Parents and guardians are raising concerns about state health department cutbacks going into effect Feb. 1 that will scale back services to more than 2,500 children and adults with developmental disabilities by 15 percent.

The state Developmental Disabilities Division wants to save at least $2.3 million through June 30 with the cuts, which target daycare, respite and skilled nursing care and personal assistant services for the developmentally disabled who qualify for Medicaid.

"All these things are vital to their well-being," Elizabeth Russell, 82, said of the services her two adult children receive. Her 56-year-old son has brain damage from birth and is autistic; her 51-year-old daughter has Down syndrome and also suffers from obsessive compulsive disorder. Both attend an Easter Seals daycare program in 'Ewa and get help from personal aides.

"I'm very concerned" about the prospect of losing services, Russell said recently, adding that she is too frail to take on more care of her children beyond what she already does. "We have been given so little time to figure out what cuts will least affect them."

Health department officials say they had no choice but to make cuts.

"Obviously, it's not something that we wanted to do," said David Fray, chief of the development disabilities division, which was facing a projected budget deficit of about $5 million before the service cuts and other cost-saving measures were taken.

The division has also instituted a hiring freeze and stopped all nonessential travel.

Fray said the division has run over budget for the past five years at least, but has always been able to go to legislators for an emergency appropriation, ranging from $2 million to $7 million. But given the state's tight fiscal picture — and mounting projected deficit — the governor told departments this year not to ask for emergency funds.

Without that stopgap, several departments have been cutting just to make it through the current fiscal year. In November, the Adult Mental Health Services division announced it will slash more than $25 million from its fiscal year 2009 budget (which runs through June 30) by capping case-management hours and cutting contracts.

Fray acknowledged that the cuts in services for the developmentally disabled will be tough for parents and guardians. The cuts could mean that a developmentally disabled adult or child will go to daycare four days a week instead of five. They could result in cutbacks in skilled nursing care for clients, or fewer hours with a personal assistant.

NOTIFIED DEC. 26

Parents and guardians got a letter Dec. 26 alerting them to the 15 percent cut in services a client already receives (as opposed to what a client may be eligible for). The letter also asked parents and guardians for suggestions on where to make the cuts.

And it warned them that more reductions are possible.

"It is my earnest plea for all of us to support one another by facing this challenge together," Fray wrote in the letter. "We understand the hardship this reduction will cause participants and their families."

Fray also said a client can appeal the cuts.

Big Island resident Becky Nakasone said she is increasingly worried about the scaleback plan and how it will affect her two 19-year-old autistic daughters, who are in job training and get personal aides to help them through daily tasks. Anticipating that her daughters will have to stay home alone one day a week because of the cuts, Nakasone is going over some basics with them, including how to call 911.

Nakasone, who just returned to work as a teacher last year after taking care of her twins since they were born, said she doesn't understand why the state can't find another place to cut funds.

"I don't know what we're going to do," she said. "My daughters would have to stay home alone É (or) I may have to quit my job. This is huge."

AGENCIES AFFECTED, TOO

Service providers are also bracing for the cuts.

John Howell, chief executive of Easter Seals Hawai'i, said that of the more than 4,000 adults and kids in the nonprofit's programs for the developmentally disabled, about 600 get services through the state's Medicaid program set to see cutbacks.

He said more than the financial hit on Easter Seals, he is worried about how the service cuts will affect families.

"The families that we work with É are already greatly challenged in a number of ways," he said. "A lot of the people we're working with don't have any alternatives. Right now, the families need us more than ever."

Some 53 agencies statewide provide services through the Home and Community Based Waiver Program that will be cut back by 15 percent. The program, which gets a 55 percent match in federal funds for all state money spent on services, is designed to keep the developmentally disabled out of institutions and in residential settings.

Over the past decade, the number of people enrolled in the program has ballooned, following two lawsuits against the state over services for the developmentally disabled.

In the past six years alone, enrollment has increased by 69 percent — about 1,000 people -to 2,532.

And state and federal expenditures on the program have gone from $17 million in 1998 to about $114 million in this fiscal year. Of that, about $51 million is state funds.

Lou Erteschik, a Hawai'i Disability Rights Center staff lawyer, said the cutbacks in services were almost to be expected, given the tight financial picture the state is facing.

"To some degree, I'm not totally unsympathetic," he said. "Everyone is going through hard times right now." He added that some families will have a tough time making cuts.

"The real bottom line, and where there would be a lawsuit, is if the reduction (in services) were to result in somebody having to become institutionalized," Erteschik said. "People with disabilities have a right to live in the least restrictive environment."