Despite the crushing tax burden Medicaid imposes, little has been done to bring the costs under control.

While other states have taken steps to trim costs, Gov. George Pataki and the Legislature have failed to agree on what to do in New York. Lawmakers last year rejected a Pataki plan to limit the choice of drug brands for recipients to enable the state to save money on bulk purchases. He's put forward that idea again this year along with a list of other cuts. The package, worth about $1.25 billion, has gotten a cool reception from lawmakers.

Democrats point out that Pataki's active encouragement of expanding the Medicaid rolls over the past few years is a major reason for the current crisis, and that only two years ago he signed an election-year deal with an influential union that added billions to health-care costs.

A task force Pataki appointed last year came up with widely praised ideas for overhauling the system, some of which have already been implemented in other states. But any cost savings from those recommendations are at least a few years away.

The big expense in Medicaid is paying for long-term care — for people like DeWitt, a former seamstress who loved to swim and ice-skate in her hometown of Troy until just a few years ago.

Three levels of government split the cost of her care: Washington pays almost $31,000, the state almost $22,000 and Rensselaer County about $5,000 through Medicaid.

The price tag for the 3.7 million New Yorkers (one in every five residents) covered by Medicaid is helping to widen the state budget gap and, along with similar problems in other states, balloon the federal deficit. But the impact is being felt most acutely at the county level, where spiraling Medicaid costs are driving double-digit property-tax hikes and sales-tax increases.

"Medicaid is killing us,'' said Rensselaer County Social Services Commissioner John Beaudoin, sounding like county officials all over the state. Like many counties, Rensselaer, which has about 200,000 residents, spent every last dime collected in property taxes last year, about $31.5 million, on Medicaid.

And it's not just county budgets that Medicaid is devouring. The state portion of the Medicaid tab is expected to approach $14 billion next year — a total nearing state money spent on education, for decades the biggest state expense.

Even the federal government, facing record budget deficits, is looking for ways to slow the growth of the $280 billion program.