Absent any help from Washington, some states are beginning to take action on their own to revamp their Medicaid programs and cut costs. While the federal government finally achieved certain reforms in welfare this year, Medicaid -- which is much more costly than other general welfare programs -- went untouched. Medicaid provides health assistance to the poor.

• While 12.8 million people receive benefits under the Aid to Families with Dependent Children program, Medicaid covers 37.5 million.

• The three largest welfare programs -- AFDC, food stamps and Supplemental Security Income -- cost $77 billion per year, compared to $156 billion for Medicaid.

• On average, the proportion of states' budgets devoted to welfare is 4 percent, while Medicaid eats up 19.2 percent.

• Combined state and federal spending for Medicaid consumes nearly 20 cents of every tax dollar.

Republicans believe that states can do a more efficient, cost-effective job, and want to turn management of the programs over to them. President Clinton wants Washington to retain control.

To the extent they can get exemptions from federal rules, the states are deciding what health and nursing-home care to provide to whom, and at what cost. These hard choices are necessitated by the explosion in Medicaid coverage and costs.

• The Medicaid caseload has grown from 10 million in 1967 to today's 37.5 million.

• Costs have skyrocketed from $5 billion in 1970 to $156 billion last year.

Sixteen states plan Medicaid reductions in their 1997 budgets.

• California plans to eliminate nine optional classes of benefits.

• Florida plans to move more nursing home residents into community-based settings.

• New York, the state with the most generous Medicaid program, plans to scale back its commitment to managed care.

Many states are opting to cut back on managed care, since about one-third of all recipients are in managed care plans. Other ways states attempt to control costs:

• Iowa put mental-health services up for bid at no more than 86 percent of current per-person expenses -- thereby immediately saving 14 percent of expenditures.

• Michigan put 80 percent of its Medicaid clients into managed care and cut the escalation of costs from 11 percent to 1 percent in a year.

• Wisconsin has used home and community care for the elderly to cut its nursing-home population by 17 percent since 1980 -- even while it was rising by nearly 50 percent nationally.

Currently, 11 percent of Medicaid patients receive Medicare -- and consume 30 percent of Medicaid's costs. Medicare covers hospitalization, while Medicaid pays for long-term care. Federal rules prohibit managed-care plans from being forced on Medicare recipients.

Experts say Medicaid's complexity remains an obstacle to reform.