Jewish health and social service agencies around the country could have to ante up “tens of millions of dollars” in the next five years, thanks to a huge and hugely controversial budget reconciliation package approved by Congress last week.

That’s according to the Washington representative of the United Jewish Communities, which along with other Jewish groups is particularly concerned about changes in Medicaid rules intended to slow the growth in the entitlement program.

Despite their efforts, the final bill includes a number of provisions that could cost Jewish agencies dearly. Included among them: changes to regulations governing assets transfers by potential recipients to both relatives and charitable institutions that could reduce charitable giving.

Last week the Senate passed its version of the budget reconciliation bill by the narrowest of margins, with Vice President Dick Cheney casting the deciding vote.

The measure aims to cut $40 billion from the gigantic federal budget deficit over five years through cuts in a wide range of programs, but lawmakers scaled back reductions that had generated the strongest opposition, including reductions in the food stamps program.

Jewish health agencies would be forced to make up the difference when Medicaid benefits for some recipients are cut because of the tighter rules, said William Daroff, the UJC Washington representative. The change could also “disincentivize charitable giving” by the elderly, he said.

UJC also expressed concerns about increased co-payments for Medicaid recipients, something that could have a “profoundly negative impact on millions of destitute Medicaid recipients who would have greater difficulty accessing necessary health services,” Daroff wrote in a memo to Jewish agencies.

Thus, some Jewish agencies could face a multiple squeeze: a spike in demand for services because of reduced government support and higher co-payments by Medicaid clients, but also diminished giving by the elderly because of the changed assets transfer rules.

Daroff warned that the full impact of the measure cannot be measured until regulations for implementing it are drawn. Still, “we’re worried about the impact it will have on our agencies, as well as on the elderly and indigent population,” he said, adding that “it’s going to cost a lot.”

Because of a legislative technicality, the House must vote again on the measure in January; some groups, like the powerful AARP, will use that occasion to try to overturn the whole bill.

Local officials, whose interests in Washington are represented by the UJC, are concerned about the tighter Medicaid rules.

“The new law will extend the ‘look back’ period to five years instead of the current three years,” said Lori Price Abrams, director of the Community Relations Committee of the United Jewish Communities of MetroWest NJ. “If a $10,000 gift were transferred within the ‘look back’ period, the person would be obligated for that money before becoming eligible for Medicaid to cover nursing home costs.

“Of course, this example keeps it simple at $10,000, but it could have been a $100,000 transfer and this may have happened in multiple instances. UJC national estimates that this may cost our providers tens of millions of dollars,” Price Abrams added.

She noted that while Congress may have been trying to solve one problem, “it seems to have created another very significant one within the fine print of this budget reconciliation bill. It will be a priority of our system to bring attention to this matter and try to seek a fix to these provisions.”

“We depend on federal funds that get passed down through the state and we also assist clients in accessing entitlements; if their entitlements are more and more limited, there’s going to be fewer options for people in need,” said Reuben Rotman, executive director of Jewish Family Service of MetroWest, a beneficiary agency of UJC MetroWest.

JFS has a total client list of about 3,000, although not everyone it serves is at the income level that will be affected by the cuts, he said. Nevertheless, monies used by JFS might have to be diverted from one program to another, creating a ripple effect.

“We do have vulnerable clients who depend on access to food stamps, access to Medicaid, for their health coverage and prescription coverage. We need to find out if this is going to trickle down and have the impact that it might have in New Jersey.”

“There’s disappointment in [the cuts],” said Jeffrey Maas, executive director of the New Jersey State Association of Jewish Federations. “We’re deeply concerned that what is being proposed will have a ripple effect on the state because any Medicaid cut, because it’s a shared program, tends to have a double whammy because then the state cuts the same amount.”

Ron Coun, executive director of the Jewish Vocational Service of MetroWest, was concerned about the effects on his organization’s clients, most of whom are low-income earners.

“The dollars that come out of the federal government are sent down through the state and the state in turn funds us directly in some areas, and in others they move it down to the county level.”

The bottom line, said Coun, was that all these areas currently “are funded pretty close to the vest.”

“We are not directly reliant on those funds, but my clients who are dependent on the money they’re getting for their personal use, the working, poor, the disabled — my major concern is for them.” Such a population, Coun said, constitutes a “silent group that gets hurt, but no one looks at them because they’re on the margins of society.

“We’re between a rock and a hard place,” Coun said, adding that the news, coming right at the holiday season, creates a particularly “scary” atmosphere.