JEFFERSON CITY - Medicaid and other health care expenditures topped Gov. Jay Nixon's list as he announced $204 million in budget cuts announced Wednesday.

Health advocates said there would be an impact on care.

Under Nixon's plan, Medicaid programs face a loss of more than $32 million, mental health programs will lose $3 million and hospitals and clinics around the state, including those in the UM Health Care System, will lose $3 million.

Despite these cuts, Nixon insisted to reporters at a Wednesday news conference that services will not be drastically affected.

The cuts will manifest themselves in a number of ways.

Increases in Medicaid reimbursement rates will be stalled --not cut-- until the legislature can come up with the money to fund it, State Budget Director Linda Luebbering said.

What passed the legislature as a three-year plan to raise the amount doctors are reimbursed for treating Medicaid patients will be suspended for the time being.

"What was supposed to be a three-year plan is becoming a five-year plan," Rep. Chris Kelly, D-Columbia, said.

But that could have effects on the willingness of doctors to take patients, said Bob Quinn, executive direction for the Missouri Association for Social Welfare

"When the reimbursement rate isn't high enough, if you as a practitioner take that patient, you're losing money on that. If you've paid your medical school debts, own the building you work in, maybe then you can take a few patients you're losing money on," Quinn said.

A major change will also come to the complex Medicaid billing formula, encompassing more than 16,000 billing codes for various procedures and services. The state is now opting to decrease the amount reimbursed for certain services that are being reimbursed at higher Medicare levels, rather than the standard Medicaid rate. This includes services such as X-rays, midwife services, optical services and audiology services.

The cuts would also shift the cost of people who receive care under both Medicare and Medicaid solely to Medicare, which is covered entirely by the federal government.

Because of the cuts to the Mental Health Department, their programs will no longer be able to accept new people seeking help for alcohol or drugs, psychiatric issues and developmental disabilities.

"Folks that want to participate in one of those services will be put on a waiting list," said Bob Bax, spokesman for the Mental Health Department. "We would still accept those at community mental health centers, typically in emergency situations," Bax later said, by sending those people to emergency rooms for care.

The $3 million cut from hospitals and clinic represents a 25 percent decrease in funds supplied by the state. Additionally, the state will be withholding about $200,000 from MU's telemedicine program that allows doctors to diagnose at a distance, usually in rural areas, and almost a million from the Missouri Kidney Program, for which much of the research is done at MU. The MU School of Medicine will lose more than $400,000 for its Institute of Mental Health.

The governor is constitutionally required to keep a balanced budget, and Nixon said part of the blame for unfunded health care rests with the legislature.

"I should also note that all of the issues around Medicaid here would have been much easier had the legislature adopted what was a very, very solid proposal last year to not use one penny of state dollars," said Nixon. "If we had that 150 million dollars in the state till all of this process would've been much easier."

The cuts by Nixon and Luebbering have garnered both support and criticism from health and welfare advocacy associations.

"This is the problem," said Amy Blouin, executive director of the Missouri Budget Project. "Missouri is facing significant critical problem with revenue structure, and we've spent the last 10 years responding to this by cutting services over and over again. It's like hitting your head against the wall and expecting a different result each time you do it. It's crazy," she said.

Quinn said the budget cuts are a result of years of not generating enough revenue to cover programs.

"She (Luebbering) is a top-notch budget director; she can't control what she has to work with. She must look at the most intelligent way she can spend this money. We all know we don't have enough money in there, and they have to say, we don't have the money to do that," said Quinn. "But the people most vulnerable are the ones bearing the brunt of this, and that's the most unfortunate part of this."