RICHMOND, SEPT. 7 -- The Virginia Department of Health's plan to meet Gov. L. Douglas Wilder's budget reductions calls for Northern Virginia health agencies to lose $400,000.

According to budget documents prepared by state Health Commissioner C.M.G. Buttery, the department will be expected to cut more than $21 million from the $540 million it was appropriated by the General Assembly during the current two-year budget cycle.

The five health departments in Northern Virginia, which are operated jointly with local governments, will have to reduce their combined spending by $400,000, or 3 percent, which may lead to higher fees at clinics, state officials said.

Bob Treibely, a finance official with the health department, said local health directors will be given latitude in dealing with the cuts -- including lowering administrative costs or increasing fees -- as long as they do not cut current services.

"That's one of the mandates from Governor Wilder -- we will not lower service below 1990 levels," Treibely said.

Nonetheless, Buttery's plan calls for saving $5 million by delaying new programs. For example, a $1 million program passed this year by the General Assembly would have given medical school grants to students if they agree to practice medicine in areas of the state that have a dearth of doctors.

Wilder is not expected to give final approval to the cuts until next week. Health and Human Services Secretary Howard M. Cullum said major changes in Buttery's proposed cuts are unlikely.

Part of the $21 million savings already has been made. In June, the department saved about $4.4 million through a series of cuts, which included closing a regional office in Staunton.

In another development in Wilder's belt-tightening program, Education Secretary James W. Dyke Jr. said that a $21 million tuition grant program that helps residents going to private schools in Virginia will be cut. Dyke said he did not now yet how much the program would be trimmed.

Meanwhile, the state Department of Social Services is expected to lose about $17.5 million under Wilder's cuts -- requiring the elimination of two of the agency's seven regional offices, but not causing any reductions in direct payments to beneficiaries of relief programs.

Closing two regional offices and consolidating services provided at five offices that help enforce the state's child support laws will save about $1 million annually over the next two years, and will result in 40 fewer employees through attrition or layoffs, according to a social services budget document. The agency will not disclose until next week which offices will be closed because employees have not yet been notified.