Alabama's legislators are scrambling this week to come up with a funding solution that would allow them to appropriate an additional $200 million to Medicaid in the budget for Fiscal Year 2013.

The House of Representatives recently passed a budget with $400 million for Medicaid, but the state's governor and top health officials claim that amount won't cut it.  Governor Robert Bentley threatened to veto the budget last week, strongly urging the legislature to come up with at least $600 million for Medicaid. Bentley warned, "I will not accept a budget with $400 million for Medicaid. I will veto the budget."

Critics of the House's budget maintain that Alabama's Medicaid program simply cannot operate with the current appropriation. State Health Officer Don Williamson remarked, "In the 20 years I've had the privilege of being state health officer, I don't think I've ever seen a situation as fraught with danger as we are in Medicaid."

Williamson said that without the additional $200 million from the General Fund Alabama might not meet threshold requirements to qualify for $4 billion in federal grants. The argument is that without at least $600 million in appropriations, a cascade would be triggered - with dire effects rippling through state's healthcare system.

While the dim predictions have many in the state worried about a healthcare collapse, not everyone is convinced that $400 million in Medicaid funding would bring such catastrophe. Chairman of the Senate Finance and Taxation-General Fund Committee, Senator Arthur Orr, responded cautiously to the doom and gloom, saying, "I don't think that number is sacrosanct. There's a healthy degree of skepticism that the wheels will come off if we come in below that number."

Lawmakers are under tight pressure to weigh the merits of their options as this is the last week of the regular session.  A number of potential budget solutions have been proposed, including raising revenue through Indian casino gambling, taking money from the Education Trust Fund, raising fees, and siphoning funding from various executive agencies. If a consensus isn't reached soon the issue could be taken up in a special session.