Mike Leavitt, the nominee for Health and Human Services secretary, this week described Medicaid as “flawed and inefficient” and said states should have greater flexibility to reshape the program. Opponents of such views fear it could lead to a net loss in Medicaid funding, the major source of paying for nursing-home care in this country.

Leavitt, a former governor of Utah, who made his comments during a confirmation hearing, said he devised a program as governor that could be a model for other states. That program, he said, offered a limited set of healthcare benefits to people who had no insurance.

Utah’s “limited benefit plan” did not include hospitalization or specialty care. But the state negotiated an arrangement under which hospitals voluntarily provided free care to the people who gained coverage, state officials said.

Leavitt was a governor for 10 years, until 2003, when he became administrator of the Environmental Protection Agency. The Senate is expected to vote on Leavitt’s cabinet appointment within the next 10 days.