ROBERT SIEGEL, HOST:
President Trump and Republicans in Congress are proposing huge cuts to Medicaid, which is best known as the government health care program for the poor. Actually, it's much more than doctor and hospital care. Medicaid spends a substantial chunk of its money on support services for the elderly, the disabled and for people with chronic illnesses.
NPR's Alison Kodjak spent time with a family in Wisconsin that has received benefits for both an elderly member and a child.
ALISON KODJAK, BYLINE: Nancy and Dan Gapinski are standing at the end of their driveway in Glendale, Wis., waiting for their son Ben to get off the school bus.
NANCY GAPINSKI: How was your day?
BEN GAPINSKI: It was good. What I did today - I had to do two star math tests.
KODJAK: It's a remarkable moment. When he was a toddler, Ben was diagnosed with an autism spectrum disorder.
N. GAPINSKI: He used to not really have any kind of conversations with us. He did a lot of echoing things that we said and scripting from movies. And kids didn't really know how to respond to him then.
KODJAK: Ben needed help. So the Gapinskis found a therapist to work with him for 24 hours a week at a cost of more than $50,000 a year. Dan's workplace insurance paid for some of it, but Ben's disability was severe enough that he was eligible for Wisconsin's long-term care program for children which is paid for with Medicaid dollars. After three years of intense therapy, Ben is now able to go to school and work on grade level in math and English.
DAN GAPINSKI: OK, Ben, let's pack it up.
BEN: Let's pack it up, pack it up...
D. GAPINSKI: Pack it up.
BEN: ...Pack it up, pack it up.
KODJAK: And on this night, he's going on a sleepover to his aunt's house. Ben's not the only one in this family that's used Medicaid services. His grandmother Evelyn is also a beneficiary. He gives her a hug as he leaves for his overnight.
BEN: Oh, I'll see you later.
EVELYN BENJAMIN: Give my love to Aunt Susie, OK?
BEN: Yeah, I'll give your heart to Aunt Susie.
BENJAMIN: OK, you do that.
KODJAK: Evelyn's 84 and has had a few falls and gets around with a walker. She also has heart disease and some breathing issues.
N. GAPINSKI: So mom needs help with things like personal care, cooking, medication. She needs some additional support at medical appointments and scheduling all those and handling some of the paperwork that comes in.
KODJAK: Medicaid helps pay for her 12 prescription medications, and through a program called IRIS, it pays for in-home care. She can go through an agency or hire a friend or relative.
N. GAPINSKI: I got you the Sleepytime.
BENJAMIN: Oh, I like Sleepytime.
KODJAK: Evelyn chose to hire her daughter, so Nancy Gapinski gave up her full-time career and now earns 11.50 an hour for 20 hours a week caring for her mother. Medicaid pays for it, and it's a bargain. If Evelyn went through an agency, the cost would be more than double. And of course the cost of a nursing home is even more. But advocates say these services are at risk under Trump's proposed budget because they're considered optional. Medicaid is required to pay for hospital and nursing home care but not in-home therapy and support.
BENJAMIN: They take very good care of me. I'm very lucky that I'm one that can stay in my home and know that I'm cared for.
KODJAK: More than 80 percent of Medicaid's money goes to care for people who are elderly or disabled or for children. And the money spent on those optional services have allowed the Gapinskis to stay together in their home in this middle-class neighborhood in a suburb north of Milwaukee. But Medicaid's budget has been growing in recent years, and it now makes up almost 10 percent of federal spending. That's why it's the No. 1 target in President Trump's proposed budget. Some estimates suggest it could be cut by more than a trillion dollars over 10 years, so Nancy Gapinski's worried. Today, Ben no longer uses Medicaid services, but he may need them again in the future.
N. GAPINSKI: I don't know what Ben will need in his lifetime. I mean we're certainly hopeful. I don't know. Will Ben need some additional supports to be able to maintain a job? Right now those are available with Medicaid services.
KODJAK: Alison Kodjak, NPR News, Glendale, Wis.
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