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Although human support services account for 40 percent of the proposed budget, the city’s neediest residents could feel the pain of fiscal restraint.

The plan cuts hospital services and specialty care from the D.C. Alliance, which provides care to about 20,000 low-income people who are not on Medicaid.

“It’s not something I feel good about, but at the end of the day we have to make the most responsible decisions that we can make around the outcomes of the budget,” Mr. Gray said Friday of the cuts.

Council member David A. Catania, at-large independent and chairman of the Committee on Health, told the mayor his cuts to the program are “very serious.”

Signaling future debate, Mr. Catania proposed a freeze on cost-of-living increases in pension plans for police, firefighters and teachers to cover the alliance-related costs and then some, noting pension expenses are sending the District “right back to bankruptcy.”

The fiscal 2013 budget will take effect Oct. 1 after approval from the D.C. Council and Congress.