1.   The state has got to find some way to balance these two needs.

2.   And the state does not get much assistance.

3.   As the states got word of the discussions, they grew distressed.

4.   Baldwin said the state may get some financial relief as it asks the federal government for more money to pay for mental-health services for Medicaid patients.

5.   Because a dollar today is worth more than a dollar in the future, the states get only a fraction of the total money they would ordinarily receive.

6.   Because the state is getting federal money to run the program, they say, it should be held accountable.

7.   Beyond that, Magaziner said, the state should get out of the way.

8.   Both sides agree that if states get involved, rather than small communities, the issue would be decided one way or the other.

9.   -- Should states get more money to support at-home care for the long-term ill and disabled?

10.   -- Substitute big block grants for dozens of federal programs, and set annual limits on how much each state would get from those grants.