SACRAMENTO - Gov. Arnold Schwarzenegger's plan to restructure the state's mammoth health care program for the poor has finally been completed and is expected to be released next month as part of his proposed budget.

But, because the plans have yet to be submitted for federal approval, final action is months away, casting doubt not only on how much the effort might save taxpayers but when the savings will begin.

Medi-Cal, the state's version of the federal Medicaid safety net for the elderly, disabled and low-income children, serves nearly 7 million residents and costs about $30 billion annually in state and federal dollars.

Virtually since he took office last year, Schwarzenegger has said he wanted to restructure the program to control costs. Since 1999, Medi-Cal costs have jumped 45 percent largely due to an enrollment expansion that added 2 million patients.

Schwarzenegger's proposals have included such ideas as limiting who can qualify for services, requiring patients to contribute a co-payment toward their care as well as trimming the kinds of services that might be made be available.

Last year, administration officials estimated that such changes could save the state as much as $400 million annually.

Because the federal government is a partner in the program, the U.S. Department of Health and Human Services must approve the proposed changes.

Twice before, the governor has pulled back his restructuring program from federal review -- once last May and again in August. Both times, the administration said the program was not ready.

Although officials at the California Health and Human Services said their plan is now finished, it has yet not been submitted to federal officials, according to Mary Kahn, spokeswoman for the federal Centers for Medicaid and Medicare.

Indeed, because of the uncertainty over the status of the restructured program, Schwarzenegger's Finance Director, Tom Campbell, said last week that he is not recommending the governor count on significant savings from the effort as part of next year's budget plan.

Donna Kingwell, spokeswoman for California Health and Human Services Secretary Kim Belshe, said details of the proposed revisions will be released as part of the governor's 2005-2006 budget, which is expected to be made public Jan. 10.

Hospital administrators, physician groups and health care advocates said they are uneasy about the governor's plan because the administration hasn't shared any information about the latest proposal with them.

"We haven't talked to them in months," said Darryl Nixon, spokesman for the California Association of Health Facilities. "Like everyone else, we expected to see the new program with the new budget in January. That's what they said they were going to do when they pulled the plan in August. If it's not coming forward, that's news to us."

Last spring and summer, the administration spent weeks holding public meetings with interest groups about proposed changes to the Medi-Cal system.

Schwarzenegger himself called for simplifying the eligibility process to make it easier to manage. He also said he wanted to promote "personal responsibility" among Medi-Cal clients in deciding whether to seek care.

Toward that end, the administration proposed that imposing higher co-payments and limiting the choices of those who can pay the least. The administration also wanted a more restrictive system for managing care of the blind and disabled.

Rachael Kagan, spokeswoman for the California Association of Public Hospitals, said the stakes are enormous because included among the proposals are new funding mechanisms for hospital reimbursements for Medi-Cal services.

"At issue is $2 billion in federal money that keeps the doors open of public hospitals that serve the state's uninsured patients," she said. "That's what is being tinkered with."

Kagan said her organization worries that any plan from the governor will leave hospitals with less money while they provide more service. "Both the state and the feds are trying to contain their obligation for medical services. And that's troubling for institutions that provide service. There's a growing number of uninsured in this state and costs continue to rise."

Just because the Medi-Cal restructuring plan has not been approved does not mean that health care programs will avoid deep funding cuts in the upcoming budget, Campbell said. He said he's recommended to the governor methods for restricting the rate of growth in a number of programs.

"We been told to expect an ugly budget," said Anthony Wright, director of Health Access, a coalition of health care organizations. "We've heard that the cuts are deep and will cause people discomfort."