California risks losing billions in healthcare dollars if the state and federal governments can't agree on a waiver to fund reforms of the Medicaid program, hospital officials and experts said. Public hospitals throughout the state are counting on the $7.25 billion in state and federal funds to treat large numbers of low-income and uninsured patients. The current waiver, which took effect in 2010, expires on Oct. 31, though the federal government can grant an extension while negotiations over the plan continue. The state and the federal government have been negotiating since March, when California submitted a plan called Medi-Cal 2020. The CEO of the California Association of Public Hospitals said one of the sticking points is how long a provision would pay for changes in how public hospitals deliver care would last, with the state proposing five years and the federal government offering only three. Disagreements also exist over how hospitals should be paid to care for uninsured patients. The state wants to have the flexibility to use the money for more primary and preventive care rather than just to pay for ER visits and hospitalizations. Medi-Cal 2020 also includes money to improve dental health programs, to expand the number of providers treating Medi-Cal patients and to start pilot projects addressing social problems of high-need patients.