Health-care advocates predicted devastating consequences for the elderly — and their caregivers, often adult children — as they awaited a budget proposal from President Trump that's expected to slash billions of dollars in aid to health and social-service programs.

Pennsylvania in particular could be forced to cut services as changes in Medicaid reimbursement create ever-larger deficits in future years, they said.

"I'm especially worried about Pennsylvania's seniors and persons with disabilities who rely on Medicaid to remain in their homes instead of having to be placed in a nursing home," said Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project.

Trump's budget won't be presented to Congress until Tuesday. But leaked details indicate it will follow contours of the health care plan passed by the House. Republicans in the Senate have pledged to create their own bill.

In a Monday briefing, Office of Management and the Budget Director Mick Mulvaney called the budget a "taxpayer-first budget." Trump, he said, is considering both the impact on people who receive federally funded benefits and the taxpayers who pay for them. "We think that balance has been lost," he said.

The budget — a more detailed version of the "skinny budget" that outlined the president's spending priorities — includes already-proposed bumps in defense spending and border security, and deep cuts to agencies like the Environmental Protection Agency and the Department of Housing and Urban Development. It also proposes six weeks of paid family leave for new parents, a cause pressed by Trump's daughter, Ivanka. It works in Trump's proposed tax plan, which cuts the corporate tax rate to 15 percent and reduces the income tax system from seven rates to three.

But details circulating Monday about the cuts in health-care funding stirred alarm.

"These Medicaid cuts will be especially devastating in New Jersey because of its higher cost of living and larger number of people in desperate need of health care. They will also hurt the state's economy," said Ray Castro, director of health policy for New Jersey Policy Perspective, "due to the loss of thousands of jobs, especially in the health industry."

The Republican plan continues Obamacare's Medicaid expansion for low-income people, but under a formula opponents say will significantly reduce funding to the states. It also changes traditional Medicaid, the joint state-federal program providing health coverage for impoverished elderly, children, and disabled people from an entitlement to a more limited benefit.

Advocates said the lower federal reimbursements would force state policymakers to make unpleasant choices, with some of the most likely cuts to home health care.

Gov. Wolf, a Democrat, previously predicted that the plan passed by the House would ultimately force Harrisburg "to either significantly scale back the health-care programs we currently offer to vulnerable residents" or to weigh cuts in areas such as education, infrastructure and the environment.

Pennsylvania House Speaker Mike Turzai (R., Allegheny) said he had not reviewed the budget "but I am sure that there's going to be a balanced approach to the federal budget — I know that they have to, really they have to, have concerns about the deficit."

The proposed budget still has to pass Congress — and portions of Trump's earlier budget outline were met with skepticism from lawmakers. The plan also assumes that Congress will pass Trump's tax policy and the GOP health care plan.

Anti-poverty advocates said they had been alarmed by proposed cuts to the Supplemental Nutrition Assistance Program: documents provided by the OMB said "reforms that tighten eligibility and encourage work" would "generate nearly $193 billion in savings" over 10 years to the program formerly known as food stamps.

About 480,000 people in Philadelphia get SNAP benefits, said Louise Hayes, an attorney at Community Legal Services, which provides assistance to low-income residents. She called the budget proposal "devastating" for low income families.

The budget also includes cuts to the Temporary Assistance for Needy Families program, which provides assistance to families with kids – saving $21 billion over 10 years, the OMB said.

"This is a budget proposal that offers enormous tax cuts to the wealthy and proposes to radically cut back on spending for programs that support low-income Americans," said Stacy Dean, the vice president for food assistance at the Center on Budget and Policy Priorities, a Washington think tank.

Staff writers Jonathan Tamari and Angela Couloumbus contributed to this article, as did Karen Langley of the Harrisburg bureau.

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