IT'S NEVER easy breaking down a $28.3 billion state budget. There are a lot of details to be sure, and finding enough time to review all of them can be time-consuming and difficult.

One of those "details" is Pennsylvania's funding of Medical Assistance for nursing-home residents. The Rendell administration's budget provides no increase in revenue. In doing so, it jeopardizes the ability of Pennsylvania's poorestamong the frail elderly and disabled to receive the level of care we all want and expect for our loved ones.

As someone who works as a caregiver at the 58th Street Presbyterian Home in Philadelphia, I could understand if under-funding was a one-year problem.

But for the past three years, the commonwealth has paid nursing homes nearly $290 million less than was owed for the cost of care for Medical Assistance residents. Here at 58th Street, we lost almost $230,000 last year on Medicaid payments - dollars that could have gone toward resident care.

And we're just one story.

Many nursing homes are struggling to meet the medical, physical and social needs of residents since two out of every three are on Medical Assistance.

Each day in towns across the state, the low-income elderly have to wait for nursing-home beds because of chronic government under-funding. At 58th Street, we take as many people as we can, but we simply can't take them all. It's heartbreaking. This is a silent, untold tragedy that is taking place every day.

This should not be allowed to happen in a state where the idea of proper health care for all residents is being propagated by many of our elected officials. Even if the Cover All Pennsylvanians health plan passes, it will never truly be a success if the elderly who need nursing home care are ignored.

This problem will only continue to grow since Pennsylvania has the second-highest percentage of people over the age of 85 among those states with larger population bases - trailing only Florida.

The proposed budget implies that the state is investing in programs that allow seniors to receive care at home. Staying at home is certainly what most people desire, but for the most ill and elderly who need round-the-clock care, it's not realistic - or safe.

To make matters worse, someone has to pay when the state fails to cover even the costs of inflation for Medical Assistance nursing-home residents. That someone often ends up being those few residents in the nursing home who have the resources to pay for their own care. It's an all-too-familiar story - seniors and their families watch helplessly as their life savings are wiped out to cover the rising costs of nursing home care due to Pennsylvania's inability to live up to its responsibilities.

IWANT OUR STATE elected officials to understand that their refusal to live up to their obligations has a real effect on residents, their families and the staff who care for our commonwealth's most vulnerable elderly and disabled citizens.

Statewide, for every Medical Assistance resident receiving care in a nursing home, that nursing home loses an average of $12 a day, or $4,300 a year.

When government refuses to pay for the care of Medical Assistance residents, it isn't a savings that comes without cost. It comes at the expense of sicker, older Pennsylvanians who rely every day on nursing homes to provide them with compassionate, high-quality care.

Places like 58th Street offer quality health care at a time when friends and family are no longer able to do so. People seem to think we can keep going forever with less and less.

We can't. The under-funding of Medicaid for nursing home residents will wreak havoc. I urge Harrisburg to make fair funding for nursing home residents a budgetary priority.

We can't afford not to. *

La'Kisha Gray is a team member of the 58th Street Presbyterian Home.