CRANSTON — The numbers don’t add up for Paula McCaffrey.

She runs down the figures scribbled on a creased slip of paper: $196 a month for subsidized rent, $180 a month for food, $70 a month for over-the-counter health products, $20 a month for laundry.

She goes on. The 20 social workers and welfare advocates around the room nod in encouragement. And the Department of Human Services official at the head of the table takes notes.

McCaffrey, 47, needs medicine to function. The disabled Providence woman takes eight medications each day for a list of ailments that include major depression, asthma, diabetes and posttraumatic stress disorder.

She doesn’t pay anything for them now. But that’s about to change.

McCaffrey is among 14,000 impoverished Rhode Islanders on fee-for-service Medicaid who will be asked to shoulder a portion of their prescription drugs — $1 for generics and $3 for brand-name drugs — as of Oct. 1. The fees were enacted by the General Assembly in the state budget, part of a larger effort to close a massive budget deficit.

State officials say the copays will save state taxpayers nearly $600,000.

McCaffrey, who is disabled and receives $680 each month, estimates her monthly drug costs will grow to about $16.

“We live on such a fixed income that any little thing that comes up is like a major catastrophe,” McCaffrey said. “I don’t have much money. And there are people who are worse off than me.”

The public was invited to comment on the new policy yesterday in a cramped conference room on the Pastore Complex near the state prison. Those who testified spoke of a fee that may seem insignificant, but would seriously affect the elderly and people like McCaffrey on fixed incomes.

“Many people with disabilities take on an average of about four to five medications each month,” said Francyne A. Fontaine, who has worked with mentally ill Rhode Islanders at the East Bay Center for the last two decades. “The added monthly expense to their budget would leave them with very little money each month. And at times, a person may have to choose between eating or taking their medications. This is America. No one should have to make that decision.”

Those who spoke yesterday acknowledged that the Department of Human Resources cannot repeal the copays, which are now state law. But they urged the DHS to accurately inform those affected.

By federal law, pharmacists cannot deny medication to Medicaid recipients below the federal poverty line, even if they cannot afford the copay. But the state has been shy about informing those people that the copays are, in effect, optional.

John Young, associate director of the DHS, said the state has refrained from publicizing the exception on purpose, because it does not plan to compensate pharmacies for the money they lose when people claim an inability to pay.

“It’s outrageous, shameful really, that DHS made a deliberate decision … not to tell people that, under federal and state law, the drugstore has to fill their prescription if they are unable to afford the copay,” Mary Curtain, a paralegal with Rhode Island Legal Services, said at yesterday’s hearing.

Later in the day, however, Young said he was working on compromise language for the notice to be sent to 30,000 Rhode Island Medicaid recipients later in the month.

“As I understand it, the notice language we’ve been asked to consider is, ‘Inability to pay is not a bar to receiving the prescription,’ ” Young said. “I need to review this with our lawyers and the director but am generally inclined to accept this addition to our notice.”

Young said the department was less receptive to suggestions at the hearing regarding capping monthly copays. “We can look at that, but my great sense is that that diminishes the effect of the [projected budget] savings,” he said.

In charging copays for this program, Rhode Island is not unique. More than 40 states already do, according to the federal Center for Medicare and Medicaid Services.

Young said the copays represent “the lesser of a set of difficult choices.”

“If it weren’t for the budget circumstances, I’d be happy to reverse the policy,” he said.

The finalized regulations for the copay policy — including language regarding notifications — will be released later in the month. The public has until tomorrow to submit written comments to the DHS.

Meanwhile, McCaffrey said she has a message for politicians who approved the copays:

“They need to think about how this is really going to affect people,” she said. “People like me are not going to be able to afford everything. It’s going to hurt a lot of people.”

speoples@projo.com