JEFFERSON CITY - For 47-year-old Herman Vance, it's the everyday things that pose the biggest challenges -- like cooking a meal, taking a shower and getting dressed.
A diving accident 17 years ago left Vance paralyzed from the neck down. The father of three relies on state-funded personal care attendants to help him with his daily chores. Because of their help, Vance says he has learned how to drive and been able to work.
"I'm paying taxes again," he said. "It feels good just to be able to get out and do something."
But now Vance says he's worried he may lose his personal attendants to state budget cuts. If that happens, he says he would have to go into a nursing home and leave his Viburnum home in southern Missouri.
"A nursing home, the way I look at it, is a prison," he said.
And Vance has good reason to worry, according to Rep. Chuck Graham, D-Columbia.
As the state grapples with budget deficit that the administration projects to be as high as $1 billion, Graham says all programs -- especially new programs -- are at risk.
"If the new programs are on the chopping block, this is one of them," Graham said. "So they've got every right to be scared."
The personal attendant service program, or PAS, is part of the Vocational Rehabilitation program in the state's Education Department. Founded in the early 1990s, PAS helps severely disabled people pay for attendants. In order to qualify, applicants must first be examined by a nurse to determine the amount of assistance needed. If people qualify, the state pays for up to six hours of attendant help per day.
Eligibility for the program is divided into two main areas: Medicaid-eligible and non-Medicaid eligible. Residents who qualify for Medicaid and meet the program requirements are entitled by law to the funding, said Jim Tuscher, vice president for public policy for Paraquad Independent Living Center in St. Louis.
People who don't qualify for Medicaid because they make more than $519 per month can also receive funding, but the state is not required by law to provide it. Because all the funding for this program comes from state funds, it is vulnerable to cuts, Tuscher said.
Last year the state spent $29 million on the two PAS programs and more than 4,200 people received aid. Of that money, $4 million goes toward the non-Medicaid eligible program which serves 165 people.
Gov. Bob Holden's budget plan recommends no cuts to PAS, but PAS advocates express concerns it might end up on the cutting room floor once lawmakers hammer out a budget.
At a recent House Education Appropriations Committee meeting, non-Medicaid eligible PAS recipients -- including Vance -- pleaded that the program be kept.
Elizabeth Moore, who is legally blind, has degenerative bone disease and suffers from bi-polar disorder, said the PAS program is critical for her.
"I just cringe to think what it would be like if that program were cut," she said. "I would become a prisoner in my home."
But when asked by a fellow committee member about the possibility of cuts in PAS, Education Appropriations Committee Chairman Kathlyn Fares said she could not specifically address whether this program is a target for cuts.
"There are a variety of solutions being floated. Some of them will be a reality and others will not," said the St. Louis County Republican.
Fares added the committee members "may need to do some advocacy work with the other 162 House members" to protect certain programs.
As legislators continue to crunch budget numbers and prioritize services, Vance waits to see how their decisions will affect his daily life.
"To me, this is life -- living outside," he said. "But you don't have a life in a nursing home."