COLUMBIA -- South Carolina Gov. Nikki Haley's nominee to run the state's cash-strapped Medicaid agency won initial approval Thursday in a Senate confirmation hearing, clearing the way for likely final approval next week. Anthony Keck, 43, would run the South Carolina Department of Health and Human Services, the Medicaid agency that provides health care coverage for the state's elderly, disabled and poor. The agency is running a $228 million deficit in the current fiscal year. Haley also charged Keck with finding a way to avoid being part of the federal health care overhaul law. The Senate could give Keck final approval next week. Keck declined to talk to reporters until after that vote. Haley has asked the Senate to wrap up all confirmation work on her Cabinet nominees by Feb. 1. "The governor was pleased to see Tony Keck unanimously approved by committee and expects his confirmation by the full Senate on Tuesday," Haley spokesman Rob Godfrey said. "He's exceptionally talented and we need him on the job now." Keck has been deputy secretary for Louisiana's Department of Health and Hospitals since October 2009. The committee's screening process turned up a couple of instances of late and erroneous taxes that Keck said he had taken care of previously. Senate Medical Affairs Committee Chairman Harvey Peeler, a Gaffney Republican, asked Keck "the $228 million question" - how he'd deal with the current fiscal year deficit at the agency. Keck's predecessor had told the state's financial oversight board that unless the state covered the shortfall, it would have to shut down payments to health care providers on March 1. Peeler wanted to know whether Keck would continue to pursue the request or pare it back. Keck said every state is running midyear deficits tied to growth in enrollment as the nation's economy recovers from a recession and ongoing state budget problems. "I think there is no silver bullet strategy to solve that problem," Keck said, noting he's still getting a grasp on the problem. Midyear spending cuts are hard and have to come within federal restrictions that limit a state's ability to reduce programs. "In this case, operating the program essentially as agreed with the federal government seems to be costing us $228 million more than we thought," Keck said. "It will have to be a multi-prong strategy. It cannot rely, in my opinion at this juncture, solely on cuts." Keck said it "just isn't possible" to wring $228 million out of a $1.3 billion general tax fund budget in three months. Peeler asked Keck how he planned to get South Carolina out of the Obama Administration's mandatory federal health care program. That's not so easy, Keck said. South Carolina still has to develop plans to comply with the law, Keck noted, even as the state develops a strategy for going its own way, other states challenge the federal law in courts and Republicans try to repeal it in Congress. "We as an agency can't make the bet that the law's going to get repealed or it's going to be found unconstitutional," Keck said. The federal law will prompt thousands of decisions that need to be made during the next few years and that means the state has to do the best it can to make sure it is treated well under the law, Keck said.