Hospitals in Western Pennsylvania are scrambling to stave off proposed cuts in the Medicaid budget.

Children's Hospital is facing an $8.2 million hit alone, which would be one of the largest among hospitals in the region, Ron Violi, chief executive officer of the Children's Hospital Foundation, said in a meeting yesterday with the Post-Gazette editorial board.

The University of Pittsburgh Medical Center's Shadyside and Presbyterian hospitals, which are operated jointly, stand to lose more than $9 million, said Ed Karlovich, chief financial officer for UPMC's academic and community hospitals. The entire health system, including UPMC's insurance subsidiary, could see a cut of at least $40 million.

And in the region's second-largest health-care network, the five hospitals that make up the West Penn Allegheny Health System, say the cuts cost them at least $12 million, including $5.2 million at Allegheny General Hospital.

At Mercy Hospital, about $4 million in reimbursements are at-risk.

Medicaid, which is a state-federal health insurance program for the needy, aged and disabled, accounted for about 10.5 percent of patient-care revenue for all hospitals in the state during fiscal 2004, according to the Pennsylvania Health Care Cost Containment Council. Called Medical Assistance in Pennsylvania, the program faces financial problems because of expanding enrollment and the increased cost of health care.

While Violi argued for a "carve-out" that would protect pediatric hospitals from cuts, the proposal from Gov. Ed Rendell already includes a safeguard for youngsters, said David Feinberg, a Medical Assistance official with the state Department of Public Welfare. Children are not subject to a proposal that would save money by restricting adults' access to hospitals, doctors, prescriptions and medical equipment, he said.

Children's Hospital would take a hit in the so-called "pass-through" money it receives from the state to help cover the costs of training physicians, running a poison center and treating both uninsured and Medicaid patients.

But those cuts would come only if the hospital's operating profit exceeded 1 percent -- it was 4.4 percent during fiscal 2004, according to the health care council.

"We've said we won't cut people off as eligible for the program, we'll take care of all kids the way we have taken care of them in the past, and we'll budget money to take care of the additional 100,000 people we believe will become eligible," Feinberg said.

"But we had to look for ways to save some money in this program."