Healthcare reform legislation is expected to be finalized sometime today in the Senate Finance Committee. But there are still a number of issues to iron out, including whether some states would be exempt from financing a Medicaid expansion plan, according to reports from Washington.

A part of the Medicaid plan, as endorsed by Senate Majority Leader Harry Reid (D-NV), has some senators crying foul, according to Arguing that his state has been hit harder than most by the recession, Reid has helped craft the bill so that Nevada would not have to pay for a proposed expansion of Medicaid. Under the original version of the bill, each state would have to pay roughly 13% of the cost of expanding Medicaid to include those with income up to 133% of the federal poverty line. This special deal also would apply to Michigan, Oregon and Rhode Island. Meanwhile, Democrats from Colorado, Arkansas and Indiana have said that their states should be exempt as well.

Many states are worried that a mandated expansion of the Medicaid program would result in increased budget strains when a majority of states are already struggling to balance their books. A recent report released by the Kaiser Family Foundation suggests that Medicaid budget woes could continue well into fiscal year 2010, putting pressure on lawmakers to make cuts to the program that could affect long-term care services. (McKnight’s, 10/1/09) Medicaid pays for the majority of nursing home care.