OAKLAND, Calif. \u2014 With a Starbucks coffee cup in her hand and a half gallon of milk under her arm, Florence Owens let herself into Carol Crooks\u2019 apartment on a Monday morning, announced herself with a cheery \u201chello,\u201d walked through the book-filled living room, and got to work in the kitchen.<\/p>\n
\u201cI see you went popcorn-crazy this weekend,\u201d Owens teased as she brushed kernels off the counter into a garbage can. Crooks, who relies on a walker or wheelchair, can steady herself against the counter while waiting for corn to pop. But back, knee, and foot problems have left the 77-year-old silver-haired retired teacher incapable of most food preparation and cleanup.<\/p>\n
Like nearly 800,000 other Californians, Crooks depends on aides from In-Home Supportive Services, a program funded through Medi-Cal, California\u2019s version of Medicaid. Owens has worked as Crooks\u2019 aide for almost three years. In addition to cooking and cleaning, she helps her shower, shops for groceries, drives her to medical appointments, and runs other errands.<\/p>\n
For more than 50 years, low-income seniors and disabled people have been able to stay in their California homes \u2014 and out of more costly nursing facilities<\/a> \u2014 with help from government-paid aides. But in their latest bid to renew President Donald Trump\u2019s tax cuts, House Republicans released a plan on May 11 that would axe about $625 billion<\/a> over 10 years from Medicaid<\/a>, and could threaten funding for Owens and other In-Home Supportive Services workers.<\/p>\n While a major structural overhaul of Medicaid appears increasingly unlikely, Republicans continue to wrestle<\/a> with how to cut the budget. Several proposals would disproportionately target California, according to Larry Levitt, KFF\u2019s executive vice president for health policy. Federal cuts, coupled with the state\u2019s existing budget woes, could inflict a \u201cdouble whammy for California and trigger reductions in Medi-Cal and other state programs,\u201d he said. KFF is a health information nonprofit that includes KFF Health News.<\/p>\n Although federal law compels states to offer certain services, such as nursing home care, they\u2019re under no obligation<\/a> to cover home-based care for low-income seniors and disabled people like Crooks, leaving the in-home services program particularly vulnerable<\/a> to cuts, said Amber Christ, managing director of health advocacy for the nonprofit legal group Justice in Aging.<\/p>\n In the wake of the Great Recession, California made a series of funding cuts to in-home support aides. Lawsuits temporarily stopped the bulk of the cuts, but a court settlement<\/a> led to an 8% reduction in 2013 and an additional 7% cut in 2014.<\/p>\n Further reducing these services would inevitably force more people to move into nursing homes, Christ said. \u201cIt would be an enormous setback from the progress we have made to provide care in the home and the community to support older adults and their families,\u201d she said. \u201cI think it will cost people\u2019s lives.\u201d<\/p>\n Owens supports herself and her teenage son with what she earns working 136 hours a month for Crooks. She\u2019s confident she can figure out another way to make a living, so she\u2019s less worried about losing her $20-an-hour income than she is about Crooks\u2019 losing her independence.<\/p>\n \u201cI absolutely adore Carol,\u201d said Owens, 36, as she chopped onions for Crooks\u2019 breakfast. \u201cI look at her as a grandma.\u201d<\/p>\n From a makeshift desk where she\u2019d been scrolling through emails, Crooks affectionately eyed Owens and announced, \u201cYou\u2019re adopted.\u201d<\/p>\n In his May 14 budget proposal<\/a>, Gov. Gavin Newsom trimmed funding for In-Home Supportive Services, most notably by putting weekly caps of 50 hours on provider overtime and travel, reinstating an asset limit, and eliminating the service for immigrant adults without legal status who aren\u2019t already enrolled.