“I’m insisting on both,” he said.

Landes said that position will hurt local governments, which must complete their budgets by the end of April. “They can’t wait until July 1,” he said.

McAuliffe used his visit to hammer home the estimated $1 billion in projected savings to the state budget through 2022 by accepting federal money that could be used to replace state dollars for hospital indigent care, community mental health services, and medical care of jail and prison inmates.

Augusta Health said 20 percent of the people it treats have no insurance and an additional 20 percent rely on Medicaid, which does not pay the full cost of care. If the state does not take the federal money, “folks are still going to come,” McAuliffe said. “Some are still going to walk though the emergency room door, and somebody’s got to pay for it.”

The governor found a vigorous ally in Jeff Clark, a 61-year-old Waynesboro man who used to go to the Augusta Health emergency department twice a month for treatment that he had no health insurance to repay.

The hospital engaged him in a “medical home” program to treat his asthma and other chronic conditions outside the emergency room and helped him qualify for Medicaid as a disabled adult.