RACHEL MARTIN, HOST:
The Republican health care plan the House passed back in May dramatically scales back Medicaid funding. The Senate is wrestling with that issue now, and it's a huge sticking point. So we're taking a look at where Medicaid money actually goes. And as Elly Yu from member station WABE in Atlanta reports, more than half of the Medicaid dollars go to the elderly and people with disabilities.
ELLY YU, BYLINE: Several decades ago, Evan Nodvin might not have been here.
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YU: He's 38 and welcomes me into his Atlanta area apartment.
Hi, are you Evan?
EVAN NODVIN: Hi. Come on in. That's me. Come on in.
YU: His roommate is at work, and Nodvin just got home from his job at a local community fitness center. He works five days a week.
NODVIN: I give out towels and put weights away and make sure people are safe.
YU: Nodvin has Down's Syndrome, a developmental disability. To get to and from work, he gets rides from people who are paid by Medicaid to help him. After he gets home, a counselor helps him with daily chores like grocery shopping, cleaning and cooking.
NODVIN: My favorite thing to cook - on most days, I like to cook turkey patties once a week. And on Thursdays, I make fish. And the other days, I make other good stuff like spaghetti.
YU: Nodvin can live on his own because of these services. They're covered under Medicaid in Georgia, which spends about 6 percent of its Medicaid budget on people with developmental disabilities. When Congress was talking about making big changes to Medicaid in the health care bill in March, Nodvin went to D.C. with a group of advocates to lobby. He read a speech there, which he recites to me in his living room.
NODVIN: I work, live and play in the community. My dream is to continue this healthy and useful life. Thank you.
YU: But the bill that passed the House puts this dream at risk. The Congressional Budget Office estimates the proposed cuts to Medicaid would amount to more than $830 billion over 10 years. And Georgia could take a big hit because the state already spends less on Medicaid per enrollee than most other states. Under the GOP's health care plan, states would be given a fixed number of dollars based on what they've spent in the past. Bill Custer with Georgia State University says if need outpaces funding...
BILL CUSTER: States are going to have to either find the money to maintain the program or shrink the program either by covering fewer services or covering fewer people or both.
YU: That worries Eric Jacobson.
ERIC JACOBSON: Medicaid is the lifeline for people with disabilities.
YU: Jacobson heads the Georgia Council on Developmental Disabilities, a state advocacy group. He says community support services like Nodvin gets are considered optional. States choose to offer them.
JACOBSON: Those are the kinds of services that we hope won't get cut but because of the reduction in funds might be the first on the chopping block.
YU: And he says services are already limited. Jacobson worries budget cuts might mean more people might be forced into institutions.
JACOBSON: The way I look at institutionalization for people with developmental disabilities - it's kind of like sending you to jail for no crime.
YU: Jacobson says there's been a movement to allow people with disabilities to live in their own communities. He says it's about quality of life, and it can save the state a lot of money. Back in his Sandy Springs apartment, Evan Nodvin tabs through his CD collection.
What kind of CDs do you have?
NODVIN: I have Michael Jackson, Beatles - what else?
YU: He's lived on his own for the last 16 years. He wanted to tell Congress he has a job, a girlfriend, an apartment, independence.
NODVIN: I am able to be independent because I get help from my Medicaid waiver in my state of Georgia.
YU: Which is why he and his family will be watching what happens next in Washington, D.C. For NPR News, I'm Elly Yu in Atlanta.
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MARTIN: That story is part of a reporting partnership with NPR WABE and Kaiser Health News.
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