Fearful that President Bush plans to shift more Medicaid costs to the states, the nation's governors are mounting a bipartisan lobbying effort to stave off new federal limits on...

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BOSTON — Fearful that President Bush plans to shift more Medicaid costs to the states, the nation’s governors are mounting a bipartisan lobbying effort to stave off new federal limits on the program.

Medicaid, the nation’s largest health-insurance program, is costing states and the federal government more than $300 billion a year. The growth of the program, which covers the poor and disabled, has outpaced state revenues; Medicaid now is a larger component of total state spending than elementary and secondary education combined, according to the National Governors Association.

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Showing rare bipartisan unity, governors of both parties said last week that they would press hard in coming months to preserve or even increase their current Medicaid allotments.

“I certainly understand the need to balance the federal budget,” said Arkansas Gov. Mike Huckabee, a Republican and the vice chairman of the governors association. “But people need to remember that to balance the federal budget off the backs of the poorest people in the country is simply unacceptable. You don’t pull feeding tubes from people. You don’t pull the wheelchair out from under the child with muscular dystrophy.”

The association’s chairman, Virginia Gov. Mark Warner, a Democrat, said the governors were “much more in unanimity on this issue than they are on most issues.”

Virginia Gov. Mark Warner

“We do see on a regular basis that unless the governors step up, you will see cost-shifting done because it relieves the federal problem,” he added.

The governors could find themselves on a collision course with Bush, who has pledged to cut the federal budget deficit in half in the next five years. A bipartisan lobbying effort also would put pressure on the Republican-controlled Congress.

The White House has not tipped its hand on its new budget and has declined to comment on its plans for Medicaid. Federal officials, however, have said they are sending auditors to state capitals to review Medicaid programs and are cracking down on methods that states have been using to try to get as much federal Medicaid money as possible.

The governors, who will be forming a committee to press their Medicaid agenda, say they are determined to avoid repeating their experience the last time they tried to negotiate Medicaid changes with federal officials, in 2003. Bush at that time proposed giving each state a fixed amount of federal money each year for 10 years, instead of basing federal payments on actual health costs and enrollment.

“They tried to cap it the last time around,” said Ohio Gov. Bob Taft, a Republican. “Then, you’re asking the states to take a risk — what if the caseload grows?” That effort to make major changes in the program collapsed after lengthy negotiations between federal officials and a bipartisan group of governors.

The governors say Medicaid, which insures one-quarter of the nation’s children and two-thirds of its nursing-home patients, has become so expensive that it now, on average, makes up 22 percent of states’ budgets, compared with 10 percent in 1987.

“It’s just a huge problem for Ohio and almost every other state that I know about,” said Taft, adding that he had titled a recent speech “Medicaid: The Monster in the Middle of the Road.”

Massachusetts Gov. Mitt Romney is among several governors battling the Bush administration’s efforts to eliminate a practice some states use to get more federal Medicaid money. The federal government says these states’ practice of transferring money to county governments or local hospitals is a way to get more federal Medicaid money by making it appear that they are spending more on Medicaid than they are.

Massachusetts Gov. Mitt Romney

In Massachusetts, the Bush administration says $580 million in federal Medicaid money obtained using such a practice was an improper grant. Romney disagrees.

“This was a practice approved by the federal government, and it’s one of the ways that we provide health care to the poor and needy,” said Eric Fehrnstrom, Romney’s press secretary. “Discussions are going on now between us and the federal government so that we can find a way to continue with this practice.”

Some governors said they hoped Bush’s selection of Michael Leavitt to be secretary of health and human services was evidence of the administration’s willingness to allow states a greater say in Medicaid changes. Leavitt, administrator of the Environmental Protection Agency, is a former governor of Utah and used federal waivers to save money and expand coverage in Utah’s Medicaid program.

Huckabee of Arkansas, whose state now has nearly one-quarter of its population on Medicaid, said the governors’ objective in coming months would be to ask the federal government to “first do no harm.”

He said the soaring federal budget deficit had made federal officials realize “their house is on fire, and they’re probably so consumed with the flames around them that they’re unaware as they look to us for water that our tanks are empty.

“Folks, our house is on fire, too,” Huckabee added, “and asking us to put out your fire is probably not the solution.”