For about 280 disabled Mainers, daily life is about to change.

If rules awaiting the final word from the Bureau of Medical Services are adopted, physically disabled adults who depend on the help of personal care assistants to continue living in their own homes may lose a substantial portion of their services. For some, the only alternative may be nursing home care.

Some Democratic state lawmakers have challenged the new rules, which are due to take effect sometime next month, but a spokesman for the Department of Health and Human Services says the changes are needed to bring the programs into compliance with tight state budget constraints and federal guidelines.

Patricia Sylvia, a 51-year-old resident of Rockland, said Thursday that the state intends to cut her weekly personal care hours from 86 hours to 64 hours. Sylvia, whose multiple sclerosis has left her a quadriplegic and confined to a wheelchair, said her aides bathe and feed her as well as run errands, do housework and perform other routine tasks, she said. Losing 22 hours a week would leave her with few choices.

“My only alternative is going to a nursing home,” she said. “It would be a death sentence for me. I figure I have maybe 30 more years of life … but in a nursing home, you’re just there to die.” Nursing home staff are overworked and underpaid, Sylvia maintained. “Everything is done on a time clock,” she said. “If it’s not done by a certain time, it just doesn’t get done.”

Under the provisions of the supplemental budget approved by the Legislature last spring, many Medicaid programs took major funding cuts. The Physically Disabled Home and Community Benefits program and the Consumer-Directed Attendant Services program – which use a mix of state and federal Medicaid funding to provide in-home assistance to disabled adults like Patricia Sylvia – lost $1.4 million in state funds. But because each state Medicaid dollar is matched with about three federal dollars, their total loss was about $4.6 million.

The two programs are administered by the Portland-based nonprofit Alpha One organization, which contracts with the state to provide the services. Eligibility depends on the level of disability, with a detailed assessment conducted to determine the appropriate amount of assistance to provide each client. Some clients receive only a few hours a week, while others use more than 100 hours. Under the proposed new rules, the number of personal care attendant hours an individual could receive would be capped at 64 hours a week.

According to Newell Augur, spokesman for Maine’s Department of Health and Human Services, the programs were created by special permission of the federal Centers for Medicare and Medicaid Services, or CMS. Their purpose is not only to preserve the independence of disabled adults, but also to save Medicaid the considerable cost of institutional care, he said. “[CMS] won’t pay more for [these programs] than they would pay for a nursing home,” Augur said. If the programs cost too much, they could lose funding altogether, he said.

Some Democratic lawmakers are protesting the changes, including Senate Majority Leader Sharon A. Treat of Farmingdale and Sen. Michael Brennan of Portland, who chairs the Legislature’s Health and Human Services Committee. In letters to state health planner Kip Neale, Treat and Brennan argue that a number of proposed changes are substantial enough to constitute a “redesign” of the program, which is expressly prohibited by the language in the supplemental budget. Cutting home-based services will lead inevitably to increased hospital care and nursing home expenses, they argue.

According to a Senate Majority Office spokeswoman, lawmakers approved the supplemental budget with the understanding that cuts would be made in administrative costs and not by decreasing or capping direct services.

“It is unfortunate that a misunderstanding has arisen around this issue,” said Augur. There was extensive discussion about where cuts should be made at the time the budget was passed, he maintained, with a final agreement that savings must be found in both services and administration. Augur rejected the notion that the changes proposed could be considered a redesign of the program. “The changes are about the quality and accountability of the program,” he said.

Auger said hundreds of Mainers with disabilities have been getting assistance from other Medicaid programs that have a 64-hour weekly cap. He added that people like Patricia Sylvia who have high-level needs might be eligible for additional hands-on care as well as homemaker services and other assistance.

“Some people may not get all the services they want, but they will receive the health care services they need,” Augur said.