The Mississippi Senate on Tuesday approved a bill to eliminate the bulk of the $148 million Medicaid deficit by using money from the tobacco trust fund along with cost-saving measures.

After nearly three hours of debate, the Senate voted 33-15 to modify a House-passed bill. Lawmakers expect to make more changes before the session ends in April.

House Bill 1200 is now expected to go to a conference committee where House and Senate members will seek to work out differences between the two chambers.

"Let's hope we can keep it afloat. It's the last train leaving town," said Sen. David Jordan, D-Greenwood, minutes after the Senate vote. "We can't let the Medicaid program die."

The federal-state program serves about 650,000 Mississippians.

The bill calls for using $87 million from the principal of the Health Care Trust Fund this year and $21 million from the Health Care Expendable Fund. Next year's tobacco payment, about $144 million, also will be used for the deficit. The money is to be repaid during better economic times.

Also, Medicaid recipients would pay $3 instead of the current $1 for each prescription. The number of prescriptions per month per Medicaid recipient would go from 10 to seven.

The Senate version allows a Medicaid recipient to get more than seven prescriptions if a doctor certifies a drug is needed to treat a life-threatening condition.

The reduction in the number of monthly prescriptions was designed to save $5. 4 million.

State-paid fees to doctors, nursing homes and other providers would be cut 5 percent to save $23 million.

The bill also provides for one pair of eyeglasses for recipients every five years instead of every three years. And it requires the Medicaid division to reimburse only for prescriptions that are 34-day supplies based on daily dosage.

Also, the dispensing fee would go from $4. 91 to $3. 91 for each new or refill prescription.

The Senate eliminated a House-adopted provision that reduced the reimbursement of pharmacists' costs for acquiring drugs. Medicaid officials said the provision would have saved $3. 5 million.

The Senate changes produce an annual $39. 7 million state savings in Medicaid.

If nothing is done, Medicaid "will run out of money," Senate Appropriations Committee Chairman Jack Gordon said during floor debate. "We've got to get a Band-Aid for 2002 and a tourniquet for 2003."

A big part of the financial squeeze for the state Medicaid program is that "we didn't anticipate 100,000 people coming on board in one year," Gordon said.

Mississippi's Medicaid shortfall isn't unique, program director Rica Lewis-Payton said. Thirty-three of the 50 states have Medicaid shortfalls, and officials in neighboring Arkansas are among those looking at trying to tap into tobacco trust funds, she said.

Senators defeated 37-13 a proposal from Sen. Mike Chaney, R-Vicksburg, to take $20 million from Attorney General Mike Moore's Partnership for a Healthy Mississippi. Moore, who was on the Senate floor during the debate, has a court order from a Jackson County judge to use the money.

Chaney's proposal was to try to stop money from going to the partnership and to put it into Medicaid, where he said it could generate a 3-to-1 match from the federal government.

With the bill likely to wind up in conference, "there could be radical changes" in coming weeks, said Rep. George Flaggs Jr. , D-Vicksburg. "Anything can happen now."

In other action Tuesday, the House defeated a bill to remove the three-day waiting period for couples who want to get married. The vote was 67-54 against House Bill 766.

Some lawmakers wanted to address the problem of Mississippi residents crossing state lines to marry because there are no waiting periods in neighboring states.

But some lawmakers raised concerns that removal of the waiting period may cause some people to make rash decisions they may later regret.