Managed Care
Managed Care Plans (MCPs) provide medicall and behavioral health services to eligible Medicaid and CHIP members. MCPs do not provide dental benefits except for members enrolled in the Children’s Health Insurance Program (CHIP). For more information about dental benefits, visit the Dental Coverage and Plans webpage
MCPs will be monitored by 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 | Healthy U: |
Molina Healthcare: | SelectHealth Community Care: |
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 (PMHP) must get inpatient and outpatient mental health services and outpatient substance use disorder (SUD) services through their PMHP.
Medicaid members are enrolled with the PMHP contractor serving in the county where they live.
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 outpatient mental health and SUD services from any Medicaid provider, including the Wasatch County Family Clinic.
PMHP County Chart
Historically, Utah Medicaid provided managed care through Accountable Care Organizations (ACO) 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 | Integrated Molina | Integrated SelectHealth |
Website | ||||
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 | Select Health: | |
CHIP Managed Care Dental Plan
CHIP Managed Care Dental Plan | |
Premier Access |
ACO
- SFY25- Health Choice ACO Contract opens in a new tab
- SFY25- Healthy U ACO Contract opens in a new tab
- SFY25- Molina ACO Contract opens in a new tab
- SFY25- SelectHealth ACO Contract opens in a new tab
CHIP
- SFY25- Healthy U Contract
- SFY25- Molina CHIP Contract opens in a new tab
- SFY25- SelectHealth CHIP Contract opens in a new tab
CHIP Dental
State CHIP
State CHIP Dental
Medicaid Dental
- SFY25-MCNA Dental Medicaid Dental Contract opens in a new tab
- SFY24- Premier Access Medicaid Dental Contract opens in a new tab
HOME
PMHP
- SFY25-PMHP-Bear River Contract opens in a new tab
- SFY25-PMHP-CUCC Contract opens in a new tab
- SFY25-PMHP-Davis Behavioral Contract opens in a new tab
- SFY25-PMHP-Four Corners Contract opens in a new tab
- SFY25-PMHP-Healthy U Contract opens in a new tab
- SFY25-PMHP-NCC Contract opens in a new tab
- SFY25-PMHP-SL County Contract opens in a new tab
- SFY25-PMHP-Southwest Contract opens in a new tab
- SFY25-PMHP-United Behavioral Contract opens in a new tab
- SFY25-PMHP-Wasatch Contract opens in a new tab
- SFY25-PMHP-Weber Contract opens in a new tab
UMIC
MLR Audited Reports
SFY2022 ACO
- SFY 2022 HealthChoice MLR Examination Report Expansion
- SFY 2022 HealthChoice MLR Examination Report Legacy
- SFY 2022 HealthChoice MLR Examination Report UMIC
- SFY 2022 Healthy U Examination Report Expansion
- SFY 2022 Healthy U Examination Report Legacy
- SFY 2022 Healthy U Examination Report UMIC
- HOME Program SFY 2022 MLR Examination Report
- SFY 2022 Molina MLR Examination Report Exp
- SFY 2022 Molina MLR Examination Report Legacy
- SFY 2022 Molina MLR Examination Report UMIC
- SFY 2022 SelectHealth MLR Examination Report Expansion
- SFY 2022 SelectHealth MLR Examination Report Legacy
- SFY 2022 Select Health MLR Examination Report UMIC
SFY 2022 CHIP
- SFY Molina CHIP SFY 2022 MLR Examination Final Report.pdf opens in a new tab
- SFY 2022 SelectHealth MLR Examination Report CHIP
- CHIP SFY22 MLR Examination Report
SFY 2022 PMHP
- Bear River Mental Health SFY 2022 MLR Examination Report.
