Two donors — Utah billionaire James Sorenson and Intermountain Health Care — did what the Utah Legislature didn't during a recent special session. The donors provided a total of $2 million in private funds for emergency dental services, which will be matched with $4.8 million in federal dollars. As acts of charity go, this was significant.

In the short term, emergency dental needs will be addressed, which is a good thing. But this is a stop-gap solution at best. In the face of shrinking federal funds, the state needs to re-examine Medicaid spending. In Utah, Medicaid comprises one-fifth of the state's budget. In the past five years, Medicaid spending has increased 12 percent — more than five times the rate of growth in other areas of state spending, according to analysts' estimates.

This past week, legislative analysts warned of an oncoming "fiscal train wreck" in terms of reductions in federal support for Medicaid programs and an expectation that states will shoulder more of the costs.

Many Utahns were angered that the Legislature refused to consider a $2 million appropriation of state funds for emergency dental services while on the same day approving a $15 million expenditure for the construction of a parking garage at the state Capitol. Lawmakers can attempt to explain the particulars — that the funds come from two different pots of money and that they hesitate to reopen the budget for any reason — yet the general public views tax revenue as its money. They want it used for the highest purpose. Helping very poor people address dental health issues that could conceivably land them in emergency rooms if left unchecked seems a very noble use of those funds.

The problem is, the federal government considers services such as dental care, vision care, prescription drugs and mental health treatment as "optional." More than half of Utah's Medicaid budget goes toward providing those "optional" services, according legislative analysts. Tinkering with the budgets for those services would impact Utah's most vulnerable Medicaid recipients.

In many respects, Utah's hands are tied by federal regulation. Congress should at least debate folding in more "optional" services into the regular Medicaid program, but it, too, fears runaway costs.

The Utah Legislature's Medicaid Interim Committee is taking a hard look at Utah's Medicaid program and expects to make policy recommendations for the 2007 legislative session. Its top priorities are cost management and accountability. Committee co-chairman Sen. Sheldon Killpack, R-Syracuse, told the Deseret Morning News that given the short time frame for study, the panel likely would not "find the silver bullet for 100 percent of the issues."

Even so, this discussion is vitally important. Somehow, Utah has to devise the best means to provide needed services to the most vulnerable among us, and do so in a cost-effective manner. It's the mother of all math problems, but credit lawmakers for taking on this important work.