The General Assembly has proposed slashing $2.4 billion from the state's Department of Health and Human Services budget over the next two years in an attempt to close a $4 billion budget gap.
In all, 717 state jobs in human services would be cut, and programs like N.C. Health Choice, the children's health insurance plan for low-income families, would be slashed.
ON THE WEB: Read The Full Budget Proposal
State DHHS Secretary Lanier Cansler said the cuts, if left as they are in the House version of the proposed budget, "would change the way we do things."
"If I eliminated every employee I have statewide, I'd only be halfway to the cut target," Cansler said.
The Department of Health and Human Services accounts for 23 percent of the overall state budget, but it is being asked to take 50 percent of the cuts, said Elaine Mejia, director of the Budget & Tax Center of the N.C. Justice Center.
The cuts would take more than $3 billion out of the North Carolina economy, said Jeff Shaw, spokesman for the N.C. Justice Center. They also would leave tens of millions of dollars in federal matching funds in Washington, because for every dollar the state spends on Medicaid, the federal government sends $3 in matching funds.
Meanwhile, human services agencies are struggling to stay afloat even before any cuts are finalized.
"We've already closed two senior dining sites," said Wendy Marsh, director of the Buncombe County Council on Aging. "We have 300 people on the waiting list for in-home aid."
Without in-home aid, many senior citizens could need nursing home care, which costs more than three times as much as caring for someone at home.
Independent living money, which helps people with disabilities stay in their homes, also faces a cut of $1.5 million, which could send more people to adult care and nursing homes.
Liz Huesemann, director of the Irene Wortham Center, said the cuts in physical and occupational therapy will cause the health of people with developmental and other disabilities to worsen.
"I'm afraid the cuts will cause some agencies to close," she said.
Huesemann and other advocates say families could be left without help, and there are not enough beds in state institutions for the people who will need them.
Mental health care in jeopardy
The budget for the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services would face deep cuts. The division's staff would be reduced by 350. Fifty beds and 102 hospital jobs at Broughton and Cherry state psychiatric hospitals would be eliminated. Money to service providers, many of whom are struggling already, would be reduced by $17 million.
The state also would try to make the local management agencies spend their fund balances - money the agencies received before mental health reform when the local agencies provided services and case management.
"It's not their money to take," said Arthur Carder, the CEO of Western Highlands Network, the management agency for eight counties in Western North Carolina. "It didn't come from them. ... The state can make its decision, but they won't get a check."
The proposed cuts, including capping N.C. Health Choice, come as a new study finds that 1.7 million people in North Carolina are without health insurance, or about 21 percent of the population - an increase of 22 percent in the last two years.
Nationally, the increase was 13 percent, to 52 million people without health insurance. Since these numbers are from January, advocates believe the true number is even higher.
"We're going to see an increase in people in jails and emergency rooms because they can't get care," said Adam Linker of the N.C. Justice Center. "Everything in health and human services is being cut into the bone. And you're essentially making these immoral cuts because a few (politicians) scream about not raising revenues."
Conditions aren't the same as last fall, when people campaigned on a promise not to raise taxes, Carder said.
"They have to look at current conditions," he said. "You can't abandon people because you don't want to raise taxes."
Community Care threatened
The cuts threaten the state's award-winning Community Care program, which provides people and families on Medicaid with coordinated care. The program is a national model, but if the cuts to Medicaid reimbursement rates are as deep as proposed, few physicians will be willing to take on these patients, Linker said.
The result is that the state's businesses could lose up to $8.34 billion in lost productivity, according to a study by the Center for American Progress.
In addition, with the cuts in Community Care, costs to deal with unmanaged chronic illness will skyrocket, Linker predicts.
"You're balancing the budget on the backs of your most vulnerable people," Shaw said. "People think human services are a luxury, but they're not."
The Rev. John H. Grant, pastor of Mt. Zion Missionary Baptist Church on Eagle Street, in Asheville, believes the cuts are immoral. He already sees suffering in the community, he said.
"I know they have to make some hard choices, but the ones who get the smallest cuts are the ones with the biggest lobbying budgets. Ordinary people don't have the money to buy lobbying power."
But, Grant said, people can have a say.
"I try to tell people, yes, your voice will make a difference if you raise it," he said.