SALT LAKE CITY — Utah's Medicaid expansion — though it covers less than the estimated 150,000 Utahns that would have been covered under voter-approved Proposition 3 — has still been viewed as a positive for treatment providers who help Utahns escape the throes of drug addiction.

Yet, even for them, it comes with a catch.

Though Utah lawmakers passed the more limited plan that extends coverage to between 70,000 to 90,000 Utahns that previously fell in the so-called coverage gap, they also cut about $10.2 million in statewide behavioral health money, meant to offset what Medicaid is now expected to cover.

So now, counties have to figure out how to adjust for those cuts — and as the county with the most social services programs, Salt Lake County must make do with a $3.6 million cut.

On top of that, the state also cut about $2 million in one-time money that funded county programs like social detox and other programs expanded as part of Operation Rio Grande.

But as Tim Whalen, director of the county's behavioral health division, and his team explained those cuts to the County Council on Tuesday, he stressed there wasn't cause for alarm. Rather, he's optimistic Salt Lake County providers will still be able to expand treatment coverage to more Utahns.

"If we do this correctly with Medicaid expansion, I think the opportunities are greater than the cuts by a large margin," he said. "I really believe that."

But that's going to take some work.

Zac Case, the county's behavioral health fiscal manager, showed the County Council a list of programs affected for the 2020 fiscal year, and how he estimated the cuts would be best distributed to minimize impact on treatment providers. The programs expected to see relief from Medicaid expansion took their fair share of cuts, he said.

That included drug treatment providers including Odyssey House, which took a nearly $600,000 cut from its roughly $3 million subsidy from Salt Lake County, and First Step House, which took a more than $386,000 cut from it's nearly $1.4 million subsidy. And Volunteers of America, which runs a detox program, took a $1.5 million cut out of it's usual $4.2 million.

Those were among about a dozen programs that use money from Salt Lake County, with cuts ranging from 9 percent all the way up to 42 percent. Plus, some programs, including drug court recovery support services, the adult drug court treatment and Operation Rio Grande treatment, got 100 percent cuts in county funding.

But still, Whalen told County Council members it's not as bad as it looks. He said he's "optimistic" Medicaid expansion will fill the gaps.

"This sounds really scary," he said. "I just want to reiterate, again, all of the programs we contract with are very very good at billing Medicaid and other insurance. We're working with them hand in hand to make sure that as we transition … they are able to leverage Medicaid. Again, our goal would be to expand treatment services."

While the cuts alarmed some providers, others were "absolutely fine with it," Case said, adding that throughout the year he planned to keep in "constant communication" with providers and adjust the dollars if some struggle more than others.

"If it's impacting a provider in a negative way, we'll do all we can to help them and to bridge to a solution as quickly as possible," Case said.

Enrollment for Utah's new Medicaid plan opened April 1. Critics continue to blast the limited expansion because it only extends to Utahns who earn up to 100 percent of the federal poverty level and not those earning up to 138 percent.

Still, "we're really optimistic here," Whalen told the Deseret News on Wednesday. "Having Medicaid expansion, that's thousands and thousands of more lives covered now."

However, the state still needs the approval of a second waiver to move from Utah paying 30 percent of the cost of the plan to only paying 10 percent — a waiver that would also allow Medicaid eligibility to last 12 months rather than only month to month as it is under the current waiver.

Though critics express skepticism that that waiver — which also includes certain work "effort" requirements — will even get approval, state officials have said they've received assurances it will come. But even if it does get approved, that waiver won't take effect until January 2020, leaving some providers anxious.

"I'm nervous," Adam Cohen, executive director of Odyssey House, told the Deseret News, explaining the main source of his anxiety is whether clients in outpatient care who get jobs and income might lose their Medicaid coverage before their treatment is complete.

Cohen said the state's dollars would have acted as a "safety net," but he wonders, "Did we cut too soon?"

"It may be fine, it also may not be fine," Cohen said. "We don't know what it's going to look like — we're, what, 30 days in? So it's nerve-wracking."

But also, Cohen said he's "optimistic" and at least confident that Odyssey House's recent expansion in residential treatment beds won't be impacted. Rather, the challenge is expanding outpatient capacity as well, he said.

Newly elected County Councilwoman Shireen Ghorbani on Tuesday expressed frustration about the state cuts. Although "a lot of these gaping holes in our system are hopefully going to be covered by Medicaid," she questioned whether the $10 million in state cuts would limit services.

"That's a long list of services in our county that is impacted by this cut," she said. She told Whalen she understood that wasn't his decision, but added, "I'm just mad about it."

Whalen acknowledged the $10 million was "a lot larger cut than we had anticipated." Originally, he said they expected a cut of about $7 million, but "at the last minute, the last night of the session they extended that cut for another $3 million."

Whalen added there are "sympathetic ears in the Legislature" and there may be opportunities perhaps in the special session expected later this year to talk about adjustments.

Salt Lake County Mayor Jenny Wilson credited Whalen and his team for working through the details and keeping the county apprised through the process.

"This is clearly something we will keep watching, and we will be a strong voice at the Legislature this year for filling the hole and going further," Wilson said.