SALT LAKE CITY — Base budget cuts of $23.5 million, or about 5 percent, in state public health and human services programs received subcommittee approval Monday, despite an afternoon of testimony from managers that thousands of homebound seniors and low-income Utahns will be hurt.

County and regional health departments are maxed out both by increasing need and the use of volunteers to supplement programs for the needy, including Meals on Wheels services to the aged, members of the Health and Human Services Appropriations Subcommittee were told.

Scott McBeth, director of the Mountainlands Area Agency on Aging in Utah County, said there are many seniors who are able to stay out of area group care centers because of meals programs, which some counties already have reduced from five days a week to four or three days.

Many are people who had their lives completely changed by World War II and whose sacrifices benefit current generations. Preserving state funding for senior services is the right thing to do, both morally and financially, he said.

Subcommittee member Sen. Pat Jones, D-Holladay, said she has been talking extensively with seniors, those who are still living at home and those in care centers. Meals are often the only chance people "who often feel they've been put out to pasture" have to interact with others about their lives, Jones said. She said many homebound seniors don't feel like cooking for themselves, that the Meals on Wheels delivery is the only meal they have in a day and that those who deliver it are the only people they ever see.

The subcommittee also endorsed cuts in various Medicaid programs, although funding decisions could be made as the session continues to backfill some programs by the time the final state budget is adopted next month.

More state dollars are spent on Medicaid than on any other state budget item other than public schools and higher education. Medicaid in Utah's overall health care spending covers about 10 percent of all health care bills, including one-third of pregnancies and 60 percent of long-term care charges.

Health care coverage could be cut for low-income Utahns with disabilities who have Medicaid insurance, including seriously ill children, women suffering from breast and cervical cancer and children transitioning out of the foster care system.

The health department has asked for funding putbacks for dental care for pregnant women with children, citing the added health problems for mother and child that occur without that basic preventative care.

Medicaid insurance will adopt cost-containment steps recommended in a recent state audit of the joint state and federal plan, executives told the subcommittee, but the level of cuts nearly dictate that coverage will have to be dropped or people who need it not enrolled if the cuts are implemented.

Low-income advocates say that reducing Utah's eligibility requirements to the most meager incomes will come at the expense of health care for the neediest. Reducing the income eligibility threshold for people with disabilities and seniors to 75 percent of the poverty level — $6,075 annual income — comes in addition to previous recommendations to eliminate dental and vision services to pregnant women over age 21, as well as reducing by a third reimbursement rates to hospitals and eliminating coverage for young adults aging out of state foster care.

"Kicking the sickest and most in need off of Medicaid is no way to balance the state budget," said Lincoln Nehring, an attorney and Medicaid/Medicare policy analyst with the Utah Health Policy Project. "These Utahns simply do not have the resources to pay for care on their own."

Dr. Joseph Jarvis, a local physician and health care reform activist leading a grass-roots effort to put reform on the November ballot, said earlier budget cuts already have eliminated virtually all possible benefits not absolutely mandated by federal rules, and Utah's Medicaid program already limits benefits to the smallest possible segment of the citizenry allowed by federal regulation.

One option lawmakers haven't considered is looking beyond the line-item method for organizing budgets, Jarvis said, noting that the way budgets are built hides millions statewide and trillions nationally spent on unnecessary overhead and waste within the health care system at large.