“I don’t know what they’re trying to do to elderly people.” That is what a friend, on the verge of her 87th birthday, says about elder service program cuts that she has heard talk of recently.

For the past six months or so, she has been enrolled in Prescription Advantage, the state’s drug program for people over 65 and low-income people under that age with disabilities. She finds that it provides excellent coverage, regards herself as lucky to be on it, and hopes the program will continue.

Some human service advocates are worried, however, about what has already happened to the program and what is likely to happen in the future. Already, as of February 1, the state office of elder affairs has cut off any further applications for membership. And Governor Romney’s budget, if enacted, will require increases in costs for current members. As of now, those increases are planned for April 1.

For the last two years, however, Massachusetts residents have enjoyed the benefits of “Prescription Advantage,” getting badly needed help with the costs of drugs. Our state has thus stepped out in front of the nation in doing something practical about the health needs of some of its most vulnerable citizens

But the new elder affairs secretary, Jennifer Davis Carey, has pronounced Prescription Advantage to be “unsustainable” because of insufficient money given her in the new budget. And yet she has cut off new enrollments despite expert opinion that larger enrollments are the key to making the program affordable for the state.

If the reductions kick in, Massachusetts will run the risk of surrendering its position as a leader in helping older citizens to meet their prescription drug needs. The only state plan in the whole nation to offer prescription drug coverage to all citizens over age 65 will have lost much of its clout.

The amounts required in premiums, co-payments, and deductibles will take the advantage away from the prescription program. These higher costs may cause many moderate-income elders to drop out.

It’s no use waiting till politicians in Washington take care of those of us over 65 and those younger but disabled. The pols of both parties have frittered away opportunities to include a prescription drug package under Medicare. Last week the president was again talking about taking action but talk will not do it.

With huge amounts of money promised or spent on tax cuts, military forces sent to the Middle East, and even some 30 billion for Turkey, there will be nothing left for Medicare improvements. No time soon, it appears, will relief come from Washington.

Many of us, perhaps, will have to see if we can buy drugs in Canada, as residents of some other states have been doing. Perhaps the Commonwealth will have to charter buses for us to travel to Montreal and other points north.

Other reasons for concern have emerged from the new governor’s budget priorities. What is happening to the drug program is of a piece with cutbacks in vital services to elders in need. The home care program for which Massachusetts decades ago established a nationwide reputation finds itself at its lowest ebb since the 1980s. Advocates such as Al Norman of Mass Home Care report that 2000 fewer elders are receiving services than 14 months ago. Adequate funding is being nibbled away.

These advocates worry about the shrinking of home care, in part, because it may drive many more people into nursing homes. This is likely to have the self-defeating effect of costing the state more money by driving up the costs paid through Medicaid.

It also seems that the state office of elder affairs is  losing much of its clout. Again, Massachusetts was the leader back in the 1970s as one of the first states to establish a cabinet level office to serve the interests of older people. Through the intervening years, it has functioned remarkably well, giving organized elders leverage to ensure that their needs are met by state government.

Last week when Governor Romney announced his budget plans, it became clear how far the elder affairs office has fallen in his hierarchy. Instead of reporting directly to him, he wants it to answer to the secretary of health and human services who will control the money and determine budget priorities.

Al Norman characterizes the elder affairs structure that will be left as only a “shell organization.” It does seem a shame that what so many leaders such as Frank Manning and Elsie Frank fought for on behalf of older citizens may now be sacrificed in the name of reorganization.

Yes, Massachusetts, like all the other states that face severe budget shortfalls, must make changes. The challenge is to make changes that will serve the greatest good and ensure the well-being of those who are most needy.

Richard Griffin