MONTGOMERY (AP) — The Alabama Senate on Thursday approved a lean general fund budget that would mean cuts in Medicaid services— and halt a long-planned reform to managed care — if it wins final approval.

Senators approved the $1.8 billion appropriations bill on a 24-10 vote, sending it to the Alabama House to start what is expected to be a lengthy negotiation.

The Senate-passed budget provides level-funding to most agencies, including Medicaid. It does not provide the additional $100 million that Medicaid Commissioner Stephanie Azar said was needed to maintain services and continue a transition to a managed care system.

Sen. Trip Pittman, chairman of the Finance and Taxation General Fund Committee, said he thought it was important to “frame the debate” around Medicaid.

“Medicaid is an important part of our health care system and we’re going to have to decide how we are going to find additional funding for Medicaid or suffer the catastrophic consequences of cutting $100 million and also taking off the table the waiver,” Pittman said during the debate.

Pittman said it was impossible to provide the additional money to Medicaid without deep cuts that would “cannibalize” other state agencies for the sake of Medicaid.

The Centers for Medicare and Medicaid this year approved Alabama’s waiver request to alter its Medicaid program from the traditional fee-for-service health care delivery model to managed care. That would involve 11 regional care organizations providing care and case management services for patients. Alabama promised in the agreement to maintain adequate funding for Medicaid.

Sen. Rodger Smitherman, a Democrat from Birmingham, said he feared the Medicaid reductions could become reality, a view shared by advocacy groups for the poor.

“Medicaid insures many of the most vulnerable Alabamians: children, seniors, and people with disabilities. As the budget debate goes forward, we hope lawmakers will be careful not to send patients a message that their basic health care could be at risk,” Arise Citizens’ Policy Project executive director Kimble Forrister said in a statement.

Legislators have so far rejected a proposal by Gov. Robert Bentley to shift some education dollars to the more cash-strapped general fund.

Senators also rejected a proposal to restore a 2 percent pay raise for state employees that Bentley had sought. Senators tabled the proposal on an 18-14 vote after senators raised concerns about affording the raise in a budget struggling to fund agencies.