Betty Parks was used to hard physical labor. In her warehouse job, she hoisted packages that weighed up to 100 pounds. Eventually, that lifting destroyed her health and left her unemployed and unemployable.

For a year, her company's insurance paid her medical bills. When that ran out, she found herself among the 6,000 Utahns a year who rely on the Utah Medical Assistance Program for the care that keeps her alive.The program provides assistance within rigid guidelines for people who can't get help elsewhere. As the legislative session approaches, it is once again in jeopardy. Without added funding, up to 350 poor Utahns may lose eligibility, and services may be cut for others.

"Utah Medical Assistance Program is the poor cousin in medical programs because it is funded completely with state money. It doesn't get the federal match Medicaid gets," said Bill Walsh, Utah Issues director. "It provides service to the most vulnerable people - those who aren't eligible for Medicaid - but it traditionally feels the squeeze because legislators, understandably, want to use state money to draw down matching funds."

Medicaid and the Utah Medical Assistance Program together form a line item in the governor's budget proposal. While the proposal contains increased funding, federal Medicaid mandates eat up more than the increase. So the two programs will take a $2-3 million cut if more money isn't allocated, said Steve Jardine, one of the governor's budget analysts.

"We didn't actually say where the cuts should be taken," he said. "We just sort of penciled them in so people would understand the impact. It wasn't our intention to cut Utah Medical Assistance Program. We assumed its budget would stay about flat. But (the medical program budget) is a moving target; we make estimates of what the costs will be, of how many people will use services. It's all estimates."

Medicaid is a categorical program. Besides stringent income guidelines, participants must be blind, disabled, elderly or welfare recipients. The Utah Medical Assistance Program is even tougher. Income is limited to $337 (raised from $289 in July with "can't-wait" funding approved by the governor and legislative leadership) and a person has to have a life-threatening, acute or infectious illness.

"Patients are frequently men and women 18-64 who are very poor. They are still functioning but have major health problems. Often they work, but in low-paying jobs without benefits," said Susan Read, director of Salt Lake Community Health Center, which contracts to operate one of three program clinics.

If cuts are needed, income levels may drop back to $289 or lower, said Robert Knudson, program administrator. "The only ways we can balance our budget is to reduce payments (for services), cut services or tighten eligibility."

During a given month, 4,500 participate in the program. The most common treatment is for injuries, like broken limbs, then life-threatening conditions like cancer, hypertension and diabetes. Chronic problems like back pain, mental illness or substance abuse aren't covered.

"This is a safety net for people who fall through the cracks. It's getting to the point where we can't absorb more cuts. People will go without services or wait until they're so sick treatment is more expensive. Others will be picked up by hospitals and the public. We are working with, not competing with Medicaid. But people forget that those on Utah Medical Assistance Program are just as sick as people categorically eligible for Medicaid," Knudson said.

"I wouldn't be here without Utah Medical Assistance Program," Parks said. "I don't know what I'd do if it wasn't there for me."