<\/p>\n The proposed changes are unlikely to affect Crooks, but if congressional Republicans slash Medicaid spending, the Democratic governor warned May 14<\/a>, California could not afford to backfill all the proposed federal cuts. Almost two-thirds of the $28.3 billion California has budgeted for the in-home support program is supposed to come from endangered federal Medicaid funding. The state legislature must pass a balanced budget by June 15, regardless of the status of federal funding negotiations.<\/p>\n Owens delivered an omelet and a mug of coffee to Crooks. \u201cI know these are politicians,\u201d she said, \u201cbut they still have to understand the elders are our roots. And I\u2019m sure they have to have some kind of heart.\u201d<\/p>\n Crooks is<\/a> less certain, more anxious. \u201cIf they start messing with my programs,\u201d she said, \u201cI\u2019m in trouble.\u201d<\/p>\n Burt Conell, 64, is also worried. A paraplegic, he\u2019s been confined to a wheelchair for 30 years, since, despondent after his girlfriend left him, he jumped in front of a train. He relies on in-home aides to help him bathe and clean his San Francisco apartment.<\/p>\n When he heard the government might cut his funding, he imagined being unable to shower, getting rashes and bedsores, and having to move into a nursing home. Again, he contemplated suicide.<\/p>\n \u201cIt made me feel like I was using so much resources that I shouldn\u2019t exist,\u201d he said.<\/p>\n At an April meeting<\/a> of San Francisco\u2019s Disability and Aging Services Commission, Commissioner Sascha Bittner<\/a> asked about the fate of In-Home Supportive Services, on which she relies. \u201cWe don\u2019t know what\u2019s going to happen,\u201d Executive Director Kelly Dearman replied, adding that Medicaid cuts could result in a decrease in the number of hours San Francisco beneficiaries, like Conell and Bittner, who is quadriplegic with a speech disability, receive. \u201cIt\u2019ll be dire,\u201d Dearman concluded.<\/p>\n Every day, around 30 people contact California Advocates for Nursing Home Reform seeking advice on how to get in-home help, said Maura Gibney, the nonprofit\u2019s executive director. These days, the group frequently hears from recipients who have achieved a semblance of normalcy in the aftermath of a major setback, such as a stroke, but fear they\u2019ll lose their benefits, she said.<\/p>\n \u201cIt\u2019s hard to really give people reassurance at this time because I don\u2019t think any of us know what will happen,\u201d Gibney said.<\/p>\n Lately, when she hears from people looking for in-home help for the first time, Gibney wonders if their efforts will end up being pointless. \u201cIt feels a little bit like trying to show somebody how to get into the building as the top floor is on fire,\u201d she said.<\/p>\n Paul Dunaway, who directs Sonoma County\u2019s Adult and Aging Division, described the dearth of information he and his staff have to offer older and disabled people about future services as \u201canxiety-provoking.\u201d<\/p>\n \u201cThere\u2019s a lot of chaos happening and not much to really grab onto yet about the funding on the federal level,\u201d Dunaway said.<\/p>\n Uncertainty and fear about service cuts, coupled with weaning off pain medicine from a back surgery, left Crooks \u2014 who retired from teaching after being diagnosed with bipolar disorder \u2014 unable to sleep, she said, and she spiraled into her first manic episode in more than a decade.<\/p>\n Owens was sweeping the living room but stopped to listen as Crooks talked about being tired, worried, and feeling out of control. \u201cI told her, \u2018Regardless, I\u2019m gonna always be here for you, no matter what,\u2019\u201d Owens said.<\/p>\n Crooks, wearing a T-shirt picturing the Statue of Liberty with her hands covering her face, nodded. \u201cIt helped a lot,\u201d she said.<\/p>\n Nonetheless, without an in-home aide, Crooks said, she would have no choice but to move into a nursing home \u2014 a fate she cannot bear to consider.<\/p>\n \u201cIt wouldn\u2019t be a home,\u201d she said. \u201cIt\u2019s where people go to die.\u201d<\/p>\n This article was produced by <\/em>KFF Health News<\/em><\/a>, which publishes <\/em>California Healthline<\/em><\/a>, an editorially independent service of the <\/em>California Health Care Foundation<\/em><\/a>.<\/em>\u00a0<\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. 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