COLUMBIA -- South Carolina legislators have banked on Congress sending about $200 million more to help pay for health and human service programs, but the money might not come through.

The House and Senate versions of the $5 billion state budget depend on Congress extending increased Medicaid assistance, first approved as part of the federal stimulus package. Earlier this year the cash looked like a sure bet, and the U.S. House and Senate approved it at one point, but it's not a done deal.

If the money does not come to the state, programs and services will be cut by about $200 million. This dilemma is a preview of what the state will face when all the federal stimulus cash is gone.

Congress sent South Carolina about $1 billion to help sustain government programs during the economic downturn. The budget supplement provided cash for the current and upcoming budgets.

South Carolina does not have a contingency plan if the increased Medicaid assistance does not pass. The result would be more cuts to programs after Jan. 1 for people who are deaf and blind, have severe autism or live with traumatic brain injuries. Enrollment in health care insurance coverage for children with poor parents would be frozen. Services also would be cut for those who rely on Meals on Wheels, get a break on prescription costs and receive cancer screenings, among a long list of other forms of government aid.

Sue Berkowitz, advocate and director of the S.C. Appleseed Legal Justice Center, said the Legislature needs to find a way to take care of South Carolinians who are suffering.

"If we don't get it, it will just be devastating," Berkowitz said.

Either the government will pay now to help people maintain their health by helping to pay for prescription drugs, or the state can pay an expensive emergency room bill, she said. Likewise, the state can provide in-home care so parents of disabled children can go to work, or the state could pay the higher cost to have those children put in institutions, Berkowitz said.

"It's either pay now or pay later," she said.

The more humane and cost-efficient solution is for the state to find a way to maintain the services, Berkowitz said. If the federal government does not agree to send the money to the state, legislators should find a way to come up with money to pay for the programs, she said.

South Carolina is not the only state in this situation. CNNMoney.com reports that at least 21 states have included in their budgets cash from the pending increased Medicaid assistance. Nationwide, the assistance would cost $25 billion.

Several South Carolina budget writers on Thursday said they have received assurances from members of the state's congressional delegation that the increased federal funding will be on its way. The House budget includes $175 million in the pending federal money. The Senate plan includes $213 million.

Rep. Tracy Edge, a North Myrtle Beach Republican who wrote the first version of the House's Medicaid budget, said the Legislature will have time to make adjustments if Congress does not approve the assistance.

"I think we're all certain that it's going to pass, so I don't see any problem with including it in our budget," Edge said. "I am optimistic that the money will be there."

Sen. Thomas Alexander, a Walhalla Republican who leads budget talks on health and human services in the Senate, said it is his understanding that the increased Medicaid assistance has broad support in Washington.

But Gov. Mark Sanford has concerns.

"Budgets of this magnitude can't be built on a wing and a prayer, and hoping yet more federal dollars appear instead of making difficult choices may end up hurting those most served by state government," Sanford's communications director Ben Fox said.

The state's budget is not finalized. House and Senate negotiators will meet in the next couple of weeks to hammer out the differences in the versions passed by each body.

Hope Derrick, communications director for U.S. House Majority Whip Jim Clyburn, said the U.S. Senate is holding up the passage of the increased Medicaid assistance. Neither U.S. Sen. Lindsey Graham nor U.S. Sen. Jim DeMint, both Republicans, could be reached immediately for comment.