MICHELE NORRIS, host:

It's ALL THINGS CONSIDERED from NPR News. I'm Michele Norris.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

Social services for the poor and the disadvantaged are being slashed across the country, that's as states try desperately to shore up growing budget deficits. Many of the cuts have already been made, affecting tens of thousands of people. And many more cuts are in the works, as NPR's Pam Fessler reports.

PAM FESSLER: Until last month, the Dunn(ph) family in Phoenix, Arizona, received state help to pay medical bills for their daughter, Jessica, who has cerebral palsy. Now, the Dunns have to shell out about $1,000 more a month for medications and doctors' visits.

Ms. PAM DUNN: Swallow.

FESSLER: Jessica's mother, Pam, gives her 14-year-old daughter one of the many medications she takes each day. She's not sure what to do now.

Ms. DUNN: She'll get them, but I'll have to figure out how to come up with the finances for them. I mean, I can't not let her get her medical if her medical keeps her comfortable and keeps her able to function in our world.

FESSLER: Jessica is among more than 1,100 children with chronic or disabling conditions who were dropped from the State Children's Rehabilitative Services program. Its one step Arizona has taken to reduce a $1.6 billion budget gap, along with reducing funds for food banks, community health centers and home health care for the elderly. And Arizona's Governor Jan Brewer has asked state agencies to find another $1 billion in cuts for next year.

(Soundbite of machinery)

FESSLER: Jeffrey Mende(ph) is having his teeth cleaned at the University of Southern California's dental clinic in Los Angeles. He's one of three million California adults who will have their dental benefits eliminated July 1 under the state Medicaid program.

Mr. JEFFREY MENDE: That's the end of my teeth work.

FESSLER: Mende says his visits here will have to stop if California tries to close its multi-billion dollar budget gap. He's HIV positive and worries about the impact on his health.

Mr. MENDE: I'm a disabled individual on a limited income and I don't have the monies to continue with my dental care.

FESSLER: Similar cuts are being felt across the country. In Rhode Island, about a thousand low-income adults have been dropped from the state health insurance program.

Linda Katz of the Poverty Institute at Rhode Island College says another 3,000 needy families are losing income assistance, and many have no job prospects.

Ms. LINDA KATZ (Policy Director, Poverty Institute): So we're very fearful that these are parents who will show up in the homeless shelters, which are already overwhelmed. They're people that will really swamp the social safety net in the community.

Mr. NICHOLAS JOHNSON (Director of State Fiscal Project, Center for Budget and Policy Priorities): We're seeing a lot of social services cuts because, to a large extent, that's what states do.

FESSLER: Nicholas Johnson is director of the State Fiscal Project at the Center for Budget and Policy Priorities in Washington. He says a lot of states spending is about health care, education and human services, so officials have few options for cuts, as state revenues decline.

Mr. JOHNSON: These are very large budget gaps states are facing, $350 billion or so over two and a half years that states have to address. It's hard for states to do that simply by cutting things that people won't notice.

FESSLER: He thinks states could do more to raise revenues, but many are already increasing taxes and fees to deal with the current crisis.

The only relief, it seems, is the federal economic stimulus package. Johnson estimates that stimulus funds should cover about 40 percent of the budget shortfall states would otherwise face. Arizona is using stimulus funds to reverse cuts it made in child care subsidies. Virginia, Maryland, Florida and Iowa are relying on the federal aid to avoid trimming education and health care.

Still, social service providers know they're now in an era of drastic cutbacks, and they worry about the long-term impact.

Joel Potts is director of the Ohio Job and Family Services Directors' Association. He says Ohio counties are already finding it much tougher to investigate child abuse cases. And he says the laying off of thousands of government workers has left too few to help all the needy people showing up at social service agencies.

Mr. JOEL POTTS (Director, Ohio Job and Family Services Directors' Association): When they can't get assistance through us, they then have to turn to other avenues to be able to provide that assistance for their families. They're showing up in the emergency room and costing taxpayers far more money than it would have cost had we been able to get them simply onto the Medicaid program.

FESSLER: And emergency room bills might not be the worst of it. Potts says the failure to help people now with a range of social services could put much more strain on state budgets right around the corner.

Pam Fessler, NPR News.

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