As lawmakers scour Gov. Dannel P. Malloy’s budget, some may be disappointed to see some of the healthcare and social service cuts they never thought they’d have to endure with a Democrat in the governor’s office.

On the campaign trail and in the weeks leading up to the budget address Malloy vowed not the “shred the safety net,” but after his speech some advocates are wondering how he defines safety net.

In his budget released Wednesday Malloy proposed limiting the number of non-emergency dental visits for low-income adults, limit’s the number of eyeglasses to one pair every two years, postpones medical interpreter services until 2014, and implements a first-ever co-pay of up to $3 for certain medical services on Medicaid recipients.

It also increases the cost-share for seniors in the Connecticut Home Care Program for Elders, which helps seniors stay in their homes, and it eliminates funding for AIDS drug assistance.

Ellen Andrews, executive director of the CT Health Policy Project, said she understand that her clients are expected to share in the sacrifice, but she will definitely be bringing up some of the Medicaid changes for low-income adults up to the legislature over the next several weeks.

Past studies by Connecticut Voices for Children have shown that when co-pays are increased on low income families with children they may forgo needed care or seek emergency care when the conditions worsen if they cannot afford the additional co-payments.

Malloy’s Budget Director Ben Barnes said Wednesday that the administration is aware of those studies and limited the co-payment to $3, not to exceed 5 percent of family income. He said the co-pay doesn’t apply to all medical care a patient seeks.

“There are a series of cuts to health and human service programs, which are unfortunate and which we made with heavy hearts,” said Barnes. “I don’t want to put co-pays on Medicaid because I agree with you it creates a barrier to utilization and it harms people.”

However, Barnes said “the underlying principle that we need to balance the budget and that we need to have shared contributions to that balance was the most important thing we need to address.”

He said he thinks the budget Malloy presented Wednesday left the core principles of the safety net intact.

Those in charge of Connecticut’s safety net saw the budget as a mixed bag.

Andrews said she was pleased to see Malloy get rid of the Managed Care Organizations, which reaped huge profits in 2009 by denying their clients medical care and overcharging them.

A decision to move to a self-insured Administrative Services Organization model brings more transparency to the Medicaid program, which accounts for close to $6.3 billion in state spending, or about 30 percent of the state’s total budget.

The model also allows the state to collect a tremendous amount of claims data that will in turn allow it to see which delivery models are working best for the various populations.

Andrews is happy about the move because will allow the state to implement Primary Care Case Management.

“Under PCCM, Medicaid recipients will have primary care givers and receive preventive care, and will no longer be reliant on emergency rooms and unnecessary tests and treatments,” Andrews said. “The program will also provide the state with better information about how the system is working, and how to best spend the state’s limited dollars.”

Brenda Kelley, executive director of Connecticut’s AARP, isn’t as happy as Andrews about some of the budget details related to senior citizens.

She appreciates Malloy’s decision to fund the transition of 2,251 nursing home residents back to the community by the end of fiscal year 2013 through the Money Follows the Person program, but she’s very unhappy about the decision to charge seniors fighting to stay in their homes.

Kelley fought to get the percentage seniors pay under the Connecticut Home Care for Elders program lowered last year, only to see it returned to where it was less than a year ago.

“We know based on past experience that the addition of a 15 percent cost-share will result in hundreds of seniors dropping off the program, putting them at greater risk of placement in a nursing facility, and ultimately resulting in the state paying more for their care,” Kelley said. “We also know that applying the cost-share as a percentage of a person’s care plan punishes those who are the most in need. This is not fair and decent, nor is it cost-effective.”

One of Malloy’s staunchest supporters, Shawn Lang, director of public policy for the Connecticut AIDS Resource Coalition, was equally disappointed Wednesday.

The budget eliminates state funding for the Connecticut AIDS Drug Assistance program, which helps cover the cost of cover the cost of drugs that prevent infections related to HIV and AIDS. The budget narrative says the $606,678 a year isn’t necessary since there are available federal funds and many people served by the program may qualify for the new low-income adult Medicaid program.

Lang, who was in Washington D.C. lobbying Congress to maintain AIDS and HIV funding at the federal level Wednesday, said she’s still not clear what impact the cuts will have.

She said she’s happy they left the syringe exchange program intact and are creating a home care waiver for about 50 individuals with HIV, which will help keep them out of hospitals and skilled nursing facilities.

“In the grand scheme overall, I think the governor was very clear there would be shared sacrifice across the board, so we were all expecting cuts,” Lang said. But she said the coalition has a good working relationship with the legislative committees of cognizance and will work hard to restore the painful cuts. She said she’s still uncertain AIDS line item in the Department of Public Health budget and if it’s a program that’s not utilized or serves no purpose then she’s happy to get rid of it. The budget narrative says the grants for the program were reduced because it only serves a minimal number of clients.

But at the moment there are still more questions than answers with regard to the impact and how many individuals who receive assistance under the state’s drug program won’t qualify for the low-income adults Medicaid program.