ALBANY – Disagreement among state legislative leaders heated up inside the Capitol yesterday even as hundreds of health care workers rallied in freezing temperatures outside the building in opposition to Governor Pataki’s proposed changes to Medicaid.

Mr. Pataki wants to lower reimbursement rates to health care facilities, increase assessments on nursing homes and hospitals, and create a commission that would review facilities across the state for possible contraction or closures.

These and other proposals are part of the governor’s plan to prevent state Medicaid spending from growing an additional $837 million this year and a projected $1.4 billion next year. The state spends 37% of its budget on the entitlement program for the poor and disabled and is under increasing pressure from local politicians to stem its growth.

But delivering reforms won’t be easy.

The governor’s proposals, aimed at limiting growth rather than cutting spending, were enough to drive more than 2,000 hospital and nursing home workers to Albany and incite Assemblyman Sheldon Silver, the Democratic leader of the Assembly, to angry outbursts at the sixth leadership meeting since Mr. Pataki outlined his budget in January. Mr. Pataki, in an effort to pass a budget on time for the first time in New York since 1985, has urged the Senate and Assembly to pass budget bills this week so conference committees can negotiate differences over language before the April 1 deadline. Senator Joe Bruno, the majority leader of the Senate, has agreed to the request. Mr. Silver has not.

At yesterday’s meeting, Mr. Silver fulminated over parts of the executive budget in which policy changes were wrapped into the appropriations bill. Demanding that the policy language be removed, Mr. Silver charged that Messrs. Pataki and Bruno had crafted a Republican version of the budget in private.

Mr. Pataki said Assembly staff members have repeatedly rebuffed efforts by his staff to negotiate. “It’s simple!” Mr. Silver shot back. “We could do it right here. We don’t have to do it in the middle of the night.”

The leaders’ meeting came three hours after Messrs. Silver and Bruno assured a convention center packed with health care workers that Mr. Pataki’s planned changes to Medicaid would not make it through the budget process. Many in the cheering crowd showed their approval by waving signs that read: “Warning: The governor’s healthcare taxes and cuts are hazardous to your health.”

Daniel Sisto, president of the Healthcare Association of New York State, an advocacy group that represents more than 550 nonprofit health care organizations, said he was “very encouraged” by the public statements of Messrs. Silver and Bruno. Mr. Sisto also said county executives have assured him privately that they do not approve of the governor’s proposed Medicaid reforms. Counties are responsible for covering 15% of the state’s Medicaid costs.

“There are many aspects of how Medicaid can be changed, but cuts and taxes on hospitals and nursing homes are not reforms,” Mr. Sisto said near the eastern steps of the Capitol in winds reaching 27 miles an hour.

When told that Messrs. Bruno and Silver had declared the cuts dead on arrival, Mr. Pataki said he is willing to listen to alternative reforms. “It’s easy to criticize,” he said. “It’s harder to solve problems. And that’s what the people of New York want us to do.” Anticipating a request from the Legislature to spend $885 million in newly projected state revenues, Mr. Pataki said the money should be saved instead.