The Vashon Methodist Church, where King County health officials distribute food vouchers to pregnant women and young mothers every month, was bustling last week.

In one room, Caroline Aaron, a nutrition assistant, asked a young woman about her toddler’s sleep patterns and eating habits. In another, Sarah Day, a public health nurse, weighed 2-year-old Zachary Wilde while he wriggled and reached for toys.

Other women lined up for their appointments, waiting quietly with toddlers in tow or babies in their arms. Little wonder it was hopping. According to Day, the caseload for their satellite clinic on Vashon — where they offer up federally funded food vouchers and provide well-baby checks and maternity support — has tripled in the last decade, from around 35 clients a month in 2000 to 96 a month this year.

Many, like Zachary’s mother Zoie Wilde, have found the services offered at the ad hoc clinic invaluable. Zachary weighed just under five pounds when he was born, Wilde said.

“Sarah’s support for me and Zachary was critical,” she said. “She coached me on his nutritional needs. She helped me stick with breastfeeding.”

The public health nurse also helped her address several other needs during her periodic home visits — tough issues, like domestic violence, housing and money problems, Wilde said.

“Sarah’s the bridge for all of this,” Wilde said. “If they take that away, we’ll be in a world of hurt.”

Unfortunately, a world of hurt is what many think is in store for Vashon and the rest of the state as lawmakers come to terms with some of the deepest cuts this state has seen in years, if ever.

The state’s shortfall is staggering. Gov. Chris Gregoire had to trim $4.6 billion from a $36 billion budget, 60 percent of which can’t be touched because of constitutional mandates or other requirements. In other words, said Jim Stevenson, a spokesman for the state’s Department of Social and Health Services (DSHS), she’s had to cut $4.6 billion from a $14 billion budget — or nearly a third of the state’s discretionary spending.

“It’s shocking how deep this crisis goes,” he said.

As a result, the governor delivered up a 2011 budget last week that has left those in the world of social services alarmed for what lies ahead.

Her budget proposes the complete elimination of Basic Health, which provides subsidized health insurance to 66,000 uninsured people; the elimination of the Disability Lifeline Medical Program, which annually serves 21,000 people who have a temporary disability that makes it impossible to work; and elimination of the Children’s Health Program, which provides medical coverage to 27,000 children whose citizenship has not been documented.

The budget also cuts maternity support services, the program that helps to fund Vashon’s monthly satellite clinic, by 50 percent — putting the jobs of the county’s visiting public health nurses in jeopardy.

“A 50 percent cut is devastating,” said Kathy Carson, administrator for Community Health Services in Public Health – Seattle & King County. “It means a lot of women won’t be served.”

Day, a Vashon resident who has worked as a public health nurse on Vashon and in Seattle for 15 years, has already had to cut back on home visits on the Island, due to a couple years’ worth of budget cuts. Such visits have helped her provide the best possible support, she said; by going into women’s homes, she can see the extent of their need as well as develop a good working relationship with her clients. Day is fluent in Spanish; many of the women she visits are Latinos, she said.

Now, though, she’s fearful for what lies ahead for them and is already trying to help them brace for a new reality.

“I’m very worried. … I keep telling people to double up or triple up, because that’s the only way they’re going to survive,” she said.

It’s particularly tricky on Vashon, where women “are not as connected to services as people in the city,” Day said.

“I don’t think people fully understand the implications of what we’re facing,” she added.

Others say the elimination of Basic Health — a program that has enjoyed strong bipartisan support over the years — will have untold effects on Vashon as well as the rest of the state. The program, which currently serves 66,000 and has another 120,000 people on a waiting list, subsidizes health insurance on a sliding scale to those who can’t afford to buy insurance on the open market.

In King County, 16,700 people are on Basic Health; state officials could not say how many of those residents live on Vashon. But some said they believe many on Vashon — known as a place where people piece together lives as farmers, artists, teachers or retailers — are on Basic Health.

“Most farmers on the Island have Basic Health,” said Michelle Crawford, owner of Pacific Potager, a popular Island farm near the Tahlequah ferry.

Crawford and her four children receive health insurance through the program. Though the insurance is “bare bones,” she said, it has proven fully adequate for her family.

“I don’t know what we’ll do,” she added.

State officials say the governor had no choice but to make these cuts; by law, she has to propose to the Legislature a balanced budget. Even so, they said, they’re deeply concerned for what lies ahead.

Some of those who can’t afford health insurance, for instance, will likely ignore medical problems until their conditions force them into an emergency room, where hospitals will cover the costs by passing them on to paying clients, said Preston Cody director of Basic Health.

“Ultimately, in the long run, we’ll all pay for this,” he said.

Cody and Todd Slevett, head of the Office of Community Services in DSHS, said they’ve instructed their staffs to maintain all their records and data so that they can rebuild their programs, should the state’s financial picture improve.

But they also said that such a full dismantling of programs makes it difficult. “If many of these programs go away, it’ll be hard to rebuild them,” Cody said.

Meanwhile, lawmakers — who will convene in January for their 105-day session — will likely put forward proposals of their own to address the yawning deficit. But Sen. Sharon Nelson (D-Maury Island) said she doubts lawmakers will be successful if they attempt to close the gap through increased taxes.

Thanks to an initiative passed in November, lawmakers will need a supermajority — two-thirds of the lawmakers in both houses — to increase taxes. Such a possibility, she said, “is remote, at best.”