Fulton County officials gave Grady Memorial Hospital a break —and a heartbreak— Wednesday, providing the cash-strapped medical center with a $30 million advance in funding but declining to back a $200 million loan.

The good-news/bad-news decisions by the Fulton Board of Commissioners arrived a week after the board budgeted Grady some $24 million below last year's funding level.

The board's actions Wednesday do not change that annual funding of $80 million, but board members approved advancing the hospital a significant amount ahead of the usual payments.

Stressing that Atlanta's charity hospital is in desperate need of cash, Fulton chairman John Eaves said, "I think they need the cash flow. And this is a way to send a positive signal."

Grady officials said the $30 million advance, expected to be delivered shortly, will help provide critical resources as the hospital board prepares to hand over management to a new nonprofit group. That transfer of power, coming after months of pressure from state and business leaders, is expected to spur millions of dollars in aid from the state and the philanthropic community.

"It covers the gap," said Grady board member Richard Teters. He said the money will help Grady avoid "another crisis."

Fulton County, which helps Grady pay for indigent care, provides about 11 percent of Grady's overall budget of $730 million. For several years, that funding has remained flat at about $84 million, but last year the county gave Grady an emergency allocation of $20 million more.

At Wednesday's meeting, about 60 medical students and residents who work at Grady implored the Fulton commissioners to increase funding to Grady.

"We are ready to give 100 percent of ourselves to Grady," said Dr. Joyce Akwe, an internal medical resident at Morehouse School of Medicine. "Please don't let us down."

Eaves, the Fulton chairman, said he sees little hope of the board reversing its budget decision soon, especially considering Fulton has a tight budget this year.

The commissioners rejected Grady's request to back a restructuring of its long term bond debt, which hospital officials had hoped would bring an extra $200 million to the medical center. Grady officials say they need the support of either Fulton or DeKalb officials to obtain the financing.

Commissioner Nancy Boxill, who proposed the move Wednesday, said it would help the hospital without increasing Fulton's annual budget.

But several commissioners said the move would be premature, that they first want Grady to renegotiate its contract with Fulton. They were also worried about the increased financial risk to the county, should Grady fail.