North Carolina is trying to squeeze savings out of Medicaid, even as more people than anticipated sign up for coverage under the government health-care program for the poor.

So far, the cuts primarily mean that doctors and hospitals are being paid less for their services, but state officials and others are warning that cuts to medical services and significant job losses in health care could be looming.

Cuts ordered by the legislature this year could mean that Medicaid, which is funded jointly by federal and state government, will lose $1.5 billion this year.

Those cuts have touched nearly all areas of health care. Doctors and hospitals are being paid less to treat Medicaid patients, and the state is spending less on community mental health and personal care services for the elderly.

Meanwhile more people are asking for help. About 8,000 more people than legislators budgeted for were signed up for the government insurance program in August, and September enrollment was 3,000 people higher than anticipated.