NORTH BAY - Budget plans approved by three North Bay counties paint a grim a picture for the region's public health care network as programs bear the brunt of reductions, reorganization and/or elimination.

But local leaders say the cuts are just the beginning of a much larger compression of the safety net expected from the state's continued financial crisis.

"The budget approved by the Napa [County] Board of Supervisors is almost a placeholder because it does not incorporate the cuts we will undoubtedly incur from whatever the state decides with its May revision," said Health & Human Services Director Randolph Snowden in Napa, where the board approved a 7.7 percent budget reduction.

In the last two weeks, boards approved county spending plans for the 2009-2010 fiscal year beginning July 1, all of which included major reductions primarily as a result of cuts made on the state and federal level this year as well as reduced income from sales taxes and vehicle license fees.

Without a finalized state budget, each county has prepared further reduction scenarios that will trigger once legislators agree on a May revise, which could be as late as September considering last year's lengthy debate.

"The changes we are making now we are doing with the knowledge that the cuts on the state level will not just have a one- or two-year impact. It will be a long haul to close a $24 billion budget gap," said Marin County Director of Health and Human Services Larry Meredith.

As of result of a history of  conservative spending, Marin proposed the least number of reductions with its most recent budget approved June 16, fewer than its two closest neighbors. The board approved reducing the $435 million budget by $8.5 million, or less than 1 percent, though the health department will lose about 3 percent of its funding including reductions to aging and adult services and alcohol, drug and tobacco programs. All departments will also undergo the largest restructuring effort ever completed.

"The plan the board approved really squeezed the last maneuverability of the department, and without other changes we will not be able to mitigate the effects of reductions we know are coming on a state level," Dr. Meredith said.

Marin leaders expect to lose another $20 million in state funding with the revise. The board will continue budget hearings next month to debate a proposed $3.4 million in additional cuts, which would be another 3.1 percent reduction to health and human services.

In Napa County, the Board of Supervisors approved a $291.8 million budget last week, shedding about $4 million from last year's finances and eliminating about 25 positions. Health and human services incurred the largest cutbacks, including the elimination or reduction of several programs for family planning, mental health, drug and alcohol counseling and a program for the elderly.

The Sonoma County Board of Supervisors on June 16 approved the reduction of 40 positions in the health care department and a budget decline of about $6.7 million. Children's medical services, disease control and the alcohol and drug division will be among services that lose capacity.

Additionally, if the May revise goes forward as written, the health department estimates it would lose an additional $17.3 million in state and federal matching dollars and have about $12.9 million in payments deferred for several months.

Among the changes suggested in the state budget, the plan could eliminate CalWorks - which impacts alcohol, drug and mental health program funding - reduce Medi-Cal drug assistance by 10 percent, cut mental health managed-care payments and early-diagnosis treatment. The governor has also suggested removing the Healthy Families program for low-income children's health coverage.