Tens of thousands of uninsured, chronically ill, disabled and mentally challenged people would be directly touched by about $1 billion in cuts proposed for many health and social programs.
Hospitals, nursing homes, hospice programs and centers for the developmentally disabled all stand to lose funds as of July 1 under the proposals. The Senate plan would cut all money for adult mental health care, except in crises, and for addiction treatment. The House budget would eliminate many public health clinics.
Legislators say they must take tough steps to fix a $3.8 billion budget hole caused by the recession. Health and social programs cost about $29 billion.
"Faced with the economy we're in, there was absolutely no other choice," said one budget writer, Rep. Marti Coley, R-Marianna.
Here are four people who could feel those cuts acutely.
The wheelchair user makes at best $150 every two weeks as a piece-work employee at Palm Beach Habilitation Center for the developmentally disabled. She calls the job essential to her family and to her identity as a productive person.
The proposed cuts would cost the Lake Worth center $300,000, forcing the layoff of 10 shop staffers, leaders say. That would mean dropping 70 of 260 workers like Manken, who receive counseling, training, life skills and other social service, as well as working five days a week packaging and assembling products for companies that pay the center.
"I love working here," said Manken, 25, who was born with the nervous system defect spina bifida. "It helps me to see all my friends, being around people, getting along with them. I'm good at my job. I'm really fast. I make money. It pays a lot of the bills. Phone bills, gas in the car, groceries. If I didn't come here I would go crazy. If I didn't have this, I don't know what I would do."
Manken's wages help keep her family afloat. Her mother, Patricia, lost her job, forcing the two of them to move in with Manken's sister. They are about to lose the house to foreclosure and are scraping together money for an apartment.
The center staff says that without the job, Manken would be stuck at home and her mother could not work because she would have to care for her daughter. Or, Manken would have to go to a state institution — if there were room.
Two tables away from Manken, Tor Lind stuffs papers into clear plastic envelopes for a car-rental company. He has Down syndrome, with poor eyesight and slurred speech, but he made his desires very clear.
"I'd like to stay here. That's all I want," Lind says. If not? "Sad. Not good."
Lind, 49, lives with his mother, Margaret, who is 93. She says they could get by without his pay. But the center staff said she could not take care of him if he were home all day. Also, without him to help with chores, she probably couldn't continue living on her own. They prop each other up.
If both went to institutions, Medicaid would pay $124,000 a year, compared with $5,000 the state pays the center and $25,000 to other agencies for his care, said center Chief Executive Tina Philips.
The Hab Center is not alone. The proposed cuts would eliminate $750,000 of the $15 million budget at the Ann Storck Center outside Fort Lauderdale. CEO Charlotte Mather-Taylor said she would be forced to lay off employees and possibly end programs for those among the 700 clients who don't live at the center.
Statewide, at least $42 million is proposed to be cut from programs to help the developmentally disabled. That would reduce state spending to 2004 levels, but the state now has 5,000 more people receiving help, according to the Florida Association of Rehabilitation Facilities.
Silverman has struggled for decades with a complex mix of mental illnesses that was finally diagnosed as bipolar disease, depression and mood disorder. At 55, she can't work and must live with family in Delray Beach.
She takes five medications that she and her doctor settled upon after much experimentation. The pills keep her stable, avoiding emotional crises that have sent her to emergency rooms many times.
The proposed cuts could alter state coverage for drugs and end virtually all outpatient mental health services for uninsured adults. Gone would be doctors, counseling and group homes. Under the Senate's $137 million of cuts, the state would cover only crisis treatment.
"I don't want to go back to the way I was. Please don't make that happen to me," Silverman said. "Is this honestly the way to try to cut costs? By driving people crazy, by making their lives miserable?"
Outpatient psychiatric programs stand to lose more than half of their budgets. Archways in Fort Lauderdale may have to close its group homes for 64 people or just shut down, said CEO Andrea Katz.
Some of the patients who lost services would wind up in jail, in mental hospitals or on the streets, said Steven Ronik, CEO at a major program, Henderson Mental Health Center.
Said Silverman: "This will bring us back into the dark ages."