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

The following members have dental benefits and must choose a dental plan:

Pregnant Women
Medicaid members who are eligible for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits

The State of Utah currently has two managed care dental plans statewide:

Managed Care Dental Plans

Medicaid Dental Plans
MCNA www.MCNAUT.net 1-877-904-6262	Premier Access www.premierlife.com/utmedicaid 1-877-541-5415

Members who are on the following Medicaid programs will receive dental benefits through fee for service Medicaid and are not required to be enrolled in a dental plan:

Foster Care Medicaid
Nursing Home Medicaid
Refugee Medicaid
Targeted Adult Medicaid (TAM) members who are age 19 and 20
Adult Expansion Medicaid members who are age 19 and 20

For more information about Medicaid dental plans and coverage, click here.

The following Medicaid members will receive dental benefits through the University of Utah School of Dentistry and their network of providers:

Targeted Adult Medicaid (TAM) members who are receiving treatment in a Substance Use Disorder Treatment Program (age 21 and older)
Adults, 21 and older, who are on Medicaid because of a disability or blindness
Adults, age 65 and older, eligible for Traditional Medicaid

For appointments or information, contact the University of Utah Dental Medicaid Call Center at: 801-587-7174.

UUSOD University of Utah School of Detistry Network of Providers to see the Medicaid Dental Provider Directory for the University of Utah School of Dentistry (UUSOD).

For more information about Medicaid dental plans and coverage, click here.

Dental care is a covered service for eligible Medicaid members who are pregnant, disabled, blind, age 65 or older, eligible for Targeted Adult Medicaid and are receiving treatment in a Substance Use Disorder Treatment Program, or qualify for Early Periodic Screening, Diagnostic and Treatment (EPSDT).

Click here, to find a provider or dental plan.

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

SFY24- Premier Access CHIP Dental Contract opens in a new tab

State CHIP

State CHIP Dental

SFY24- Premier Access CHIP Dental Contract opens in a new tab

Medicaid Dental

HOME

SFY24- HOME Program Contract opens in a new tab

PMHP

UMIC

MLR Audited Reports

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

Managed Care

Medicaid Managed Care Plans

Managed Care Health Plans

Managed Care Dental Plans

Who will be in the Utah Medicaid Integrated Care plans?

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

Why have Utah Medicaid Integrated Care plans?

Where will the Utah Medicaid Integrated Care plans operate?

Managed Care Health Plans

CHIP Managed Care Health Plans

CHIP Managed Care Dental Plan

ACO

CHIP

CHIP Dental

State CHIP

State CHIP Dental

Medicaid Dental

HOME

PMHP

UMIC

MLR Audited Reports

SFY2021 ACO

SFY 2021 CHIP

SFY 2021 PMHP

SFY2020 ACO

SFY 2020 CHIP

SFY 2020 PMHP

SFY2019 ACO

SFY2019 CHIP

Medicaid Managed Care Program Annual Report (MCPAR)

PRISM Access Trainings

PRISM FAQs

Managed Care Specific Transaction Companion Guides

PRISM EDI and Interface Resource Documents