Leavitt made the case Thursday for a series of reforms to the Medicaid system that he said would save nearly $60 billion over 10 years for the program that provides health care coverage to 50 million poor Americans.

Leavitt said the “rigid inflexibility” of Medicaid has kept it from meeting its potential and needs to be changed.

“It's not sustainable for states in particular or the federal government,” he said in a conference call with reporters.

But calls for Medicaid reform have alarmed Utah legislators and governors in other states, who fear the federal government may shift more Medicaid costs to the states.

Utah's Senate Majority Leader Peter Knudson is drafting a resolution urging Congress not to stick states with any additional Medicaid costs. The Brigham City Republican said Utah's sluggish job growth, rising health care costs and growing elderly population have forced double-digit increases over the past three years. In a letter to Congress in December, the leaders of the National Governors Association urged reforming Medicaid but said it should not be done if it would simply result in additional costs to the states.

Kansas Gov. Kathleen Sebelius also urged caution.

“As we consider changes to Medicaid, we should seek, first, to do no harm,” she said in a speech Wednesday. “Second, while I am abundantly aware of the fiscal crisis the federal government faces, the solution cannot include balancing the budget on the backs of the neediest citizens in the country.”

Ron Pollack, executive director of the health advocacy group Families USA, said that is what Leavitt's proposed cuts would do. He said states would have to scale back or eliminate coverage to the so-called optional populations, which are made up of some of the neediest citizens in the program.

Roughly a third of all of those covered by Medicaid are considered to be optional under the law, including 3 million seniors, 5 million children and 6 million low-income adults.

“Our concern is that if you cut benefits for this sickest portion of the population, you're placing their health and possibly even their lives in risk because this is the group that needs health care the most,” Pollack said.

Leavitt said that giving governors more flexibility would allow states to continue covering the needy populations without adding to the state's fiscal burden or eroding coverage for optional populations.

Thursday afternoon, hours after Leavitt's briefing, Utah Medicaid recipients pleaded with the state's lawmakers to restore dental and vision benefits that were cut in the recession of 2002 after Leavitt, as governor, was granted a Medicaid waiver allowing the state to reduce benefits in order to provide bare-bones coverage to about 18,000 uninsured people.

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Tribune reporter Kirsten Stewart contributed to this report.