Proposed service cuts put ‘vulnerable’ at risk

Many could lose assistance

BY JIM ASH and JOHN TORRES, Florida Today

April 23, 2008 

Some wear tubes in their throats. Others depend on a machine for every breath.

Many can't speak, can't walk or turn over in bed. If they have a family, their needs are too overwhelming for them to live at home.

They are some of the "most vulnerable" residents that lawmakers pledged to protect this week as they negotiate more than $4 billion in budget cuts while holding the line on tax increases in an election year.

Under spending plans released so far, advocates warn that thousands of Floridians with cerebral palsy, mental retardation, autism and other crippling conditions could lose state assistance they've come to depend on. Many of them rely on Medicaid, the Florida ICF/DD Community Residential Program and "intermediate care facilities."

"What disappoints me the most is that Florida already ranks 48th in the amount of dollars provided for persons with disabilities,' said Dayle Olson, executive director of the Brevard Achievement Center. The program that employs disabled people and places some into the mainstream workforce. "This has really caused a hardship for us."

Olson described the proposed cuts as a trickle-down effect that is turning into an avalanche.

While no programs have been eliminated, many of them have been trimmed back. He's had to ask staff to do more.

"But you can stretch people only so much," he said. "In 22 years doing this, there has never been a year that compares to what's happening this year."

The center typically gets $4 million in state funding.

David Cooke, president of Bridges, said the Rockledge-based nonprofit organization will work to avoid program cuts or reductions in services.

Bridges, founded in 1956, provides residential, community employment, in-home support and advocacy services to children and adults with disabilities.

"We're always concerned as 85 percent of our funding comes from the state mainly through the Medicaid Waiver Program," Cooke said, adding that he will look at cutting administrative expenses and facility costs before letting the budget crisis affect those in need. "The more services we can put out there in the field, the better it is. That's much more important than what types of buildings we are in."

Cooke also noted that he's been through this before.

"Cuts are nothing new," he said. "It's always a matter of doing more with less."

The developmentally disabled aren't the only vulnerable Floridians who would feel the sting of the budget cuts.

The news got worse last week when a House social services spending chairman announced that the $1.1 billion in cuts to health programs proposed by the House would have to go even deeper, by $82 million.

"As the economy worsens, agencies can do less and people come to us for more," said Olson of the Brevard Achievement Center. "It's a vicious cycle."

Some of the belt-tightening could be lethal, warns Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, which includes 14 teaching, public and children's health care systems.

Carvalho points to a Senate proposal that would eliminate an optional program for 24,000 elderly and severely and permanently disabled Floridians, some of whom are transplant recipients who need $6,000 a month for life-saving anti-rejection drugs.

Others with failing organs need state coverage to help qualify for a transplant in the first place, Carvalho said.

"Some of these people will be in life-threatening situations," Carvalho said.

The House would cut $238 million in Medicaid reimbursements to hospitals, the Senate $148 million. The hospitals are already losing money treating Medicaid recipients, Carvalho said.

"The very best thing that can happen is that the people who will lose eligibility will end up in an emergency room for their care, if they can get it."

Cutting Medicaid programs, either through reimbursement rates or eligibility, doesn't make economic sense, advocates say.

Where the state proposes to wipe $300 million off its ledger, the true cut is closer to $700 million, because of the loss of $400 million in federal money that comes with the program. Carvalho and others argue that the difference will be made up in local communities and the average Floridian who will see health insurance premiums rise to make up for the cuts.

Sen. Don Gaetz, R-Niceville, is fighting proposed cuts to a $60 million program that pays for hospice care for some 46,000 dying patients on Medicaid. Eliminating the hospice option means the state is turning its back on the $50 million in savings attributed to the alternative program for the terminally ill, Gaetz said.

"Dying people aren't going to get better and they're not going to wander off into the woods," Gaetz said. "They're going to end up in acute care hospitals. This is one of the cuts that will immediately, and I mean immediately, create more expense."