Echoing the laments of nursing home directors across the state, Stephen Flanagan, administrator of the Salisbury Nursing & Rehabilitation Center, a family-run facility in Worcester, said the state repays him $104 per day to care for Medicaid patients, while the care costs $124.

That could mean some families will have to drive longer distances to visit their relatives in nursing homes, in addition to other less obvious consequences. State Senator Harriette Chandler, Democrat of Worcester, said UMass Memorial Hospital worries that with fewer nursing home beds to absorb recovering patients, its floors will be overcrowded, worsening emergency room backups that sometimes force ambulances to travel longer distances.

The federation is supporting a bill - introduced by state Senator Stephen F. Lynch, whose South Boston district includes the state's largest nursing home, Marian Manor - to increase Medicaid spending by $200 million. That is more than twice the amount in [Paul Cellucci]'s budget.