RALEIGH, N.C. — Wake County commissioners Monday voted to formally oppose a proposal that would ask the state to take over Medicaid payments currently paid by the county.

Proposed by the North Carolina Association of County Commissioners, the plan calls for counties to give up 1 percent of their sales tax to help other, more rural counties pay for their health care.

North Carolina is the only state that requires counties to pay part of the bill for the federal Medicaid program. This year, the counties' share to provide health care to the poor is nearly $500 million.

Rural counties argue their Medicaid costs cripple their ability to pay for other essential needs. The proposal would benefit them the most because it would help ease the burden they face from soaring costs.

"The number one thing here is Medicaid relief," said Rebecca Troutman, director of Research and Public Technology for the Association.

"(Rising Medicaid costs are) an expenditure going up 10 percent a year, and our counties have no control of that," Troutman said.

In an urban county, such as Wake, however, leaders say that with millions of dollars taken away, they too would be crippled.

"For us, it would be a disaster; for those small counties, it would be a good thing," said Wake County Commissioner Betty Lou Ward.

Ward doesn't support the idea, despite being the past president of the Association.

Under the Association's proposal, Wake County would give up $70 million in sales tax for its $19 million Medicaid payment -- a loss to the county of $51 million.

The idea would then allow counties to then enact an additional-penny sales tax.

"They are going to take local money and then force counties to tax their citizens," said County Commissioner Joe Bryan. "Anyway you look at it, 7 to 8 cents is a tax increase."

The North Carolina Association of County Commissioners votes on the proposal Thursday. If passed, the plan still needs legislative approval.