It has been said that the true test of a civilization is how it treats it most vulnerable members. By that measure, Oklahoma does not score highly.

Chronic under-investment in our health care system has left the state's skilled nursing facilities, which care for the vulnerable, elderly and very sick, with some of the lowest funding rates in the nation. Over $92 million in annual cuts have forced more than 100 (roughly one-quarter) of Oklahoma nursing facilities to close their doors in the past 10 years. The profession has long been facing a rolling crisis, as lack of funds make it difficult to recruit qualified and committed staff, maintain high-quality facilities, or even stay financially solvent.

With state government now facing a $900 million budget shortfall, the situation may get considerably worse. Oklahoma agencies have been asked to plan for a 14.5 percent cut in their appropriated budgets, which would most likely trigger a reduction of at least 25 percent to Medicaid rates.

That level of cut, should it come to pass, represents a virtual apocalypse for skilled nursing facilities in Oklahoma. Very few homes, if any, will be able keep their doors open. Their residents, many of whom require around-the-clock medical care, will lose that care and be left without a roof over their head.

That means there are almost 20,000 nursing home residents in the twilight of their lives who are terrified.

Some of them have families to return to. Many of them do not, and would be ostensibly homeless.

Imagine the fear that a sick, elderly resident is feeling today, knowing they may lose their medical care and their home. Consider the frustration and angst of a son or daughter who is considering how to care for a frail, elderly parent by themselves.

Our optimistic legislators tell us not to worry. They have a laundry list of potential policy measures at their disposal to avoid deep cuts: an increase in the cigarette tax; increases in other taxes and fees; the emptying of revolving funds or the rainy day account; or other long-established legislative practices of making money appear in time to fill a budget hole.

I hope they're right. I hope they understand that any cut to the state's Medicaid rate would be unsustainable for dozens of skilled nursing facilities and could lead to widespread closures.

However, I also want them to understand that a budget process that forces a sick, elderly man or woman to contemplate being homeless is cruel and immoral. Whether or not the state is able to avoid further cuts to skilled nursing facilities, we have already spent the early months of this year dragging residents and their families through the emotional wringer. Real damage has been done to real people.

Any lawmaker with a conscience is doing what he or she can to prevent deep cuts to core government services. Now we need lawmakers with vision, bravery and leadership to find permanent solutions for government sustainability and an escape from an inhumane budget-by-crisis process that has regrettably become the new normal.

Nico Gomez is president and CEO of the Oklahoma Association of Health Care Providers.