Each morning, Steve Mabbitt helps his longtime friend, roommate and boss, Tammy Jennings, out of bed.
He helps her to the toilet, bathes her, dresses her, feeds her and gives her the pills she needs to treat the cerebral palsy she has had since birth.
At 39, Jennings finally had secured a loan to buy her own house after living with Mabbitt, 50, for 12 years at Freedom House, a federally subsidized apartment complex downtown. Mabbitt, her longtime companion, planned to move with Jennings.
Just days after the pair learned the closing date for their new house in Ashland had been set for later this month, they found out that Gov. Matt Blunt plans significant cuts to Medicaid, the federal health-care assistance program that Jennings relies upon.
Now Jennings wonders whether she will even be able to move into her own home, let alone pay for her medical needs.
“How does our governor expect these groups of people who are already struggling to live to survive without Medicaid coverage?” Jennings asked. “I am in a wheelchair all the time. Without Medicaid coverage, I couldn’t do anything at all without my wheelchair. It is like Gov. Blunt is taking away my legs.”
Such uncertainty is common among Missourians on Medicaid. From a struggling family in Mexico to dozens of disabled residents of Freedom House, many face a choice between quitting work to avoid earning more than the reduced threshold for Medicaid eligibility or keeping their jobs but being unable to afford doctors’ visits and prescription drugs.
“I live under fear. I’m afraid I’ll lose my wheelchair,” said Susan Hailey, 55, who has cerebral palsy. “There are many disabled people in Boone County. The reason we’re here is because Columbia is a wonderful place to live in terms of accessibility.”
Among the proposed cuts in Blunt’s budget is a reduction in Medicaid programs that help the elderly and those with permanent physical disabilities. Under the proposed revisions, an individual such as Jennings will receive only $579 per month and must have no other source of income. Jennings earns $600 a month now and still receives benefits.
Jennings learned of her new dilemma from Services for Independent Living, a nonprofit center that helps people with disabilities live independently.
To remain eligible for Medicaid, she must prove she spends the $21 she earns over the limit on prescriptions or medical equipment and services.
All totaled, nearly 40,000 state residents would lose benefits under the proposed cuts to the program for those with permanent disabilities, according to the Missouri Department of Social Services.
Losing Medicaid would make it impossible for Jennings to afford a new wheelchair, the seven drugs she takes daily or Mabbitt’s help, let alone a $1,000 monthly house payment. Without insurance, her prescriptions would cost $450 each month, she said.
“When somebody needs something to live, like rehab programs, but they can’t afford it, what are they going to do?” Jennings said. “If they need a wheelchair to do everything in their life, but they can’t afford it, they will have to stay in bed all the time.”
Under the proposed cuts, wheelchairs would be considered optional services slated for elimination. Other optional services would include prosthetics, hearing aids and glasses. Adult dental services and podiatry care, crucial for people with diabetes, also would be cut.
Jerry Morris, a Services for Independent Living specialist, teaches clients the skills needed to live independently. Morris, 57, also has cerebral palsy. He said those cuts could change his clients’ lives drastically.
“There will be no way for them to get out of bed or (enjoy) daily living,” he said. “Quality of life will greatly diminish, and many people will have no choice but to go to a nursing home and that will be a meager existence.”
Nursing-home care costs the state an average of $2,316 per person per month, according to Services for Independent Living. Opponents of Blunt’s cuts say those costs would increase the tax burden, not save the state money.
Columbia resident Anthony Flanagan, 36, has been advocating for disability rights for the past 14 years. Paralyzed from the chest down, he lived in a nursing home for a year when he was 20 and wants to avoid being forced into a similar situation.
“I would like to ask these legislators: ‘Do any of you have close relatives with any severe disability — mentally, physically or cognitively — and who is taking care of them?’ ”
Blunt spokesman Spence Jackson said the governor “understands that tough choices have to be made, but he has made it clear that no children are being taken off the Medicaid rolls. In order to ensure that the neediest Missourians receive the care they need, some reductions have to be made in the system.”
Rep. Judy Baker, D-Columbia, predicted the increase in the number of uninsured Missourians would cost Missouri hospitals and doctors $500 million to $600 million.
“And it will affect rural doctors and health centers greatly, and that includes us,” Baker said.
Blunt would reduce Medicaid eligibility for the elderly and people with disabilities from 100 percent of the federal poverty level to the supplemental security income limit of 75 percent for individuals and 82 percent for couples.
For instance, an individual receiving assistance under either of the two programs can now earn up to $9,312. Should Blunt’s proposal pass, however, that person could earn only $6,948.
Blunt’s budget also would cut some financial aid for those with disabilities who earn too much to qualify for Medicaid but receive money for personal assistants.
Jeannie Coley, 32, who has diabetes, is struggling to raise three children, ages 3, 13 and 15, in Mexico, Mo. For 15 years, Coley and her children have been off and on Medicaid, getting assistance for regular checkups for her children and her diabetic supplies.
Coley volunteers for Grass Roots Organizing and works part-time at Brookstone.
“I’m working, but because of the income I get, I will be forced to … quit my job to remain on Medicaid,” Coley said.
Opponents of the cuts say the state would lose tax revenue by forcing people to quit work.
Some Medicaid recipients in Columbia are going back to school to study lobbying and political protest. Last week, 20 area residents attended a political organizing session at Columbia Public Library sponsored by Services for Independent Living.
Marcie Luebbert said she wanted to learn how to speak out to save her home. Under the new eligibility limits, Luebbert, who is 50 and has cerebral palsy, exceeds the cutoff by $45. With the proposed cuts, she expects to have to increase co-payments on medicine and lose the money she has for personal items such as toilet paper and light bulbs.
Her personal-care attendant, Roberta Mahannah, also worries she will be out of a job. When Luebbert’s husband died, Mahannah, 57, began caring for her. She is paid through Personal Assistance Services, which the cuts would eliminate.
“I would still be there to take care of her, but I wouldn’t be able to buy things for her that she needs,” Mahannah said. “She has the niceties because I get paid, and I allow some of my salary to help her with the personal items she can’t afford. But I have medication to buy, too, and I would be devastated to be in a hospital without employment.”
Medicaid has given Bethany Greenfield, 51, the means to pay for an education at Moberly Area Community College, where she is studying speech. Greenfield has athetoid cerebral palsy, characterized by uncontrolled writhing movements. She must be in a wheelchair with a belt and keep one arm and both legs restrained.
Since 2001, Greenfield, has been taking classes in her hometown, a childhood dream no one thought she would achieve. But losing her education is the least of her worries if Medicaid is cut.
“That’s a very minor worry, because I could live without college,” she said. “I can’t live without food or help, wheelchair or medications.”