New York Gov. David A. Paterson has presented a plan to trim $1 billion from the state's budget that includes cutting spending on Medicaid assistance. By proposing a $500 million reduction in the Medicaid budget, Paterson may have a confrontation with the state's hospital lobby and healthcare unions. Kenneth E. Raske, president of the Greater New York Hospital Association, said the cuts were possibly "the single most damaging budget proposal I've seen in my career."