MADISON COUNTY, Ala. (WHNT) - Budget hearings at the state house put the Alabama Medicaid Agency before lawmakers, asking for a bigger piece of the general fund.
"But where's it going to come from," said Representative Mike Ball. "What are you going to cut? Or are they going to have to cut some of their services?"
Medicaid alone accounts for more 1/3 of Alabama's general fund spending, making it the state's largest consumer of dollars.
Medicaid leaders say the $157 million is needed just to maintain their current services.
"There's a lot of frustration with Medicaid," said Senator Arthur Orr. "When the federal government gives every 2 dollars for every 1 dollar, but they also set the rules, that makes it very difficult for us to manage."
For example, private insurance charges extra for smokers, but Medicaid rules coming from Washington D.C. won't allow it.
Another option would cut state reimbursement to healthcare providers, but that could reduce the number of people willing to see Medicaid patients
"If a doctor can't get adequately compensated, they'll say 'I'm just not going tot make Medicaid patients,'" explained Sen. Orr. "That just narrows things even further."
More than 1 million Alabamians are on Medicaid, including more than half of the state's children.
The 2016 legislative session begins February 2.