It's the governor's duty to submit a balanced budget to the General Assembly every year. Gov. Martin O'Malley claims he has done so. However, his budget is only balanced because he assumed the presence of $389 million in federal Medicaid funds that have yet to be appropriated -- and will likely never materialize. Counting on this nonexistent money is a poor way to write a budget, but it's the inevitable result of the failure to confront out-of-control Medicaid spending.

The reason O'Malley resorted to shady bookkeeping to balance the budget is because spending on the state's medical care programs, of which Medicaid is the largest one, is increasing rapidly.

Total Medicaid spending has increased by 29 percent, but state-only spending on Medicaid has actually decreased. This is because of temporary federal actions to increase the matching rate for Medicaid. O'Malley is counting on this to occur again, although legislation to do this has cleared neither the House of Representatives nor the Senate.

There is every reason to think the governor's spending proposal for these programs will be too low. In the past, more often than not Medicaid has come in over budget. This is mainly due to Medicaid being an entitlement program -- anyone who meets its qualifications is entitled to receive coverage. That makes it difficult to predict how many people will be using government care in any given year.

Spending has increased dramatically in recent years and will continue to do so because those in Annapolis lack the political will to reform a broken system.

Instead of looking for ways to control Medicaid's growth, the governor and legislators expanded the program in 2007.

While other states, such as Florida and Georgia, were restructuring their Medicaid programs to contain costs, Maryland policymakers preferred to ignore the problems in the system.

Without Medicaid reform, Maryland will continue experiencing budget difficulties, especially during recessions. The refusal of O'Malley and the General Assembly to address Medicaid's structural problems has resulted in the budget trickery we see this year. The governor rightly deserves condemnation for his reliance on nonexistent federal funds, but state policymakers deserve even more condemnation for their continual refusal to fix Medicaid's spending problems.

Marc Kilmer of Salisbury is a senior fellow at the Maryland Public Policy Institute, a public policy think tank based in Rockville, Md.