Because Medicaid regulations require states to provide nursing home care to receive federal Medicaid money, legislators often have more leeway to cut from home services. Advocates for the elderly and the disabled worry that these cuts are just the beginning, because state ledgers tend to recover more slowly than the national economy.

“The situation is grim, and it’s safe to say that present trends are expected to continue,” said JoAnn Lamphere, the director of state government relations for health and long-term care for AARP. “Nearly every state has proposed cuts of some sort to Medicaid. Some might seem small, but it’s death by a thousand slashes.”

The cuts in Oregon have been particularly painful to people who work with the elderly, because for more than three decades the state has been a leader in rebalancing long-term care away from nursing facilities and toward the home. The cuts here indicate how fragile these services can be against states’ needs to reduce spending.

“I’m seeing in a matter of months 30 years of work go down the drain,” said Donald Bruland, the director of senior and disability services for the Rogue Valley Council of Governments.

The state spends more than half its Medicaid long-term-care dollars on home care and has a separate $13 million program for people who do not qualify for Medicaid; on average, states spend just 25 percent of their long-term-care budgets on home and community-based care.

Bruce Goldberg, director of the Oregon Department of Human Services, said the agency did not have an estimate for how many of the people losing home care would end up in assisted-living facilities or in nursing homes  or, if they did, how the state would pay for them.