OKLAHOMA CITY — For a second year in a row, nursing home caregivers in Oklahoma are trying to shelter some of the state’s most vulnerable residents from a dose of scary news.

Come next year, if lawmakers can’t find a way to increase payments to the state-managed insurance program — Medicaid — thousands of elderly Oklahomans may have to find a new nursing home or risk ending up homeless, according to a bulletin released by the state’s Association of Health Care Providers, which advocates for nursing homes.

Many of those oldest residents have outlived all their relatives or don’t have anyone else to provide a roof over their heads, the group said. They’ve long exhausted all their savings and rely on taxpayers to help shelter them. Now they risk losing access to their daily medical care and their homes in one blow, the group said.

With Oklahoma’s $878 million shortfall, the state’s largest insurer is facing reimbursement rate cuts as high as 25 percent, which could threaten the health of hospitals, physicians, pharmacies and nursing homes, officials say.

Even if lawmakers don’t cut a penny from their budget, provider rates would still face an 8 percent cut because of decreased federal funding coupled with increased health care costs, state Health Care Authority officials announced late last month.

If lawmakers cut the agency’s budget 15 percent to fill the financial gap, those reductions would reach 25 percent, agency officials said.

In all, more than 800,000 Oklahomans — almost 1 in 5 — rely on Medicaid. Among those are about 75 percent of Oklahoma’s nursing home residents — or nearly 16,800. They rely on Medicaid to provide shelter, medical care and food on their tables.

Most of Oklahoma’s nursing homes are already operating on a razor-thin profit margin. Cutting the rate 10 percent would force more than half of the remaining 300 nursing homes to close, said Nico Gomez, president and CEO of the Association of Health Care Providers.

Many of those closures would likely be in rural parts of the state, he said.

Since 2010, nursing homes have seen their share of state and federal funding slashed by about $93 million. Oklahoma’s reimbursement rates for long-term care are now among the lowest in the nation, according to Gomez’s group.

As rate cuts have deepened, so have the number of closures. In 2000, the state boasted 417 nursing homes. During the past 17 years, 116 have closed.

“We’re trying to be careful not to scare residents, but we have a reality that we’re dealing with,” Gomez said.

Gomez said if the elderly have no family left to take them in, they could face homelessness or having to find a nursing home in surrounding states that can better subsidize the care.

“I don’t believe in our moral society we’re going to let somebody become homeless,” he said. “But the reality is people will be forced to make very difficult decisions about where they’re going to receive their care.”

In addition, nearly 17,000 Oklahomans could lose their jobs if the nursing care industry collapses, Gomez’s group notes, costing the state about $495 million in lost wages.

Gregston’s Nursing and Rehab in Marlow, which provides care to about 54 residents, faces losing about $50 to $60 per patient per day if officials make the deepest cuts. Nursing facilities statewide would likely receive at most about $90 to $95 a day per patient to provide 24/7 care, said Jessica Garvin, who manages the home that employees about 90 people.

“No one can live off that,” she said.

And if half of the industry folds, Garvin said she doesn’t know what the lawmakers will do with elderly Oklahomans under the protection of the Adult Protective Services division.

Surviving nursing homes may decide to only accept private-pay patients or there won’t be enough beds left to accommodate the thousands of displaced Oklahomans, she said.

Many nursing home owners currently operate their homes with little or no profit expectation because they feel it is their moral obligation, want to ensure the state’s aging population has a place to live and provide local jobs, she said.

Garvin said it’s going to be heartbreaking situation for owners, employees and residents if the cuts ultimately come to fruition.

“We have residents who never had kids, never got married, so they have no one,” she said. “There’s just nowhere else for them to go, and that’s the hard reality.”

Janelle Stecklein covers the Oklahoma Statehouse for CNHI’s newspapers and websites. Reach her at jstecklein@cnhi.com.