The start of Alabama’s next legislative session is six days away and a member of Limestone County’s legislative delegation is forecasting rough seas on the horizon.

State Rep. Lynn Greer, R-Rogersville, said time is of the essence to figure out how to permanently fund the state’s struggling Medicaid program, which serves about 1 million Alabamians. Greer said Medicaid needs $869 million, though $15 million in BP funds will be used in 2017 and $105 million in 2018.

Medicaid Commissioner Stephanie Azar on Monday called those funds a “god send” for the program. However, she said Medicaid faces a “train wreck” in 2019 without new revenue.

Looking into the future, Greer predicted Medicaid costs could hit the $1 billion mark in 2019.

“I think we’re going to be looking at some major tax measures,” Greer said.

The topic of Medicaid was front and center during legislative budget hearings in Montgomery on Monday, which Greer attended. The state has been working on a plan to shift Medicaid recipients over to managed care provided by Regional Care Organizations but pushed implementation back to Oct. 1 because of funding concerns.

The RCO plan was dependent on a Section 1115 Demonstration Waiver and the promise of $328 million in federal funding over the next three years to implement the RCO plan. State officials previously said about two-thirds of Medicaid patients, or about 650,000 people, would receive care through the new system.

Lawmakers approved the shift to managed care in the hope it would slow the growth of Medicaid expenses.

Azar told lawmakers that federal Medicaid officials will withdraw the waiver if the state does not implement the regional care program by October.

“We are at a crossroads at the program. We can’t implement it any farther than Oct. 1. and funding, obviously, remains an issue for the program and our Medicaid program in general,” Azar said.

She said the state Medicaid program will need an increase of about $44 million in the budget lawmakers will begin writing in the session that begins next week.

Azar said she did not know what changes the Trump administration will bring to Medicaid. Greer said the state could benefit if Trump’s promise of block grants holds true.

“It would allow us to decide how to fund the programs and we could make the rules,” Greer said of the benefits of block grants.

— The Associated Press contributed to this report.