- Central Utah Counseling Center SFY 2022 MLR Examination Report
- Davis Behavioral Health SFY 2022 MLR Examination Report
- Four Corners Community Behavioral Health SFY 2022 MLR Examination Report
- Healthy U Behavioral Health SFY 2022 MLR Examination Report
- Northeastern Counseling Center SFY 2022 MLR Examination Report
- Salt Lake County Behavioral Health SFY 2022 MLR Examination Report
- Southwest Behavioral Health SFY 2022 MLR Examination Report
- United Behavioral Health SFY 2022 MLR Examination Report
- Wasatch Behavioral Health SFY 2022 MLR Examination Report
- Weber Human Services SFY 2022 MLR Examination Report
SFY 2022 Dental
- SFY Premier Dental SFY 2022 MLR Examination Report
- SFY 2022 MCNA Insurance Company MLR Examination Report
SFY2021 ACO
- Health Choice ACO Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Healthy U ACO Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- SelectHealth ACO Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Health Choice ACO SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Healthy U ACO SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Molina ACO SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Healthy U ACO UMIC SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- SelectHealth ACO UMIC SFY 2021 MLR Examination Final Report.pdf opens in a new tab
SFY 2021 CHIP
SFY 2021 PMHP
- Bear River Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Central Utah Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Four Corners Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Healthy U Behavioral Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Northeastern Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Southwest Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Weber Expansion SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Davis SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Salt Lake County Behavioral Health SFY 2021 MLR Examination Final Report.pdf opens in a new tab
- Wasatch SFY 2021 MLR Examination Final Report.pdf opens in a new tab
SFY2020 ACO
- Health Choice ACO Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Healthy U ACO Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- SelectHealth ACO Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Health Choice ACO SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Healthy U ACO SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Molina ACO SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- SelectHealth ACO SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Health Choice ACO UMIC SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Healthy U ACO UMIC SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- SelectHealth ACO UMIC SFY 2020 MLR Examination Final Report.pdf opens in a new tab
SFY 2020 CHIP
- Molina CHIP SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- SelectHealth CHIP SFY 2020 MLR Examination Final Report.pdf opens in a new tab
SFY 2020 PMHP
- Bear River Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Central Utah Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Four Corners Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Healthy U Behavioral Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Northeastern Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Southwest Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Valley Behavioral Health Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Weber Expansion SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Bear River SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Central Utah SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Davis SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Four Corners SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Northeastern SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Salt Lake County Behavioral Health SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Southwest SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Valley Behavioral Health SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Wasatch SFY 2020 MLR Examination Final Report.pdf opens in a new tab
- Weber SFY 2020 MLR Examination Final Report.pdf opens in a new tab
SFY2019 ACO
- Health Choice ACO SFY 2019 MLR Examination Final Report.pdf opens in a new tab
- Healthy U ACO SFY 2019 MLR Examination Final Report.pdf opens in a new tab
- Molina ACO SFY 2019 MLR Examination Final Report.pdf opens in a new tab
- SelectHealth ACO SFY 2019 MLR Examination Final Report.pdf opens in a new tab
SFY2019 CHIP
Medicaid Managed Care Program Annual Report (MCPAR)
SFY2025 MCPAR Reports
SFY2024 MCPAR Reports
SFY2023 MCPAR Reports
SFY2022 MCPAR Reports
Directory contents
Documents/pdfs/edv/
ACO Quality Measures opens in a new tab
ACO Contract and Rate Setting Resources
Annual EQR Technical Report 2025 opens in a new tab
Annual EQR Technical Report 2026 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
PRISM Authorized Representative
PRISM Access Trainings
- MCO Administrator Manual opens in a new tab
- MCO Access Profile Manual opens in a new tab
- MCO User Access Agreement opens in a new tab
- Creating a Utah ID Account for new MCO Staff opens in a new tab
PRISM FAQs
Managed Care Specific Transaction Companion Guides
- 837I – Encounter Health Care Claim: Institutional opens in a new tab
- 837P – Encounter Health Care Claim: Professional opens in a new tab
- 837D – Encounter Health Care Claim: Dental
- 820 – Payroll Deducted and Other Group Premium Payment opens in a new tab
- 834 – Benefit Enrollment and Maintenance opens in a new tab
- 270/271 – Eligibility Benefit Inquiry and Response