Managed Care

Managed Care Plans (MCPs) provide medical, dental and behavioral health services to eligible Medicaid and CHIP members. MCPs will be monitored via performance and quality measures to deliver quality of care by managing medical assistance programs and benefits.

For additional information on any of the Managed Care plans, please contact a Health Program Representative at 1-866-608-9422.

Medicaid Managed Care Plans

Members who live in Utah, Salt Lake, Davis, Weber, Box Elder, Cache, Iron, Morgan, Rich, Summit, Tooele, Wasatch, or Washington County, must choose a health plan. Members who live in any other county in Utah have the option of selecting a health plan or using the Fee for Service Network. The State of Utah currently has four managed care health plans/ACOs:

Managed Care Health Plans

Managed Care Health Plans
Health Choice Utah: 1-877-358-8797 healthchoiceutah.com	Healthy U: 1-833-981-0212 uhealthplan.utah.edu/medicaid
Molina Healthcare: 1-888-483-0760 molinahealthcare.com	SelectHealth Community Care: 1-800-538-5038 selecthealth.org/plans/medicaid

Your Medicaid Dental Care

Dental care is a covered service for everyone who has Medicaid. To learn more about your dental benefits, visit the Medicaid Dental Benefits webpage.

Some people get their dental benefits through a dental plan, and others get their benefits through Fee-for-Service Medicaid.

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Dental Plan

You get your dental benefits through a dental plan if you are:

A child (from birth until their 21st birthday).
A member on Targeted Adult Medicaid who is 19 or 20 years old.
A member on Adult Expansion Medicaid who is 19 or 20 years old.
A pregnant woman.

These groups get special benefits through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. For more information about the EPSDT program, go to the Early and Periodic Screening, Diagnostic and Treatment webpage.

How to Choose Your Plan

Medicaid has two dental plans for you to choose from. You need to pick one, or one will be chosen for you.

Both plans give you the same dental services. The only difference is that they might have different dentists. Be sure to go to a dentist who accepts your plan.

The two plans are:

MCNA Dental (Call 1-844-904-6262)
Premier Access (Call 1-877-541-5415)

How to Find a Dentist

You can use these ways to find a dentist who accepts your plan:

Call your plan using the number above.
Go to your plan’s website using the link above.
Use the InsureKidsNow.gov dental locator tool.
Call a Health Program Representative (HPR) at 1-866-608-9422.

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Fee-for-Service Medicaid

You get your dental benefits through Fee-for-Service Medicaid if you are on one of these programs:

Foster Care Medicaid
Nursing Home Medicaid
Refugee Medicaid

How to Find a Dentist

You must use a dentist from the Medicaid Adult Dental Provider list. There are many dentists on this list all over the state.

If you need help finding a dentist, you can call a Health Program Representative (HPR) at 1-866-608-9422.

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More Information

If you are 21 years or older, please go to the Dental Coverage and Plans webpage to find out about your dental benefits.

Free language help is available for you. If you have questions or want more information, call 1-866-608-9422 to speak with a Medicaid HPR.

También tenemos servicios de ayuda con idiomas gratis. Si tiene preguntas o quiere más información, llame al 1-866-608-9422 para hablar con un representante de Medicaid.

Note: The information below does not apply to Medicaid members who have Adult Expansion Medicaid coverage and live in Davis, Salt Lake, Utah, Washington, and Weber counties. Information about coverage for these members is in the section below titled “Utah Medicaid Integrated Care (UMIC).”

Medicaid members enrolled in a Medicaid Prepaid Mental Health Plan (PMHP) must get inpatient and outpatient mental health services through their plan.

In most areas of the state covered by the PMHP, Medicaid members must also obtain outpatient substance use disorder (SUD) services through the PMHP.

Medicaid members are enrolled with the PMHP contractor serving in the county where they live.

Medicaid members living in Box Elder, Cache, or Rich County are not enrolled in the PMHP for outpatient SUD services. They are enrolled in the Medicaid Fee for Service Network and can get outpatient SUD services from any Medicaid provider, including the Bear River Health Department.

Medicaid members living in Wasatch County are not enrolled in a PMHP. They are enrolled in the Medicaid Fee for Service Network and can get mental health and SUD services from any Medicaid provider, including the Wasatch County Family Clinic.

View the PMHP County Chart to find the PMHP available in each county.

Historically, Utah Medicaid provided managed care through Accountable Care Organizations (ACO) and PMHP County Chart opens in a new tab Prepaid Mental Health Plans (PMHP). The ACOs managed physical health benefits and the PMHPs managed behavioral health benefits that include both mental health and substance use disorders.

