AUGUSTA — A budget to support MaineCare services at hospitals and clinics failed for a third time Thursday, falling two votes short when Republicans again called for additional changes.

The 22-10 vote, which is less than the two-thirds needed for passage, means the state will not immediately get an infusion of $118 million to fill a gap in MaineCare, the state’s Medicaid program.

That in turn means the Maine Department of Health and Human Services will continue to cap payments to hospitals and others who provide services to 400,000 Mainers.

“The refusal of Senate Republicans to support the bipartisan agreement on the supplemental budget is harmful for Maine health care providers and their patients," Gov. Janet Mills said in a statement issued Thursday. "Providers have said loudly, and clearly, that this stalemate is endangering their finances and will impact care for vulnerable people all around our state. Yet instead of paying hospitals, nursing homes, and other health care providers what they are owed, Senate Republicans have put them at even greater risk.”

During floor debate, the Republican holdouts said they want systemic changes to MaineCare before they will support any bill to fill the spending gap.

Sen. James Libby (R-Standish) said he also has concerns about General Assistance spending, saying that Portland gets a disproportionate share of the funds leaving his 13 communities with very little.

“The fact is that the so-called amendment compromise gives the 13 towns in my district nothing,” he said. “I have nothing to vote for.”

Earlier this week, Senate President Mattie Daughtry (D-Brunswick) offered an amendment to the bill in hopes of winning GOP support.

It directed the state to pay cost of living increases to direct care workers, limited General Assistance for certain types of housing expenses to 12 months in a 36-month period and required annual training for local General Assistance administrators.

It also set aside $250,000 in state funds — to be matched by $250,000 in federal funds — for a third-party review of MaineCare.

The budget also earmarks $2 million to fight spruce budworm which poses a threat to northern forests.

Democrats implored their Republican colleagues to set aside their opposition and vote for the budget to keep hospitals and clinics open. Sen. Cameron Reny (D-Bristol) said most people who rely on MaineCare are senior citizens, children and people with disabilities.

“These emergency items are not luxuries, they are lifelines,” she said. “This is not a partisan issue. It’s about making sure health care doesn’t collapse.”

Sen. Rick Bennett (R-Oxford) was one of only two Republicans to support the budget. He said things happening at the State House are different from what matters to everyday Mainers.

“In the world out there, we have over 400,000 Mainers relying on a sustainable MaineCare program for their critical health care needs at a time of disruption,” he said. “Under the State House dome, we lurch along from one manufactured fiscal crisis to the next adding to the havoc.”

At several points during the debate, Republicans asked Democratic leadership for assurances that they will include them in passing the much larger, two-year state budget.

That $11.6 billion spending plan covers all state spending for the next two years. But while two rank and file Democrats offered their assurances of working in a bipartisan way, Democratic leaders did not answer the question.

Assistant Senate Minority Leader Matt Harrington (R-Sanford) also accused Democrats of intentionally scheduling a Thursday session when they knew three Republican senators were not available.

“It was the Democrat way or the highway, as always Democrats are choosing exactly what they want to do,” he said.

He said Republicans have been clear about what they need to support the MaineCare budget, with various members floating ideas such as adding a work requirement for “able-bodied childless adults” or putting in measures to reduce the number of enrollees.

“We are not going to bail out a welfare program that is failing,” he said. “We find ourselves here playing a game of chicken.”