Local nursing home officials are bracing for cuts in Medicaid, after Ohio expected 43,000 new recipients in the past six months — and got nearly twice that many.

        Ohio, which has 1.4 million residents on Medicaid rolls, isn't alone in the financial scramble caused by the economic recession.

        Thirty-eight other states reported Medicaid budget shortfalls of more than $1 billion for fiscal year 2002. And 37, including Ohio and Indiana, said Medicaid costs exceeded estimates on which budgets are based.

        While officials in Columbus decide how to serve more people with the same funding as last year, local administrators expect a negative trickle-down effect.

        “It's a major concern,” Sandy Gay, administrator at Western Hills Retirement Village, said Monday. “You need sufficient funds to provide care for residents. We've had a lot of changes in Medicaid. And we're a highly regulated industry.”

        Half of Western Hills' 120 patients receive Medicaid, which pays for nearly two-thirds of such patients in the U.S. Long-term care and soaring costs of prescription drugs are two of the biggest costs.

        “It would impact us highly if they cut it a big amount,” said Shirley Brady, administrator at Mason Health Care Center, where 37 of the 50 patients receive Medicaid.

        “In our business,” Ms. Brady said, “you wait till it comes down in writing.”

        It's not likely to do so anytime soon.

        Dennis Evans, spokesman for the state's Department of Job and Family Services in Columbus, which handles Medicaid, said it's too early to speculate where cuts would come.

        “All states are facing this as caseload continues to grow,” he said. “A lot of it is linked to the economy. We're not necessarily looking at cuts in service, but in how to serve more people.”

        That's what Ms. Brady calls a Catch-22: Cutting more slices from the same-size pie.

        Mr. Evans said the state would pursue administrative cuts before trimming assistance, but he added, “there might be some hard decisions to make down the road. We'll be looking at where the high costs are, and long-term care and pharmacies are there.”

        Medicaid helps pay health care costs for the needy and aged.

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