Michael CollinsQ. I live in Northern California and currently use a network of medical providers to keep me healthy, all based locally. I have heard rumors that the state will soon enroll me (whether I want this or not) in a Health Maintenance Organization of its choosing just because I am on Medi-Cal. Is that true, and if so what can I do to prevent it?

My disability causes paralysis and may be progressive. My care has been provided by several personal assistants who were paid through the state In-Home Supportive Services program. I have been getting round-the-clock care that allowed me to move away from my parents’ home to live independently for a while at college. The state health services agency recently cut back my IHSS providers from 24 hours per day to just 13 hours per day. That forced me to drop out of school and move back home so my mother can help supervise my caregivers. Also, in the past, IHSS would pay for things like cooking, but I was recently told that would not be the case if the governor’s proposed budget cuts are accepted. My mother, who works long hours, no longer has time to do that for me.

I want to avoid hospitalization or nursing home care at all costs. I am even willing to consider moving to another state where relatives might be able to help me out, but I hear that similar cuts are taking place across the country. What is behind these cuts and how serious is it going to get? What can I do to help stop these changes from happening?

— Worried and Scared

A. With the economy still struggling and the federal government and most states facing financial crises, unfortunately Health and Human Services programs are usually the easiest cuts for lawmakers to use in trying to balance budgets. Federal Medicare and Medicaid programs have used many s