WASHINGTON--Medicaid reform stood center stage at the four-day National Governor's Association Winter Meeting, which ended March 1.

At the meeting, the NGA released its Medicaid in 2005: Principles and Proposals for Reform, a report giving various recommendations to modernize the failing health care program for the poor, funded jointly by the federal government and the states. "Today Medicaid is largely what it was in 1965," the report stated. "Unlike other programs, it has not been modernized. It still has many of the original eligibility and benefit mandates, discourages personal responsibility, limits cost sharing, emphasizes treatment rather than prevention, and does not reflect the changing demographics of Medicaid beneficiaries."

The report recommends, among other things, basing Medicaid eligibility on income only, and simplifying the process for obtaining Medicaid waivers, including those for family planning and home- and community-based health.

During talks with governors at the meeting, HHS Secretary Michael Leavitt said he saw agreement on several issues, including the fact that Medicaid should recognize home- and community-based care as a "preferred alternative" to nursing homes, the New York Times reported.

And although partisan politics seemed alive and well, governors on both sides of the aisle expressed admiration for the new HHS secretary. "We like Mike Leavitt. We trust Mike Leavitt," Michigan Gov. Jennifer Granholm told reporters last week.

A former governor himself, Leavitt oversaw changes within Utah's Medicaid program, which has recently gained favor as a model for lawmakers nationwide seeking to save their own state programs. Utah's Primary Care Network provides coverage of more low-income people but offers fewer benefits. Among other things, inpatient hospitalization, specialty pharmacy services and most catastrophic costs aren't covered.

While state governors struggle to provide options for the over-burdened program's future, the Bush administration has proposed cutting $60 billion from projected federal Medicaid spending over the next decade.