Medicaid now accounts for slightly more than one-fifth of Virginia's general fund.
"Thus the time is now to dramatically reform the way we deliver medical services in Virginia to mitigate against and possibly reduce such future spending growth," he wrote. "As part of our Medicaid overhaul, we must act now to obtain the approval for the necessary reforms and flexibility from the U.S. Secretary of Health and Human Services."
"We have one chance to do this right," he cautioned.
McDonnell wrote his letter on the same day that Florida's Republican governor, Rick Scott, announced that his state would expand Medicaid coverage to roughly 900,000 more Floridians, a surprise decision from the vocal critic of Obama's health care reforms. So far, seven Republican governors have agreed to expand Medicaid under the overhaul.
Also on Wednesday, Virginia Tea Party Patriots Federation chairman Mark Daugherty warned McDonnell and Virginia's GOP-dominated General Assembly "not be seduced by the lure of federal funds in the short-term to expand Medicaid."
McDonnell's letter: http://www.governor.virginia.gov/utility/docs/20130220144607989.pdf