As states struggle to tackle soaring budget deficits, the nation’s top health official is offering advice on trimming Medicaid costs, but says cutting people with disabilities from the program is a no-no.

In a letter sent to governors across the country on Thursday, Health and Human Services Secretary Kathleen Sebelius offered suggestions for Medicaid cost savings, pointing out that 40 percent of 2008 spending on the program covered benefits that are considered optional.

“I know you are struggling to balance your budget while still providing critical health care services to those who need them most,” she wrote. “I want to reaffirm the Obama administration’s commitment to helping you do both.”

Specifically, Sebelius said adjustments to prescription drugs, dental services, speech therapy and other similar benefits could help save money. States could also institute or increase co-payments, she said.

In addition, the letter highlights programs like the Community First Choice Option, which allow states to access more federal matching dollars, as a way to alleviate some state spending.

Under that initiative launching in October, states can receive increased federal matching funds if they agree to eliminate caps on the number of individuals with disabilities who can live in the community as opposed to institutional settings.

It remains to be seen, however, whether the alterations the administration is recommending would be enough to make a dent in many state budgets.

Meanwhile, disability advocates say they are concerned by the administration’s focus on curtailing optional benefits.

“‘Optional services’ is a misnomer,” Peter W. Thomas, a lawyer for the Consortium for Citizens with Disabilities, told The New York Times. “These items and services, which include artificial limbs, wheelchairs and kidney dialysis, are life-saving and life-sustaining. They improve functional abilities and the quality of life for millions of people.”