COLUMBIA, S.C. (AP) — The director of South Carolina’s Medicaid agency told state senators Wednesday that whether they support or oppose federal health care reform, they need to get ready for costs associated with the government health insurance program to increase rapidly.

Department of Health and Human Services Director Tony Keck said his agency estimates the changes mean about 200,000 more people will join the 1 million adults and children in the state already using Medicaid. And he warned lawmakers that he can’t guarantee the numbers won’t be higher.