Maryland officials warned yesterday that new federal regulations could disrupt medical and social services to as many as 200,000 poor adults and children in the state, many of them with disabilities or chronic health problems.

John G. Folkemer, a deputy state health secretary, told members of the House Health and Government Operations Committee that up to $75 million the state gets in federal Medicaid matching funds is at risk if the rules take effect as proposed March 3.

"Every single program we have in the state is out of compliance with these new regulations," he said. "We think there really would be a reduction in the services provided and in our ability to manage them."

The regulation, published Dec. 3, would set strict new requirements for reimbursing states for Medicaid case-management services. Case managers typically help individuals get services they need, such as therapy and home care or transportation to doctors. They also may help some patients manage their medications, pay bills, get child care or apply for other services.

Congress required that the scope of some Medicaid payments be limited when it passed a deficit-reduction law in 2005. But the rules issued by the Department of Health and Human Services go beyond what Congress called for, Folkemer argued.

The administration originally estimated that the rules would cut Medicaid payments to all the states by $760 million over five years, but the Congressional Budget Office recently estimated the regulations would reduce payments by nearly twice that.

Calls to a spokeswoman for the Centers for Medicare and Medicaid Services were not returned yesterday.

Maryland legislators heard yesterday from a parade of local health officials, care providers and recipients of such help.

Valderas Oliver of Baltimore said her 2-year-old son, Gerod, who sat with her quietly during the hearing, relies on the at-home speech therapy he got through one of the programs that is now at risk. "Without this," his mother said, "he might not be ready for school."

The rules would limit the type and duration of case-management assistance that could be provided and would require the state to rework every program it has that provides such help, Folkemer said. Some services, such as a hot line operated by his department, might lose federal funds under the rules.

"It appears these regulations tear holes in the safety net we've worked so hard to create," said Del. Peter A. Hammen, the Baltimore Democrat who chairs the Health and Government Operations Committee. "At best, the regulations are rushed and not thought out thoroughly. At worst, they are draconian."

Gov. Martin O'Malley has written to Michael O. Leavitt, secretary of Health and Human Services, asking him to rescind the regulation, and U.S. Sens. Benjamin L. Cardin and Barbara A. Mikulski, both Democrats, have joined about 10 other senators in co-sponsoring a bill that would delay the regulation until April 2009.

"These regulations would deprive care to those who need it most," Cardin said in a statement released yesterday.

tim.wheeler@baltsun.com