With a state deficit projected to be at least $2.3 billion this year, Gov. Ed Rendell's 2009-10 budget calls for, among other things, providing more Pennsylvanians with access to health insurance. For that, the governor is to be congratulated. In tough economic times the less fortunate among us truly need that safety net.

But this year's budget will present challenges for those of us in the business of ensuring that all Pennsylvanians have access to affordable, high-quality health care.

It is imperative that we do not jeopardize the health-care safety net that our most vulnerable citizens rely on each and every day: the Medicaid program.

Medicaid is a taxpayer-funded health-insurance program that finances essential health care and long-term care for roughly 2 million Pennsylvanians. A well-funded Medicaid program guarantees access to affordable health care for our most vulnerable residents. A well-managed Medicaid program saves taxpayers hundreds of millions of dollars each year.

Legislators need to keep in mind two key points as they look at Medicaid this year. First, the people who rely on this system for health care have nowhere else to turn. Forty-six percent of Medicaid recipients are children under 18; 10 percent are seniors 65 and older; 17 percent are disabled.

And this isn't just a "big city" issue. Two-thirds of Medicaid recipients in Pennsylvania live outside of Philadelphia and Allegheny counties, and 27 percent live in rural counties. Allegheny County has more than 185,000 people on Medicaid. Seven other counties in our region -- Armstrong, Beaver, Butler, Fayette, Greene, Washington and Westmoreland -- have more, with approximately 188,000 residents who rely on the program. In these eight counties alone, the Medicaid population includes more than 163,000 children, 38,000 seniors and nearly 74,000 disabled citizens.

The second point for lawmakers to consider is the job that Medicaid Managed Care Organizations are doing to deliver health care to more than 60 percent of those on Medicaid in Pennsylvania, including two-thirds of the population in Western Pennsylvania. Each of the MCOs in the state has been ranked among the best in the nation; combined they have saved the commonwealth more than $2.7 billion over a recent five-year period, according to an independent study by the health-care consulting firm The Lewin Group.

The MCOs are able to generate cost savings by coordinating the care their members receive, emphasizing lower-cost preventive care and avoiding unnecessary hospital stays. We integrate care-management, increasing access to quality care for special-needs individuals. Our case management addresses both the health and social needs of our clients. We tackle chronic conditions head on.

We also integrate delivery of pharmacy services, a critical role with the Medicaid population. Many consumers have separate plans -- one for routine doctor visits and a second for pharmacy. But remember, many Medicaid recipients are chronically ill or needy. Their needs mandate a comprehensive and seamless delivery system.

The news of more job losses in our area adds to the urgency of this situation. Every time a worker loses a job, a family faces the potential loss of its health insurance, and one more family may need Medicaid.

Pennsylvania's MCOs look forward to working with the Rendell administration and the General Assembly to strengthen this vital safety net for our most vulnerable citizens while delivering significant savings for taxpayers.