SPRINGFIELD, Mo. –- Gov. Eric Greitens’ budget cuts take effect in Springfield nursing homes Tuesday, Aug. 1. The $251 million cut to Missouri’s budget translates to half a million dollars gone at just one of Springfield’s many nursing homes.

Keith Steenbergen, the administrator for Glendale Gardens Nursing and Rehab, expects to make tough budget calls day by day, with each harder than the previous.

“Today starts a very difficult period for our industry,” Steenbergen said.

It’s the day Gov. Greitens’ budget cuts to Medicaid reimbursement take effect in Springfield, and all across the state. The building received a 3.5 percent cut to Medicaid reimbursement, which amounts to $5.37 gone per resident on Medicaid per day.

“It adds up pretty quick, that’s anyone who receives Medicaid funds,” he said. “So for our facility itself, over a year, it’s getting close to half a million dollars.”

Most administrators, like Paige Wheeler at Life Care Services, agree that nurses should be the last to go.

“We have to try to look at what we can do to not compromise quality of care when our reimbursement rates are consistently less,” Wheeler said.

Steenbergen says it could happen.

“Unfortunately if it continues like it’s going right now, nursing will be affected as well,” he said.

Residents might also have to go. Along with the budget cuts come a harsher point system to determine who’s eligible for Medicaid. The lower your number, the healthier you are.

“Until now, residents needed a 21 on the scale to be admitted into a skilled nursing facility and receive Medicaid services in Missouri. Starting Tuesday, they’ll have to be a 24 to be eligible, and in some cases as high as a 27.        

“A  21, truly, in our scope, is someone who’s needing 24-hour care,” Steenbergen said.

No residents should lose Medicaid services Tuesday, even with a score of 21. That would potentially happen the next time they’re assessed.

“Generally those assessments, I believe, take place on a six month basis,” Wheeler said.

For now, homes will have to choose what they and their residents can live without.

“Administrators are responsible for that,” Steenbergen said.

The Missouri legislature will be back in session in September to potentially override or veto the legislation. Steenbergen told KOLR10 he’s staying in touch with his state representative until then.