Thousands of Minnesotans with disabilities could lose medical and personal-care services that allow them to stay in their homes and live independently if Congress passes the GOP health bill that heads to a crucial vote in the U.S. House on Thursday.

The bill is the House Republicans' vehicle to repeal the 2010 Affordable Care Act, also known as Obamacare, but its biggest impact would fall on the federal-state Medicaid program, which provides health coverage for the poor, elderly and disabled.

The bill cuts $880 billion in federal funds to the states over 10 years and could reduce enrollment by 24 million people by 2026, according to a recent Congressional Budget Office (CBO) estimate.

In Minnesota, that would mean a $2 billion shortfall shortly after the cuts commence in 2020, with the impact falling disproportionately on people with disabilities and low-income seniors, according to a state analysis released this week.

State officials have not estimated how many of Minnesota's 1.2 million Medical Assistance enrollees would lose coverage, because ultimately the Legislature will decide how to make up for the loss of federal funds. That could mean tightening eligibility, slashing benefits, charging co-payments or reducing provider payment rates.

However, funding formulas written into the bill mean that by 2025, the funding shortfall for people with disabilities will account for more than half of the state's losses caused by new funding caps.

"It is potentially going to have a devastating impact," said Jeffrey Nachbar, a lobbyist with the Roseville-based Minnesota Brain Injury Alliance. "The biggest impact is going to be on services that help keep people independent."

While state officials haven't estimated specific coverage losses, Human Services Commissioner Emily Piper said Wednesday: "We do know that no group of people can be held harmless under this proposal. The cuts are so significant."

The projected cuts could also wind up costing Minnesota more money in the long run, according to Steve Larson, senior policy director for the Arc Minnesota, a disability rights group in St. Paul. Medical Assistance funds services such as home-care and transportation that allow people with disabilities to stay in their homes and live independently; deep cuts to those services could force them into costly institutions such as nursing homes, Larson warned.

Piper concurred: "People with disabilities want to be integrated into the community. It is not only the right thing to do, but ultimately in the long term it helps us save money and control some of the costs."

Congressional Republicans have said the cuts are warranted because Medicaid has grown beyond its original purpose of serving the very poor, and that the proposed caps would come with more flexibility for states to tailor the program to local needs.

In addition, they noted that the CBO has projected that the bill would reduce federal deficits by billions of dollars over the next decade.

64,000 Minnesotans

Delores Flynn, 72, of Roseville said the legislation makes her fear for the future. For the past 16 years, Flynn has relied on Medical Assistance to fund home-care services for her 46-year-old son, Scott Semo, who suffered a severe brain hemorrhage. The family relies on a network of personal care attendants to help Scott eat, bathe, and walk, and to perform a range of complicated tasks, such as suctioning his breathing tube five times a day. Were it not for this regular care, her son could die from an infection or choke on the mucus from his breathing tube, Flynn said.

"There is no humanity in this," Flynn said. "My son has a right to live like everyone else."

Currently, about 64,000 Minnesotans with disabilities and the elderly receive home and community-based services through Medical Assistance, with a median cost per recipient in 2015 of $22,000. The services include help with eating, dressing and transportation to and from jobs.

In recent years, under pressure from disability advocates and the federal courts, Minnesota has made strides in reducing long waits for these services. In some cases, families were waiting months, even years for assistance. Those long waits would "almost certainly return" under the GOP bill, Larson said.

"This would pull the rug out from under the whole community-based system that we, in this state, have built," Larson said.

Complicating matters, federal rules require states like Minnesota to pay for the more expensive forms of care, such as nursing homes, but not for the services that allow people to live at home. With limited funds, Minnesota might be forced to spend most of its money on the required services, with little left over for the more cost-effective home and community based care.

Round-the-clock care

Francis Hall, a nurse and home caregiver from Ironton, Minn., said she worries about the future of her clients.

Hall, 59, cares for August, an 18-year-old with a neurodegenerative disease known as spinocerebellar ataxia, which steadily erodes his muscle coordination. Since he was diagnosed with the disease at age 4, August has gradually lost his ability to walk, eat, bathe and speak, and now requires round-the-clock assistance. August was removed from school because his immune system was too weak. As a child, doctors predicted he would never reach puberty, Hall said.

With even a modest cut in home care services, August would be unable to live at home and likely would face moving into a nursing home, Hall said.

"It's a huge fear," Hall said in an interview this week. "I will do everything in my power to make sure he can stay at home and live with dignity, but there's a real chance he may be forced to live out the rest of his days in a nursing home."