Growing concern that the federal government may reduce its funding for Medicaid, which provides medical care for the poor, elderly and disabled, has the nation's governors worried that states will have to pick up more of the costs.
In Nevada, Medicaid already is the third most costly program behind public schools and the university system. The overall Medicaid cost is split between the states and the federal government.
Gov. Kenny Guinn, in Washington, D.C., for the inauguration of President Bush, was one of more than a dozen governors who met Wednesday to discuss strategies for heading off any reductions.
"There is (bipartisan) concern across the board," said Michael Hillerby, Guinn's chief of staff, who also attended the session.
This fiscal year, $323 million has been set aside in state money for Nevada's share of Medicaid. That trails the $884 million in the general fund going to public schools and the $506 million to the University and Community College System of Nevada.
Hillerby said there is no "firm proposal" yet from Bush, but word of possible reductions in Medicaid funding has leaked out from federal agencies.
State Budget Director Perry Comeaux said this has been a "constant concern" about the government reducing its aid.
"They talk about cost containment and that means cost shifting," Comeaux said. "And the only place they can shift the costs is to the states."
Since fiscal year 2001, the Medicaid caseload in Nevada grew from 117,643 to an estimated 177,096 this fiscal year, a 51 percent increase.
In Nevada, those eligible for Medicaid are on welfare, low-income pregnant women and children, the blind, aged and disabled receiving assistance and children in the foster care program.
More than two-thirds of the cases on Medicaid are families on welfare and mothers and children who are just above the welfare-income limit but still considered to be living in poverty.