PROVIDENCE, R.I. (AP) — Rhode Island is proposing an unprecedented overhaul of its Medicaid program that Gov. Don Carcieri says will save this cash-starved state millions of dollars — but could risk leaving the poor and elderly with fewer services should the plan not work.

Instead of having the federal government reimburse Rhode Island more than 50 cents for every dollar the state spends to care for the needy, disabled and elderly, Carcieri wants the state to get its federal money in a lump sum.

The federal government would benefit because its spending would be capped over the three-to-five year experiment. In return for agreeing to spending limits, Carcieri wants freedom from rules governing how the money can be used. For example, his administration wants to use Medicaid money to help keep seniors in their homes with care instead of moving them to nursing facilities.

That freedom comes with a risk. If Rhode Island miscalculates and exhausts its funding too quickly, state officials say they may have to cut services for Medicaid recipients deemed the least needy. Carcieri's administration is also seeking the authority to charge recipients more for Medicaid coverage.