Today is the first day without Medicaid’s extended, inflated matching pay rates of the last two years, a scenario that has state officials and providers worrying about what will come next. The bigger FMAP rates were part of the 2009 stimulus package. Originally, the extra pay was to end in December 2010, but then it was continued, on a declining basis, through Thursday. Some policy wonks are suggesting the rates simply be extended, with states paying back Uncle Sam when their economies recover. Budget hawks, meanwhile, have resisted efforts to extend the more generous rates. Providers are concerned about ever tighter Medicaid funding and are lobbying their respective lawmakers about it. Medicaid is the single largest payer of nursing home services in the United States.