ANNAPOLIS -- They are the kinds of programs nearly everyone agrees make sense: They help people who can't help themselves. They save money. And they work.
Now, they're on Gov. William Donald Schaefer's hit list.
He says he doesn't have much choice.
Faced with a deficit he now believes could reach a half-billion dollars, certain the General Assembly will not raise taxes, and convinced the economy will not offer up even a modest boost in revenues, Mr. Schaefer warned yesterday that for short-term savings he may be forced to cut some of the programs that offer the best long-term results.
One of them now sends helpers into the homes of poor, frail, elderly Marylanders so they do not have to move into nursing homes at far greater government expense.
Another pairs poor people with specific doctors in an effort to decrease the rate of infant death, to discourage expensive hospital emergency room visits, and to encourage early screening of children for various medical ailments. By most measurements, the program has been successful and cost-effective.
But Mr. Schaefer, discussing budget problems at a State House news conference, said both are likely to be cut if he's forced to develop unilaterally a plan to trim the deficit.
He made no demands on the General Assembly, neither asking it to raise taxes nor appealing to lawmakers to return for a special session inthe fall. He merely said, "It would make it easier if we had more latitude than we have."
Yet it was the kind of warning sure to attract public attention and keep the heat on legislators to join him in the unpleasant business of cutting state spending for what will be the eighth time in three years.
Sen. Barbara A. Hoffman, a Baltimore Democrat who is the vice chairwoman of the Budget and Taxation Committee, said, "The Senate is not just sitting still. We are going to start meeting very shortly in small groups to start talking about what we think the appropriate action is. The governor is going to need legislative authority to do some things."
House Speaker R. Clayton Mitchell Jr., a Kent County Democrat, agreed that the legislature intends to become fully involved in the budget-cutting process. Mr. Mitchell said he already has spoken with Mr. Schaefer about some ideas for cost savings.
Restructuring and streamlining government, including the possible merger of major state agencies such as the departments of Agriculture, Natural Resources and Environment, or melding the Department of Personnel into the Department of Budget and Fiscal Planning, are ideas that will be put on the table, he said.
"It's time we looked at it with a feeling of 'Let's do it and not just talk about it,' " Mr. Mitchell said. "It has to be done."
Mr. Schaefer broadly praised the state health department program designed to improve medical care for the poor by matching medical assistance recipients with individual doctors or clinics. The program emphasizes preventive care in an effort to avoid the more costly care required once someone becomes ill.
Under the program, said Health Secretary Nelson J. Sabatini, fewer medical assistance recipients are entering the hospital even though the program's rolls have risen. The number of emergency room visits are growing at a rate much slower than the growth in enrollment, and preventive screening for children has increased 58 percent while the medical assistance population has grown by just 15 percent.
Maryland has dropped from seventh in the nation in the rate of infant deaths to 14th, an indication that early intervention is beginning to result in the birth of more healthy babies, Mr. Sabatini said.
Nonetheless, Mr. Schaefer said,"That program, right now, there's good chance Nelson won't be able to continue it."
He said the same is true with the Senior Care program run by the Maryland Office on Aging. It now helps about 3,000 elderly poor, and another 600 are on a waiting list. Spokesman N. Gary Tavin says it costs the state about $3,000 a year to care for each person. It would cost the state about $11,000 a year if the person were forced into a nursing home and Medicaid paid the bill.
Told of the governor's proposed cuts, Ms. Hoffman remarked, "That's really counterproductive. The last thing that should be cut is anything that could be called a preventive service, and that includes education in my book."