People with cancer, palliative care patients and couples struggling to start a family are among those who could lose out as a result of a projected budget shortfall.
The director of finance at the Department of Health has warned that the draft budget will result in patients "being disappointed and finding that their needs are not met".
According to the draft budget for the upcoming financial year, there is not enough money for the Department of Health to deliver a series of commitments set out in the New Deal, New Approach deal to restore Stormont.
These include £6.5m for 900 nursing and midwifery students, £10.6m for the mental health action plan, £10.7m to rebuild cancer services, £9m to improve end of life care and £8.1m to fund three cycles of IVF treatment.
Addressing the Stormont health committee, Brigitte Worth said: "I think this is where being the finance director in the Department of Health can be particularly difficult because I don't think we have anything on our list of priorities that we think is unimportant.
"Everything we have on our list represents a service that people need, represents an operation that somebody needs to have, a particular issue around mental health that they need to have addressed, so this is difficult. It's incredibly difficult and it will inevitably lead to some people being disappointed and finding that their needs are not met."
As well as presenting significant issues in meeting the commitments made by the returning Assembly in January 2020, Ms Worth also poured cold water on hopes that health officials will be able to tackle Northern Ireland's hospital waiting list crisis once the pandemic is brought under control. She explained: "You will already be aware, prior to the Covid-19 pandemic, the health and social care system was already under mounting pressure.
"The costs associated with maintaining our existing models of service were increasing at a pace that could not be sustained within the budget available and these issues have been further compounded by the pandemic.
"We require major investment on a sustained basis to rebuild our struggling services and reduce waiting times.
"In particular, increasing the capacity of our elective care system, whether in house or in the independent sector, requires recurrent funding commitment to enable us to invest in the staff and infrastructure required to make progress. Unfortunately, the funding available within our draft budgetary allocation just does not allow us to make any significant headway into this issue which was already estimated to cost between £250m and £1bn before the impact of the pandemic is taken into account.
"Similarly, the draft budget will not allow us to undertake a transformation programme with any level of ambition. You will appreciate that we are still working through the detailed implications of the budget settlement at official level before bringing recommendations to the minister on the key issues associated with the constrained position."
Ms Worth also warned that the current draft budget does not allow for the Department of Health to meet the commitments to address staff shortages which helped to bring an end to crippling strike action at the beginning of last year.
A spokeswoman from the Department of Finance said Finance Minister Conor Murphy anticipates the £20m required will be made available during the June monitoring round.