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Nursing home and hospital officials say deep cuts to the state's Medicaid system could lead to layoffs at facilities throughout the commonwealth.

The threat of having to cut thousands of health care jobs is part of a nursing home and hospital lobbying effort to persuade lawmakers to support an increase in the state's cigarette tax. Gov. Tim Kaine proposed doubling the cigarette tax to 60 cents per pack, raising an estimated $148 million for Medicaid.

Because state Medicaid contributions are matched dollar for dollar by the federal government, the total amount in potential Medicaid funding is about $300 million.

As the debate over the cigarette tax increase intensifies, the Virginia Hospital & Healthcare Association released new data suggesting that without that additional money, 11,314 jobs may have to be trimmed.

The association, which represents 46 hospital systems throughout the state, says its members would likely have to cut 4,532 jobs. Including health care jobs not represented in its membership, the association argued that number could jump to 6,321.

The indirect economic impact on other sectors brings the total in potential job cuts to 11,314, said Chris Bailey, a senior vice president of the association.

Nursing home advocates argue even if the cigarette tax increase is approved, job cuts could still occur given the low rate of Medicaid reimbursement.

"We see it as a public-private partnership that has been broken," said Steve Morrisette, president of the Virginia Health Care Association, which represents nursing home and assisted-living facilities. "The state has not fulfilled its obligation to take care of these patients."

Morrisette said nursing homes are at "a breaking point."

"You try and cut everything that isn't people that you possibly can, but at some point you have to pay for the food and you have pay for the electric bill," he said. "People are the last place that you want to go, but given the dire situation that could be presented to us come July, that could happen."

About 63 percent of all residents in Virginia nursing homes are on Medicaid, Morrisette said.

Many say a poor economy has already led to increases in uninsured, underinsured and the number of people enrolling in Medicaid.

Ted LeNeave, president and chief executive officer of American Health Care, said he's already preparing for the ramifications from low Medicaid reimbursements.

American Health Care laid off four employees at its Roanoke corporate offices, and LeNeave said he will likely announce this week a wage freeze for the year affecting all 2,200 employees.

"I doubt anyone will tell you the big scare is quality care will be impacted," LeNeave said. "Nobody wants to go on record to say that. ... But when is the point that you can't take anymore cuts before the resident will start feeling the effect?"

LeNeave said he is also worried that quality of life of residents could be affected as nursing homes consider trimming extra programs such as entertainment activities.

Bailey agreed that even if the cigarette tax increase is approved, job cuts could still occur.

"The pressure is already being faced," Bailey said.

Officials at Carilion Clinic and HCA Southwest Virginia said it was too soon to comment on what the local consequences would be if the additional cigarette tax is not approved.

"I don't have a sense if we would have additional job cuts," said Victor Giovanetti, president of HCA Southwest Virginia and chief executive of Lewis-Gale Medical Center. "The biggest concern is for those individuals who are covered by Medicaid. This is an essential safety net for the most vulnerable."

Similarly, Carilion Chief Operating Officer Nancy Agee said, "It's very hard to answer in the abstract."

Agee, who is also president of the hospital association, said Carilion has no plans for job cuts but called the association's efforts "very useful."

The hospital association estimated about 900 jobs would be cut by its members in Southwest Virginia if the cigarette tax increase fails.

About 11 percent of the patient care provided at Carilion's Roanoke hospitals is Medicaid, and between 9.5 percent and 10 percent of Lewis-Gale's patient population is Medicaid.