A medical assistance program "of last resort" and other "optional" programs may be among the first casualties in the Department of Health if proposed tax initiatives win voter approval in November.Because certain programs are federally mandated and therefore protected from state cuts, other programs will feel a greater impact should cutbacks be necessary, according to Dr. Suzanne Dandoy, Health Department director.

The Utah Medical Assistance Program (UMAP) is vulnerable because it is entirely state funded. The program, which has taken severe cuts recently, provides medical care for people who do not qualify for Medicaid or Medicare, but only if they face an acute, life-threatening or infectious medical condition.

To qualify, one must have an income below $289 a month and assets of $500 for an individual and $700 for a couple.

The department will decide by the end of the month which programs it will recommend for cutbacks or elimination, should it be necessary for fiscal year 1990 (when the initiatives, if passed, would take effect).

"UMAP is on the table right now because everything's on the table," Dandoy said. "Health, Social Service and Corrections programs take huge amounts of state revenue. We could wipe out everything else, with the exception of education, and not cut enough to meet the limitations."

Most of the money her department would consider cutting is in the Division of Health Care Financing, which administers low-income medical programs like Medicaid and UMAP, she said. Those programs have more optional components, so they can be cut.

Among other options Dandoy said the department is considering are reductions in the "Baby Your Baby" prenatal care program and cancer screening projects. The department may increase fees for immunizations and the cost of birth and death certificates. Both the cancer registry program and the Smoke-Free Utah program are possibilities for complete elimination, as are environmental and air quality programs.

Proponents and opponents of the limitation have argued whether the initiatives would cause a 13- or 6-percent cut. Dandoy said that the cuts, if spread over the entire fiscal year '90 budget, would be 6 percent, the figure proponents cite. If the cuts were confined to the second half of the year, when the initiatives would become effective, the cut would amount to 13 percent of that half of the budget.