Accountable Care Organizations

Utah Medicaid contracts with health plans, or Accountable Care Organizations (ACO), to provide medical services to Medicaid members. Members living in Box Elder, Cache, Davis, Iron, Morgan, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, or Weber counties must choose an ACO. Members that live in any other county have the option to choose an ACO or the Fee for Service Network.

Each ACO is responsible to provide enrolled Medicaid members with all medical services covered by Medicaid. Medicaid typically pays a monthly fee for each Medicaid member enrolled in an ACO. Each ACO may offer more benefits and/or fewer restrictions than the Medicaid scope of benefits. The ACO must specify services which require prior authorization and the conditions for authorization.

Members enrolled in an ACO must receive all services through a provider on that ACO’s network. The provider is paid by the ACO. Members enrolled in the Fee for Service Network may use any Utah Medicaid provider. The provider is paid by Medicaid.

Utah Medicaid’s Accountable Care Organizations:

Can I Change My Health Plan?

Medicaid members who live in Box Elder, Cache, Davis, Iron, Morgan, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, or Weber County can change their ACO during the first 90 days after it was chosen or had been assigned.

Changing your plan may change the doctors, hospitals and other providers you can use. Make sure your providers will take the plan you want to choose before making a change.

You can also change your health plan each year between mid-May and mid-June, this is open enrollment. During this time, you can ask to change your health plan for any reason. If you do make a change, your new plan will start on the first day of July.

Contact a Health Program Representative (HPR) by calling 1-866-608-9422 if a health plan is not working for you.