Effective January 1, 2020, the Utah Medicaid Integrated Care (UMIC) program will manage physical and behavioral benefits through integrated managed care plans in five counties.

Who will be in the Utah Medicaid Integrated Care plans?

Senate Bill 96 (2018 General Session)Will Targeted Adult Medicaid (TAM) members be enrolled in managed care? opens in a new tab established Medicaid’s adult expansion allowing individuals up to 138% federal poverty level (FPL) to be eligible for Medicaid benefits. This limited expansion is called Adult Expansion Medicaid. Adult Expansion Medicaid members in Davis, Salt Lake, Utah, Washington, and Weber counties will be required to enroll in a UMIC plan.

Will Targeted Adult Medicaid (TAM) members be enrolled in managed care?

Not at this time. TAM members will continue to receive benefits through the Medicaid Fee for Service Network for now.

Why have Utah Medicaid Integrated Care plans?

According to national data, integrating physical health, mental health, and substance use disorder services, produces the best outcomes and proves the most effective approach to caring for people with multiple health care needs. Medicaid created integrated care plans in order to get the best health outcomes for members while managing the cost of services.

Where will the Utah Medicaid Integrated Care plans operate?

Davis, Salt Lake, Utah, Washington, and Weber counties will be the only counties that have UMIC plans. UMIC plans will only include Adult Expansion Medicaid members.

Managed Care Health Plans

Integrated Medicaid Managed Care Health Plans
County	Integrated Health Choice 1-877-358-8797	Integrated Healthy U 1-833-981-0212	Integrated Molina 1-888-483-0760	Integrated SelectHealth 1-800-538-5038
Website	healthchoiceutah.com	uhealthplan.utah.edu	molinahealthcare.com	selecthealth.org
Davis	●	●	●	●
Salt Lake	●	●	●	●
Utah	●	●	●	●
Washington	●	NO	●	●
Weber	●	●	●	●

The HOME program is a managed care program for individuals with developmental disabilities. Services will be provided through the HOME clinic.

HOME provides both medical and behavioral health services through a medical home model of care.
Members may need to change their current providers and use the providers available through the HOME program’s provider network.
Members will be assigned a case manger to assist with coordination of services.

Additional information to note:

There may be a waiting list to enroll in the HOME program.
For information on primary care providers, call toll-free 1-800-824-2073.
For information on specialists, visit the following website: https://healthcare.utah.edu/uni/programs/home

Children who qualify for the Children’s Health Insurance Program (CHIP) need to sign up for a health plan. The CHIP health plan covers regular health care, mental health and medicine. CHIP has three health plans statewide. Members may choose which plan they want to enroll in. CHIP has one dental plan statewide that will cover all dental benefits. Visit the CHIP website to learn more about CHIP coverage.

CHIP Managed Care Health Plans

CHIP Managed Care Health Plans
Molina Healthcare 1-888-483-0760 molinahealthcare.com	Select Health: 1-800-538-5038 selecthealth.org	Health U 1-833-404-4300 uhealthplan.utah.edu/chip

CHIP Managed Care Dental Plan

CHIP Managed Care Dental Plan
Premier Access 1-877-541-5415 http://www.premierlife.com

ACO

CHIP

CHIP Dental

SFY25- Premier Access CHIP Dental Contract opens in a new tab

State CHIP

State CHIP Dental

SFY25- Premier Access CHIP Dental Contract opens in a new tab

Medicaid Dental

HOME

SFY25- HOME Program Contract opens in a new tab

PMHP

UMIC

MLR Audited Reports

SFY2022 ACO

SFY 2022 CHIP

SFY 2022 PMHP

SFY 2022 Dental

SFY2021 ACO

SFY 2021 CHIP

Molina CHIP SFY 2021 MLR Examination Final Report.pdf opens in a new tab

SFY 2021 PMHP

SFY2020 ACO

SFY 2020 CHIP

SFY 2020 PMHP

SFY2019 ACO

SFY2019 CHIP

ACO Quality Measures opens in a new tab

ACO Contract and Rate Setting Resources

Annual EQR Technical Report opens in a new tab

The following material was created prior to the merger between the Utah Department of Health (UDOH) and the Utah Department of Human Services (UDHS). This material is required by federal or state statute to remain on our website.

Managed Care Quality Strategy opens in a new tab

MCE Accreditation Status opens in a new tab

MCE Ownership Disclosure opens in a new tab

Utah Medicaid Mental Health Parity Analysis

PRISM Authorized Representative