The State of Washington has no money. Or, more accurately: We have less money, and it costs more to do the same things we did last budget cycle.

Three weeks ago, responding to a state budget shortfall of $4.6 billion, Gov. Chris Gregoire released her all-cuts budget proposal including cuts from current state projects and “activities." The toplines: Health and Human Services is being reduced $1.4 billion; K-12 education loses $2.2 billion, while higher education loses $630.7 million. The remaining $400 million is distributed among natural resources, public safety, government efficiency, and economic development.

These are big numbers. But they're hard to translate into practical terms: The number of people who won't be able to bathe, exercise, or change their bedpans as often as they do now.

So I’ve done some calling. And predictably, this is not a happy story.

I’ve written before about the governor’s cuts to Medicaid subscribers, with special regard to home care hours. Because of the people I met I’m highlighting three sections of the proposed HHS cuts:

Medicaid home care hours:

  • Reduce in-home Medicaid personal care hours to 45,000 individuals. ... Clients will see their hours reduced by 4 to 22 hours each month for assistance with bathing, medication management, dressing and other activities. ($97.5 million)

Food Assistance:

  • Eliminate the State Food Assistance Program, but provide funding in the Department of Agriculture budget to purchase commodities for food banks. ($45.6 million)

And Medicare Part D subsidies:

  • Eliminate the Medicare Part D co-payment subsidy. The state will no longer reimburse qualifying Medicaid clients for co-payments related to Medicare Part D drug purchases. ($16.4 million).

Because it seems an awful lot like dog piling on to the cuts already sustained by people like Sandel DeMastus and Calvino Neidigh-Kumm.

Sandel DeMastus is 64 years old, the president of AARP 414 in Renton, and starting January 1, her home care hours were reduced from 125 hours per month to 53.

For DeMastus, that means that roughly three hours with a professional home care nurse, Monday through Friday. “She cleans, does my clothes. I do most of my cooking. She does the things that I can’t do anymore.”

DeMastus is worried that if her condition worsens, she could be transferred back to a nursing home. DeMastus battled with a particularly devastating form of cancer that required her to have a colostomy, "and after the surgery I couldn’t get around very well so I was in a nursing home. I had a hernia from the surgery and they didn’t want me lifting anything heavy.”

To say the least, it was not a pleasant experience. DeMastus experienced neglect from her nurses, especially because she required assistance to go to the bathroom (she relayed some pretty harrowing stories that we were squeamish about putting in print).

“I never want to go through that again as long as I live. They can take a gun and shoot me as far as I’m concerned. I can’t live like that,” DeMastus said.

Instead, she wants to get by on her own. “I’ve been used to being independent my whole life. Cutting back my home care hours makes that harder."

DeMastus referred me to her friend Calvino Neidigh-Kumm (to friends, he goes by Cal), whose situation is even more drastic than DeMastus’. Starting January 1, he lost 17 hours per month of home care.

At first, that didn’t sound like a lot. But Neidigh-Kumm is completely bedridden. Neidigh-Kumm is diabetic, and has what is referred to as a degenerative joint and muscle disease: a type of condition where the muscles and joints atrophy to the point of shutting down. “Basically, my muscles atrophied, and I am totally immobile. It eventually became impossible to sit up or stand up,” Neidigh-Kumm explained.

And for Neidigh-Kumm, home care is the only way he’s been able to remain in his home. His caregivers deal with everything, starting with basic hygiene issues—“They cook, they clean, they wash things, and they bathe me. They help take care of [my cat] Ricky-Bobby, who is my only companion for nineteen hours a day. They are my arms, my legs, and sometimes, my ears and my eyes.”

The concern here is the same as Demastus’: If Neidigh-Kumm’s condition worsens, or if his home environment is deemed unsuitable, he’ll be transferred to a home. “People say, ‘why don’t you go into a skilled nursing or adult day.’ I value my independence, such as it is,” Neidigh-Kumm says.

But Neidigh-Kumm has lost more than home care hours: starting this year, Neidigh-Kumm will have to copay on his prescriptions for the first time. (Again, the budget proposal by Gregoire “will no longer reimburse qualifying Medicaid clients for co-payments related to Medicare Part D drug purchases." Part D is a prescription drug benefit program created by U.S. Medicare Prescription Drug, Improvement, and Modernization Act in 2003.)

The reality is that because he now has copays, Neidigh-Kumm is going to have to choose among his many prescriptions. “Next month, I have to decide what’s most important. I’m not ordering allergy meds or water pills, because if I buy them, I can’t afford my insulin or needles or test strips.”

And more: in July, Neidigh-Kumm learned that his food assistance had been reduced from $146 to $16 per month. On his own, Neidigh-Kumm says, he can come up with a budget of $50-75 for an entire month’s worth of food.

He’s had to rely on food banks, which Gov. Gregoire has said will receive subsidies from the Department of Agriculture to make up for slashed food assistance.

Unfortunately, the help Neidigh-Kumm can get from food banks doesn’t always help: “Food banks give out mostly starch and carbs. It’s not intentional on their part, but for a diabetic like me, it’s like a death warrant.” Carbohydrates turn to sugar in the body, wreaking havoc with their blood sugar levels and adjusting their insulin needs. And since Neidigh-Kumm is bedridden, he doesn't get exercise that could otherwise burn those carbs.

DeMastus and Neidigh-Kumm are only two examples of the 45,000 people affected by Medicaid home care hour cuts, and the broader looting of health services in Washington States will surely affect thousands more.

I’m hoping to talk to people about the other effects as well: transportation cuts have cost people to lose their jobs because they can’t get to work, and students have lost their financial aid because state higher education spending has been suspended or killed altogether. Gifted students in school districts across the state are losing funding, sticking them back in classrooms they find unchallenging.

The bottom line: Unless the state can find the political will to cut something else or raise some revenue, people like DeMastus and Neidigh-Kumm are just out of luck.
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