Arizona's Medicaid agency faces a $1 billion budget shortfall at the start of the 2012 fiscal year as stimulus assistance from the federal government expires, yet another sobering reminder of the fiscal fiasco Arizona is in.

Tom Betlach calls himself a “numbers geek,” which is a really good thing considering he’s in charge of managing Arizona’s Medicaid system while the state’s finances are in the gutter and while the federal government is requiring an even larger investment in health care.

Hope is fading that Congress will approve hundreds of millions of dollars that Arizona is counting on to operate its Medicaid program, and state lawmakers don’t know whether they’ll have to scrounge for cash, beg for help or drastically downsize the state-run health care system.

Arizona is facing the possibility that it won't get extra federal health care funding that legislators expected would prop up the state's ailing budget.

So what does the future look like in Arizona now that the Legislature and the governor have made the deepest cuts in health and human services in 25 years in the last two legislative sessions? It is not a pretty picture.

The number of kids in an Arizona children's health care program has fallen 28 percent since state officials decided no new children would be enrolled in the KidsCare program.

Gov. Jan Brewer on May 6 signed a bill to restore funding that was stripped from AHCCCS and KidsCare, a move aimed at preventing the loss of more than $7 billion in federal money for health care.

KidsCare offers affordable health insurance for children in working families. It has been an Arizona success story for more than 10 years, helping thousands of children grow up healthy and strong. But a year ago, Gov. Jan Brewer and our legislative leaders began cutting KidsCare.

UPDATE: After voting on about two dozen measures, the Senate has taken a recess to allow lawmakers to have dinner.

Arizona legislators are poised to take up unfinished business related to the state budget and the federal health care overhaul.