LANSING (AP) — Lora Lee Phillips has had three surgeries on her back and two operations to remove extensive scar tissue from her uterus over the past two years.

The state’s Medicaid program covered those procedures, the physical therapy that followed each of her back surgeries and her prescription drugs.

“Medicaid pretty much saved my life,” said Phillips, a 28-year-old preschool teacher in Grand Blanc who has degenerative disc disease. “I never would have been able to get any of my surgeries without it and that would have meant being stuck in a wheelchair — or worse, being paralyzed.”

The situation could be different the next time Phillips goes under the knife, this time to repair a kneecap that frequently dislocates. She would have to pay for her physical therapy and reduce her prescriptions to four a month if state lawmakers approve Gov. Jennifer Granholm’s spending proposal for Medicaid.

Phillips is one of 40,000 residents who get state health coverage because they take care of a low-income child or other relative covered by Medicaid. The Democratic governor recommended limiting coverage to such caretakers and to 19- and 20-year-olds to help balance the budget.

The plan would limit hospital stays to 20 days a year, require a $10 copay on emergency room visits and limit prescriptions to four a month. It also would eliminate coverage for hearing, speech and physical therapy, occupational therapy and vision services, starting Oct. 1.

No new 19- and 20-year-olds would be covered by Medicaid after that date. The federal government does not require Medicaid coverage for those young adults.

The changes would save a combined $11.4 million, with the state saving $5 million and the federal government the remaining $6.4 million.

The measures are among several in Granholm’s budget proposals aimed at cutting Medicaid costs while continuing coverage for groups the governor considers the most vulnerable: the disabled, seniors, children and pregnant women.

“She’s really clear, even pounding on the table, that she won’t cut services to these groups,” state Community Health Department spokesman T.J. Bucholz said. “When you look at this budget and the work that we put into it — and that so many people still are eligible for Medicaid — it is remarkable given the hole that we’re looking at.”

Without changes, the state $8.9 billion general fund budget for the upcoming fiscal year is expected to be $773 million in the red.

The increasing Medicaid caseload — now at a record 1.4 million — is one reason this year’s $8.8 billion general fund is short by $376 million.

The Granholm administration expects to spend $6.1 billion to provide health care coverage this fiscal year and $6.9 billion to cover about 1.5 million low-income recipients in the year ahead.

Republican legislative leaders would not comment specifically on Granholm’s Medicaid proposal.

But Rep. Bruce Caswell, a Hillsdale Republican who heads the House Appropriations Community Health Subcommittee, said the panel will begin looking over the governor’s proposal and taking testimony from the state and advocacy groups this week.

Other states also are trying to keep their Medicaid programs afloat by proposing a variety of changes. South Carolina is considering giving Medicaid recipients control of a set amount of health care money through a debit card. Some states are looking at higher patient copays on prescription drugs.

Granholm and other governors met last month with President Bush to push for Medicaid reforms. Both Republicans and Democrats told the president they do not support his proposals to reduce federal Medicaid spending by $40 billion and limit some payments to the states.

“We are ready and willing to discuss meaningful reforms outside of the budget process that will ultimately achieve efficiencies without jeopardizing health care to the vulnerable,” said Granholm, chairwoman of the National Governor’s Association health committee.

While Granholm’s proposed Medicaid changes would help the state save money, some advocates for low-income adults worry that cutting off health care to about 14,000 19- and 20-year-olds a year will mean higher costs down the road.

Sherri Solomon-Jozwiak, president and CEO of Catholic Social Services of Lansing, said most Medicaid recipients that age need state aid because they are just getting out of foster care or the juvenile justice system and may have missed getting primary medical care as children.