“It’s heartbreaking.”

That’s how Sal.Lee Sasser-Williams sums up what cuts to Medicaid will mean to nursing homes and their residents. Sasser-Williams is director of operations for Sasser Enterprises, which owns Andalusia Manor.

In the current fiscal year, the state’s Medicaid budget has been cut approximately $68 million. A proposed state General Fund budget unveiled to the legislature this week would cut the program an additional 30 percent, taking $175 million out of the program.

Funded by federal and state governments, Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States. Every dollar that Alabama spends on Medicaid is matched by approximately $2 in federal spending, which effectively means that Alabama residents dependent upon Medicaid for health care lose $3 in services for every $1 the state cuts.

Dr. Don Williamson, director of the Alabama Department of Public Health and head of a task force to hire a director for the state Medicaid agency, said Wednesday that proposed cuts could literally mean life or death for some patients. Among the health services the agency might not cover as a result of austere cuts next year is dialysis.

“As a doctor I know exactly what happens if you don’t give dialysis to people,” Williamson said. “They are dead in two weeks.”

Williamson said dialysis, like adult pharmacy and out-patient hospice, are not mandated by the program. The agency also is considering lowering doctors’ reimbursements for Medicaid, which could limit access to health care for recipients.

That’s another thing that worries Sasser-Williams, who said that about 60 percent of the residents of Andalusia Manor are Medicaid eligible.

“The doctors’ offices are affected, too,” she said. “Will my residents still be able to see a doctor?”

And if nursing homes and other medical-related facilities are forced to make cuts, that will mean job losses, too, she said.

“It’s going to be hard,” Sasser-Williams said.

“We’re going to be here taking care of people as long as we possible can,” she said. “This is our family.”

And while she feels a tremendous obligation to care for older residents “who took care of us,” she is quick to point out that nursing homes are not just for those in the 80 to 100-year-old age bracket.

“I have a friend who runs a facility in North Alabama and she has four residents under 30,” she said.

If Medicaid isn’t available, and families have to pay for round-the-clock home care, they can expect to pay about $6,000 per month, she said.

As they wait with other health care providers to see what the future holds, she and other members of the management team are looking for small cuts that don’t affect patient care, she said.

“So far, it’s little things,” she said. “Volunteers make a huge difference,” she said. “If they do an activity with residents, it frees our activities director to do other things.”

Medicaid funding has always been an issue, she said.

“But this is mind boggling,” she said. “At this point, it is the scariest I’ve ever seen.”

The Alabama Nursing Home Association on Wednesday issued the following statement about Medicaid: “More than one million Alabamians depend on Medicaid for some type of health care service. Alabama nursing homes are dedicated to working with state lawmakers to preserve access to the vital services our citizens need and deserve. We agree with Dr. Williamson that current budget figures for the next fiscal year will make it virtually impossible to avoid serious cuts in the access to care and the quality of care delivered.”

Gov. Robert Bentley, who is a physician, called the proposed cuts “irresponsible,” but he also has already said he would not support any tax increases or other means of raising revenues.