JEFFERSON CITY, Mo. -- Several other states already were using a creative technique to get more federal money when Missouri officials decided to try the same thing.
Because the federal government was considering a crackdown on the practice, then-Gov. Mel Carnahan wrote to President Clinton with a plea to approve Missouri's money request.
"Under Missouri's plan, every penny would go into the state's nursing home program," Carnahan wrote in a June 22, 2000, letter. "At a time when this industry is being asked to care for more and more vulnerable citizens, these funds would be a crucial step in the right direction."
The federal government granted Missouri a share of the money, dubbed in bureaucratic circles as "intergovernmental transfers," or even more bureaucratically as "IGT" money.
Since then, the state has received $340 million and expects to receive another $100 million before the federal government cuts off cash flow on Sept. 30.
But contrary to Carnahan's pledge, not every penny has gone toward nursing homes.
In fact, less than $1 of every $4 the state has received so far has gone to nursing homes.
Of the money still to come, the state Senate has proposed to use less than 5 percent to provide new funding to nursing homes. The House, in its version of the budget, proposed to use 10 percent for new nursing home grants.
Those percentages have prompted the nursing home industry to spend considerable time lobbying lawmakers -- generally to no avail.
"We are diluting the ability for nursing homes to take care of patients in the state of Missouri," said Earl E. Carlson, executive director of the Missouri Health Care Association, an industry group for nursing homes and long-term care facilities.
"We've got a budget crisis, granted, but ... it's patient care we're talking about," Carlson said.
It's precisely because of the budget troubles that lawmakers are proposing to use more of the money for other purposes.
For example, the Senate's proposed budget for the fiscal year starting July 1 called for $12.2 million of the money to help open a new prison in Bonne Terre and another $5.3 million to reimburse school districts for the costs of their bond attorneys.
House negotiators rejected some of the Senate's ideas as they settled differences in the chambers' two versions of the budget.
If not all the money is going to nursing homes, then the House has insisted that most of it should at least go to the Department of Social Services, which administers the state's Medicaid health-care program for the poor and disabled.
What the state needs this year is a balanced budget -- a task made tougher by lower-than-expected state tax revenue.
That's why even supporters of nursing homes are directing the money toward other purposes.
"The nursing home industry makes a point that they were the ones who came up with the idea to persuade the state to go after some IGT money," said Senate Appropriations Committee Chairman John Russell, R-Lebanon. But "they're not necessarily entitled to all of it."