AUGUSTA, Maine — Saying Maine cannot afford one of the country's most generous Medicaid programs over the long term, Gov. Paul LePage on Tuesday proposed tougher eligibility standards and other changes that would leave more than 60,000 people without coverage they are now receiving.

In a news conference Tuesday, LePage said an analysis of state spending in current fiscal year, which ends in June, shows a shortfall of $120 million in Medicaid, known in the state as MaineCare. The shortfall for the 2012-13 fiscal year is an additional $101 million "that we know of," he said, creating a $221 million gap.

The 361,000 people now on Medicaid "is pushing one-third of our population," said the Republican governor, while the national average is about 20 percent.

"This gap is what is causing our problem," said LePage, whose proposed changes would reduce the state's enrollment to the health care program to fewer than 300,000. To do so, he will ask the Legislature in January to restructure eligibility standards, reset the benefit structure to more closely reflect the national average, and change some payments.

"The ability to not balance the budget is the ability to print money," said LePage. "We here in the state of Maine are required to balance our budget, and they have not allowed me to print any money yet."

The proposed reductions in Medicaid, which accounts for more than 20 percent of all state funding, focus on "optional" services that go beyond what's required by the federal government. Coverage would be repealed for childless adults, and 19- and 20-year-olds. Coverage for chiropractic, dental, occupational and physical therapy, podiatry, sexually transmitted disease clinics and some other services would be gone.

A payment overhaul would include expanded use of generic drugs and reduced payments for hospital services.

"This is a very, very difficult day for all of us," said Commissioner Mary Mayhew of the Department of Health and Human Services, which administers Medicaid. "It will have a real impact on the people of the state."

But, Mayhew added, "We are in a financial crisis."

Despite the dire scenario painted by administration officials, Democrats, whose votes would likely be needed to pass the changes, were not impressed.

"The governor has taken the wrong approach to finding common ground with this dangerous and shortsighted proposal," said Rep. Emily Cain of Orono, the House Democratic leader. "The proposal puts our economy in jeopardy and undermines public health and safety. It hurts Mainers who are already struggling, with absolutely no plan to get people back to work."

Democrats said they are concerned about reductions in programs like prescription drugs for the elderly and dental care, and child immunizations. They were also skeptical of the numbers presented by the administration, saying they have been inconsistent in recent presentations to the Appropriations Committee, which plays a central role in adopting the state's $6 billion two-year budget.

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"We won't be rushed into making any decisions until we have an accurate accounting of the figure," said Rep. Peggy Rotundo of Lewiston, the lead House Democrat on Appropriations.

But state Finance Commissioner Sawin Millett, who served on the same committee as a legislator, said the Medicaid problems are longstanding, but have always been papered over in the past by short-term fixes, most recently by stimulus funds from Washington.

"It's impossible to look down the road and see the program as sustainable," said Millett.

Figures presented by the administration said that since 2002, Maine's Medicaid enrollment has exploded by 78 percent, while between 2000 and 2010 the state's population grew by 7 percent. It also said that Maine is among only 15 states that cover 19- and 20-year-olds through Medicaid, and among only seven states that cover childless adults. Maine's per-capita Medicaid costs were $1,895 in 2009, compared to $1,187 nationally that year, the administration says.

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