Carrera, who helps him with housekeeping, meals and bills. Credit Melissa Golden for The New York Times Every weekday, Medicaid allows Matthew Foster to spend a few hours pursuing one cherished activity after the next: working out at the gym, taking an art class, shopping for groceries, visiting his elderly aunt. The program pays for an aide to spend 20 hours a week with Mr. Foster, 34, who has Down syndrome and cannot read well or drive. Mr. Foster spent eight years on a Medicaid waiting list to get the coverage. Before he got it, help came from his mother, Susan Ellis, and his two younger siblings, who have since moved away. His father, Michael Foster, worked six days a week as a coal miner, though he retired recently. Both parents are 67 and have health problems of their own, although Ms. Ellis still works for a nonprofit disability rights group. Mr.

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