Ted Strickland and lawmakers negotiated a two-year state budget barely five months ago. Remarkably smooth, the budget process appeared to have set the governor on a path to advancing on a campaign promise to turn around Ohio.

A key part of the promise called for better health-care for Ohio's poor, for strengthening the safety net. The governor strongly advocated and lawmakers supported raising the income limit to permit more poor children to qualify for Medicaid, restoring dental coverage for indigent adults and increasing reimbursement rates to better compensate hospitals, clinics and physicians who care for the poor.

Strickland's decision on Monday to delay the reimbursement increases and dental coverage signals that in an important way, the turnaround isn't going to start just yet.

The changes were due to take effect Jan. 1. In explaining the retreat, Strickland cited rising caseloads since July (about 17,000 over the projected level). He pointed to the impact of such increases in Medicaid spending on the overall state budget.

Fluctuations in Medicaid enrollment and high costs are a constant source of worry. The projected cost of the dental coverage for adults and the payment increases to health-care providers amount to $65 million a year. Strickland advises caution while he monitors the state's finances.

Still, the decision is a striking and unexpected reversal. The quarterly Medicaid cost management report from the director of the Department of Job and Family Services earlier this month acknowledged the rising caseload, but it offered little indication the situation was approaching a level that would put the planned changes in jeopardy. Current enrollment in Ohio Medicaid, at 1.74 million including the rising caseload, is lower than it was a year ago at 1.76 million. According to the report, Medicaid spending overall in the first quarter of this fiscal year is about $2.3 million below budget.

Health care providers don't recover the full cost of services to Medicaid patients. According to the physicians association, Medicaid payments to doctors have been flat for seven years. The budget Strickland signed assured hospitals and health-care providers increases of 3.2 percent and 3 percent in 2008 to help make up some of their costs.

Not only does it break good faith to renege on the plans at this late date, the decision promises to weaken the safety net the governor wants to protect. Poor patients have a difficult enough time locating doctors and dentists willing to accept Medicaid payments. Shortchanged, more providers likely would leave the program. For their part, hospitals rack up high costs from overuse of emergency rooms. The governor jeopardizes his credibility with his abrupt switch.