(Bloomberg News) Republican governors are renewing a push for more flexibility in running Medicaid health programs for the poor, urging Congress to roll changes into a debt-cutting deal federal lawmakers are negotiating.

Twenty-nine Republican governors asked for more independence from the U.S. in designing and running programs in a June 13 letter to Senator Orrin Hatch of Utah, the top Republican on the Senate Finance Committee. Medicaid is being expanded as part of the 2010 U.S. health-care overhaul.

"As federal funding has expanded, so has federal control," the letter said. "States should not have to seek waivers to manage their unique programs."

States run Medicaid with the federal government, with the U.S. approving changes in eligibility standards by granting waivers from national law. Without more flexibility, Medicaid--among the biggest expenses for states--is draining budgets and "crowding out other essential services" including education, public safety and public health, the governors said.

President Barack Obama's administration has issued several directives it said were aimed at giving states more options to design their own programs. A February letter from the U.S. to states raised the prospect of dropping some adults with incomes exceeding 133 percent of the federal poverty level from the program to close budget shortages.

Federal Spending

The U.S. Centers for Medicare and Medicaid Services is "committed to giving states the flexibility they need to administer their Medicaid programs while ensuring protections for patients," said Brian Cook, a spokesman for the agency.

Republicans are pushing for the Medicaid changes as part of negotiations to lower federal spending and raise the U.S. statutory borrowing limit, known as the debt ceiling. Medicaid covers about 60 million low-income people, about half of whom are children, according to the nonprofit Kaiser Family Foundation in Menlo Park, California. Medicaid cost $339 billion in 2009.

A House Republican budget plan by Representative Paul Ryan of Wisconsin, chairman of the chamber's Budget Committee, would cut $771 billion across a decade by converting the program into a series of grants the U.S. awards to states to run Medicaid as they see fit.

Democrats have criticized that approach, saying it would leave poor people vulnerable by cutting benefits and eligibility. Senate John Rockefeller, a West Virginia Democrat, has said he knows of 41 senators who will oppose any effort to significantly cut the program.