The state health department has drafted a $480 million list of potential program cuts that, if enacted, would deprive thousands of children of free health insurance coverage and shutter four mental health facilities, and could force women to pay for their own laboratory tests after rapes, according to documents obtained yesterday by The Sun.

"It basically tells people if you are sick, leave the state," said Sen. Paula C. Hollinger, a nurse and chairwoman of the Senate Education, Health and Environmental Affairs Committee. "It's like taking health care off the respirator and saying goodbye."

The Department of Health and Mental Hygiene developed the list in response to Gov. Robert L. Ehrlich Jr.'s request that agencies devise ways to cut spending by 12 percent.

The elimination of programs, the governor has said, is the only way to close a projected $800 million budget deficit without raising taxes.

The governor and his aides said they had hoped to keep the proposals confidential, issuing a gag order last month that prohibits agencies from sharing budget requests with legislative analysts. Yesterday's leak violated that order.

"You hope that everyone within an administration would be on the team," state Budget Secretary James C. "Chip" DiPaula Jr. said. "There is a question now that somebody might not be."

Because an improving economy could make many cuts unnecessary, Ehrlich staffers said they hoped to avoid the kind of outcry that followed the leak of the health department's budget planning document yesterday, as lawmakers and health advocates digested the scope and specificity of the reductions under consideration.

"These cuts are just immense and are devastating to public health, not just in Baltimore but in the entire state," said Dr. Peter L. Beilenson, the Baltimore health commissioner.

The proposal would eliminate health programs for at least one in six city residents, he said.

DiPaula would not comment on the list, saying he has yet to receive submissions from the health department.

Ehrlich is months away from making final budget decisions before he submits his next spending plan in January, DiPaula said.

"It's unofficial, if not fake," he said. "How can [The Sun] have something that we don't have?"

But outgoing state Health Secretary Nelson J. Sabatini acknowledged that he asked his staff to identify programs not mandated by federal or state law that could be eliminated.

To meet Ehrlich's request for a 12 percent cut, the health department has to identify about $430 million in programs, $50 million less than what the draft list contains, he said. The department's $3 billion-plus in general state funds is supplemented by about $2.5 billion in federal funds.

"[DiPaula] has repeatedly said you can't get to the level of reductions that we are going to be facing by nibbling at the margins anymore," Sabatini said.

Last spring, Ehrlich launched a review of agency spending by asking managers to complete a "strategic budgeting guide," identifying less-than-critical programs in the state's $24 billion budget that could be eliminated.

The health department proposals include eliminating a popular health insurance program for children and pregnant women to save $47 million, and abolishing health care for medically needy Medicaid recipients to save $115 million.

Another proposal would curtail a sexual assault evidence collection reimbursement program, which a department budget planning document warns "could lead to victims being billed, thereby creating a barrier to care."

"Can you imagine a rape victim being charged for evidence collection?" Beilenson said. "I cannot believe anybody would even remotely consider such an inhumane budget cut."