIMATES IT WILL COST $165 MILLION IN MINNESOTA ALONE.

NORTH SHORE HEALTH CEO KIMBER RALSTAD SAYS SHE REACHED OUT TO REPUBLICAN CONGRESSMAN PETE STAUBER.

>> I SHARED MY CONCERNS.

I'M THANKED FOR MY CONCERN.

NO REAL RESPONSE, NO.

>> Kaomi: STATES CAN APPLY TO CMS FOR GRANTS FROM A NEWLY ESTABLISHED $50 BILLION RURAL HEALTH FUND.

IN REPLY O "ALMANAC," CONGRESSMAN STAUBER SAID, I SUPPORTED THIS CRITICAL BILL BECAUSE IT DIRECTLY BENEFITS RURAL HEALTHCARE PROVIDERS LIKE NORTH SHORE HEALTH.

THE RULE HEALTH TRANSFORMATION PROGRAM IS THE SINGLE LARGEST INVESTMENT IN RURAL HEALTHCARE IN AMERICAN HISTORY.

MORE SPECIFICALLY, IT ALLOCATES 10 BILLION ANNUALLY FROM 2026 TO 2030 TO THE CENTERS OF MEDICAID SERVICES.

50% OF THIS FUNDING WILL BE EVENLY DISTRIBUTED ACROSS STATES, WHILE THE OTHER ALF IS BASED ON EACH STATE'S RURAL POPULATION AND HE NUMBER OF RURAL FACILITIES.

THIS GUARANTEES MINNESOTA AT LEAST $100 MILLION PER YEAR TO KEEP RURAL HEALTHCARE PROVIDERS OPEN.

>> WE FELT THAT IT WAS JUST AS SAFE AS THE TWIN CITIES IN TERMS OF HEALTHCARE DELIVERY.

>> Kaomi: SAM AND HIS WIFE MOVED THEIR YOUNG FAMILY FROM GRAND MARAIS TO THE TWIN CITIES URING THE PANDEMIC.

NOW HE'S ON THE BOARD OF NORTH SHORE HEALTH.

THE HOSPITAL LOSES MONEY EACH YEAR.

EVEN WITH A $1.8 MILLION PROPERTY TAX LEVY TO MAKE UP FOR SHORTFALLS.

MOVED FROM THE TWIN CITIES TO GRAND MARAIS.

>> AS A HOSPITAL, THERE