After having been spared major budget cuts this time around, the city’s Health and Hospitals Corporation could face draconian cuts when budget negotiators meet next.

This could shutter many of its programs, tossing thousands of the poor and sick into the streets.

State politicians won a rare victory for the Health and Hospitals Corporation this fall during bruising special-session budget cuts: they saved Medicaid spending, reducing cuts from a proposed $63 million to only $8.4 million. But this winter, even as many public programs and social services around the state are about to go under the budget axe, the agency appears to be in for a major reckoning.

“We are grateful to the Senate for reducing the amount,” said Pamela McDonnell, a spokeswoman for the Health and Hospitals Corporation, about the midyear cuts. ”We hope that they take into consideration the essential role that public hospitals play when planning for the next fiscal year.”

In March, the agency announced the closure of programs that treated more than 11,000 patients, including four school-based mental health programs and a hospital-based one for adults. But in July, according to advocates, without much fanfare, the Health and Hospitals Corporation quietly closed more services. The agency also closed HIV/AIDs programs at Jacobi and Harlem Hospitals, and closed or cut back primary care services in Sheepshead Bay, Highbridge and Tremont.

And the Health and Hospitals Corporation— which relies nearly entirely on public money, since much of their funding comes from Medicaid reimbursements—expects more cuts on the way. Under the pressure of the deficit, few health services can be considered off-limits to cuts.

“I think everyone involved feels that this is about the most gruesome budget year we have ever dealt with,” said Assembly Member Richard Gottfried, the chair of the Assembly Health Committee. “Where would you draw the line? Frail, elderly people in nursing home beds? Children with earaches? People who need cancer screenings? All of these things are either life-and-death or serious pain and physical damage.”

The number of New Yorkers who are uninsured or publicly insured is rising and advocates say the Health and Hospitals Corporation can expect to face a structural deficit of anywhere from $300 million to $1 billion in fiscal year 2011.

Ultimately, the agency must decide which clinics to shutter after cuts come through. But in some cases, legislators can step in to protect certain clinics or hospital programs, and they can be lobbied hard to do so by constituents and advocates. The agency then must balance between shuttering relatively little-used clinics and succumbing to the entreaties of the well-connected. For example, the Health and Hospitals Corporation announced in March the closure of a clinic in Springfield Gardens, Queens, but Assembly Member Barbara Clark and State Sen. Shirley Huntley fought successfully to keep it open.

The trouble right now, legislators say, is deciding what deserves special treatment.

“What can afford to take a hit is completely a matter of where you sit, right?” said Denise Soffel, the director of the Senate Health Committee under State Sen. Tom Duane. “It’s very subjective.”