Gov. Mark Sanford's plan to change the Medicaid program was met by a steady drumbeat of skepticism at a public forum Tuesday night.

The meeting was one of several across the state hosted by the South Carolina chapter of the NAACP to elicit public input on the proposal, which calls for sweeping changes including establishing personal health accounts that beneficiaries can use to buy their own insurance from state-approved plans. About 100 attended.

Sanford says change is necessary to rein in growth of the $4.5 billion health care program -- $1.16 billion in state money -- which now covers nearly one in every four state residents.

Opponents say the changes could leave poor, sick people with reduced services, and argue beneficiaries may not be able to navigate proposed self-managed plans.

Deirdra Singleton, an attorney with the state Department of Health and Human Services, said Medicaid now consumes 19 percent of the general fund, a number that will climb to 29 percent in a decade without action.

"It would be fiscally irresponsible if we did not do something," she said.

But City Councilwoman Lillian Brock Flemming said she's concerned the changes will increase the number of uninsured in the state, which last year grew to 14 percent of the population, according to Susan Berkowitz, an attorney with the South Carolina Appleseed Justice Center.

Flemming also said many changes could be implemented without seeking a waiver from federal Medicaid regulation, such as managed care plans and primary care homes for beneficiaries to save money.

"What I heard tonight is there are things they know will make a better plan," she said. "Well if they know it works, why aren't we doing it?"

John Ruff, research director for South Carolina Fairshare, a consumer advocacy group, said the waiver will shift the burden of spending from the federal government to South Carolina, putting the state at financial risk.