The province's budget cuts to Hamilton public health and child care will be in "the low millions," which means the city will have to look at restructuring and cuts to local health services.

That was the dire message from Paul Johnson, Hamilton's general manager of emergency and community services, as he fielded questions from city council Wednesday.

The city still doesn't know what the cuts mentioned in the Ontario PC budget this month mean to Hamilton. Right now, the province funds 75 per cent of the city's public health budget, and the city pays for a quarter of it, or $12.5 million this year. That will change to 70/30, although programs in the budget are funded in various ways, so the math isn't straightforward.

Public health deals with restaurant inspections, vaccinations, prenatal programs, sexual health clinics, overdose prevention, bed bug remediation, air quality, and cigarette and cannabis enforcement, among other programs.

The city also spends about $70 million per year on child care programs, including subsidies to families who earn up to $80,000. It also helps fund child care spaces, Ontario Early Years Centres, before- and after-school programs and wage subsidies for early childhood educators.

The city will have to start funding about 20 per cent of those costs, Johnson said, which will cost as much as $5 million annually.

Whatever the cost, Johnson said, the city will have to look at restructuring, service cuts or some other way to pay for its programs.

"The information we've received to date does concern us from a structural and financial perspective," Johnson said.

The cuts won't be in the thousands, or hundreds of thousands, he said. "We're potentially talking about the low millions."

Cities are still waiting for new funding agreements following the provincial budget this month — the first of the Doug Ford government.

The budget is "an even-handed approach to balancing the budget" while "protecting public health care and education," said Donna Skelly, PC MPP for Flamborough-Glanbrook.

But Hamilton city council was lamenting it Wednesday. The 2019 budget has already been established, and the first of the tax bills have gone out, said finance head Mike Zegarac. Whatever changes happen, the city will have to raid its reserves to find money this year.

The result, said Coun. Sam Merulla, is "chaos."

"We've never encountered this type of nonsense before."

Possible health unit merger

At this point, the city isn't even sure the fate of its public health unit. The budget referenced turning 35 Ontario public health units into "10 regional public health entities."

Whether the city is looking at service cuts, or job losses, or widespread restructuring, "we don't know that," said Mayor Fred Eisenberger. "There's concern, no question about that."

"All of these are done on the fly, it seems. They put out there as a trial balloon and gauge the reaction and adjust from there. I expect that's what we're going to continue to see."

The city has a limited number of reserve accounts it could use to make up for provincial funding shortfalls.

One is the tax stabilization reserve, which only has about $3 million left after the city set aside $11 million to conduct a judicial investigation into the Red Hill Valley Parkway. The investigation could actually cost more than that, since the judge in charge of the inquiry controls its scope.