Va. Providers Brace for Cuts In Services for Poor, Elderly

Doctors, advocates, service providers and others who work with Virginia's poor, elderly and disabled residents are bracing for what they see as inevitable as the state attempts to close a projected $2.5 billion shortfall in its two-year 2009-10 budget: steep cuts in services for the state's most vulnerable.

Advocates for those who rely on such services said the cuts would be particularly devastating because Virginia spends relatively little on such programs compared with other states, and many have not fully recovered from the last economic downturn.

Social service programs in Maryland and the District are feeling the pinch of budget shortfalls aimed at direct services. In Maryland, state officials helped close their current $350 million budget shortfall by shaving millions to Medicaid providers and eliminating a free breakfast program at 20 schools. Advocates there see more on the horizon. Meanwhile, D.C. Mayor Adrian M. Fenty (D) has suggested cutting $1 million from the Child and Family Services Agency for this fiscal year.

"It's as ugly a budget climate as I've seen in 15 years," said Christopher Bailey, a senior vice president at the Virginia Hospital and Healthcare Association, a Richmond-based lobbying group. "It's hard to see how this is not going to impact real people."

This month, when Gov. Timothy M. Kaine (D) announced a round of deep cuts for the current fiscal year, he focused on administrative jobs and functions. The $87 million in cuts to public health care, child welfare and mental health were generally steered away from services that directly affect patients in nursing homes and group homes for the mentally disabled.

Instead, Kaine laid off 570 state workers, delayed a planned 2 percent pay raise for state employees and decided to leave 800 jobs unfilled.

But for the fiscal year that begins July 1, state officials predict a shortfall that could reach $3 billion, which means that Kaine will have to sharply reduce spending or raise taxes to close the gap.

And because human services -- broadly defined as programs that deliver public health care, child welfare, services for the mentally disabled and mentally ill and services for troubled youths -- make up about one-quarter of state expenditures at $4.7 billion for fiscal 2010, they will probably bear the brunt of the cuts.

"The governor has said that everything is on the table, and that does mean everything," said Kaine spokesman Gordon Hickey. "It's not going to be pretty."

Advocates and analysts are most concerned that Kaine will target Medicaid, the federal-state program for the poor, elderly and disabled. At $3.1 billion for 2010, it is one of the state's largest single payouts, providing much of the aid for nursing homes, hospitals and health care for poor women and children. Virginia ranks 48th in the country in per capita Medicaid spending and has some of the nation's tightest eligibility requirements.

Richmond pediatrician Joseph Boatwright said he dodged a bullet during the first round of cuts when payments that he and other doctors receive to care for the city's poor children were spared.

But he expects that the funding that helps sustain his small practice in one of the city's most beleaguered neighborhoods will not be spared this time around.