Read the letter to Sen. Manchin here.

CHARLESTON, W.Va. -- In a letter to U.S. Sen. Joe Manchin, the chairmen of the West Virginia Legislature's health committees warn of "terrible consequences to our state" if the federal government slashes the state's Medicaid funding.

"Not only would it be devastating to our families, it would also be devastating to our economy and totally detrimental to any hope of job creation in West Virginia," wrote Senate Health and Human Resources Chairman Ron Stollings, D-Boone, and House Health and Human Resources Chairman Don Perdue, D-Wayne.

Medicaid pays for the health care of more than one in five West Virginians, including three of every four nursing home beds.

A budget approved by the U.S. House of Representatives in April would cut 40 percent of West Virginia's Medicaid dollars, a loss of more than $15 billion, over the next 10 years, according to health-care consumer group Families USA.

Under that proposal, West Virginia would lose more than 10,000 health-care jobs over the next ten years, according to the Families USA analysis. About 116,000 state residents work in health care and associated fields, according to Workforce West Virginia.

Manchin repeatedly has said he could support "flexible" block-granting and reduction of Medicaid. But in a statement Tuesday, he said he opposes the House Medicaid plan, which he called "draconian."

"Like all West Virginians, I believe that taking care of the truly sick and poor is critically important," Manchin said.

Last week, Manchin questioned Medicaid care for healthy people. "I do not believe that the federal government should mandate that any state should have to take care of a healthy poor person the way those states have the moral obligation to take care of a sick poor person," he said.

About half the 405,000 West Virginians who receive Medicaid-funded health care are children, according to the state Department of Health and Human Resources. Another 141,000 are elderly, blind or disabled.

Stollings, who is a physician, said if the state is to get a grip on its soaring chronic disease costs, "we have to keep our citizens healthy." The new health-reform law expands Medicaid eligibility, he noted.

Manchin said he favors Medicaid proposals that give states flexibility. "Make no mistake, giving states the flexibility to tailor services to their own people can improve the effectiveness of vital programs, wipe out tens of billions in waste, fraud and abuse and protect services for the truly needy," he said in a statement provided by his staff.

Perdue said Tuesday that "flexibility" can be a code word for taking funding away from the states and loosening requirements that people be covered. "If I jump off a cliff," he said, "I'll be really flexible all the way down."

In their letter, Perdue and Stollings expressed concern about Medicaid funding for nursing homes and in-home care, as Baby Boomers age. "Even if someone has saved their entire life to cover their needs as they age, very few people will have the resources to maintain the cost of long-term care indefinitely," they wrote.

"The needs will not go away," Stollings said. "States could end up holding a pretty big bag that potentially breaks the budget."

Stollings is right, said Michael Bird, chief lobbyist for the National Conference of State Legislatures. "The states are going to be handed cuts in the Medicaid program and, in a sense, will be told, 'You figure it out,'" he said.

Manchin said Medicaid dollars can be stretched. "When I was governor, with more flexibility, we expanded services, better addressed our peoples' needs and made our dollars go further than the federal government could with one-size-fits-all mandates," he said.

Perdue said the Manchin administration stretched Medicaid dollars by refusing to spend about $350 million of them, keeping them in a surplus account instead.

"If we had spent those dollars he was holding back, we might have fewer kids with diabetes or fewer adults with expensive chronic conditions," Perdue said. The Manchin administration also repeatedly made it harder for elderly people to get Medicaid-funded in-home care, he said.

Manchin spokeswoman Marnie Goldberg said Manchin is concerned that, in 2010, the Government Accounting Office identified $22.5 billion in improper Medicaid payments to contractors. Such payments could be avoided if recently passed laws are properly implemented, the GAO report said.

No matter what happens with block granting, states face lower Medicaid funding, the NCSL's Bird said, because President Obama's budget also shifts part of the cost of Medicaid and the Children's Health Insurance Program to the states.

West Virginia enjoys one of the best Medicaid matches of any state. For each Medicaid dollar West Virginia puts up, the federal government puts up three. That could end, Bird said.

If the House proposal became law, states would receive a reduced, set "block grant," and nothing else. President Obama proposes that states get a "blended Medicaid rate" that also cuts federal dollars to states, according to a new report from the Washington-based Center on Budget and Policy Priorities.

"The truth is," Manchin said, "this nation is facing a death spiral of debt, and if it continues to spiral downward, we will be facing cuts in areas no one wants to think about cutting."

"No one wants to think that we can't take care of our kids and old people," said Renate Pore, health policy director of West Virginians for Affordable Health Care. "The federal deficit is serious, but we have other choices of ways to deal with it. Why balance the budget on the backs of vulnerable people, but refuse to end billions in tax breaks for the most wealthy? Those are the bottom-line questions."

Reach Kate Long at katel...@wvgazette.com or 304-348-1798.