Medicaid agency: DHHS, Division of Integrated Healthcare
Utah Medicaid sits within the Division of Integrated Healthcare, part of the Department of Health and Human Services' Healthcare Administration area. Physical health care is delivered through four statewide Accountable Care Organizations (ACOs), Health Choice Utah, Healthy U, Molina Healthcare, and SelectHealth Community Care, mandatory in 13 counties, with Utah Medicaid Integrated Care (UMIC) layering integrated physical and behavioral health on top of the same four carriers for Adult Expansion Medicaid members in five of those counties. Behavioral health for nearly everyone else runs through county-based Prepaid Mental Health Plans. The program operates under Utah's Medicaid Reform Section 1115 demonstration, approved in 2002 and currently authorized through June 30, 2027; a 2027-2032 renewal, including a resubmitted Community Engagement work-requirement amendment and a request to end Targeted Adult Medicaid on the same date, is pending CMS review. Separately, federal H.R. 1 (the One Big Beautiful Bill Act) imposes its own community-engagement and eligibility-review requirements on Adult Expansion and Targeted Adult Medicaid members starting January 1, 2027.
Four Accountable Care Organizations (Health Choice Utah, Healthy U, Molina Healthcare, and SelectHealth Community Care) hold statewide ACO contracts, with combined enrollment of roughly 210,000 members in 2024, per CMS. Enrollment is mandatory in 13 counties (Utah, Salt Lake, Davis, Weber, Box Elder, Cache, Iron, Morgan, Rich, Summit, Tooele, Wasatch, and Washington); members elsewhere may enroll voluntarily or stay fee-for-service. In five of those counties (Davis, Salt Lake, Utah, Washington, and Weber), Adult Expansion Medicaid members (those up to 138% of the federal poverty level) enroll instead in Utah Medicaid Integrated Care (UMIC), effective since January 1, 2020, which combines physical and behavioral health through the same four carriers (Healthy U does not offer a UMIC plan in Washington County). Targeted Adult Medicaid (TAM) members in those same five counties remain fee-for-service rather than joining UMIC. Both the ACO and UMIC structures operate under Utah's Section 1115 Medicaid Reform Demonstration.
Most long-term services and supports run fee-for-service outside the ACOs, through nine active Section 1915(c) home- and community-based waivers covering populations such as acquired brain injury, intellectual and developmental disabilities, aging, and technology-dependent or medically fragile individuals. The exception is HOME, a managed care program specifically for individuals with developmental disabilities delivered through a University of Utah Health medical-home model, covering roughly 1,400 members in 2024 across Salt Lake, Utah, Weber, Davis, Tooele, Summit, and Wasatch counties.
Partially integrated into managed care
Outside the five UMIC counties, behavioral health is carved out to 11 county-based Prepaid Mental Health Plans (PMHPs) covering 28 of Utah's 29 counties; members get inpatient and outpatient mental health services and outpatient substance use disorder services through the PMHP contractor serving their county of residence. Wasatch County is the one exception; its members are not enrolled in a PMHP and instead access behavioral health services through the Medicaid Fee for Service Network. Within the five UMIC counties, Adult Expansion Medicaid members get behavioral health integrated directly into their UMIC plan rather than through a separate PMHP.
Carved out
Medicaid dental care (covering children through EPSDT, pregnant and postpartum members, and, since Utah expanded the benefit to all adults 21 and older effective April 1, 2025 under the Section 1115 demonstration's Targeted Adult Dental Benefits component, adults generally) moved from managed dental plans (MCNA Dental and Premier Access) to fee-for-service statewide effective July 1, 2026. Providers must separately enroll in the University of Utah School of Dentistry's Medicaid Associated Provider Program to bill for services. Premier Access continues to administer dental benefits for the Children's Health Insurance Program, a separate program unaffected by the Medicaid dental transition.
Effective January 1, 2026, Utah moved to a Hybrid Unified Preferred Drug List, created by a bill passed in the 2025 General Legislative Session, binding fee-for-service and all four ACOs to the same combined preferred-medication list to help control medication costs. The state has not named a pharmacy benefit manager for the program.
Modivcare is Utah's statewide non-emergency medical transportation broker, confirmed in both the state's Medical Transportation provider manual and CMS's own managed care enrollment data.
PRISM, Utah Medicaid's Provider Reimbursement Information System for Medicaid, replaced the state's legacy Medicaid Management Information System, going live in a soft launch in January 2023 and reaching full operation in April 2023.
17 agency updates tracked for Utah. Available with Pro.
See them with ProUtah has expanded its healthcare artificial intelligence program with three new pilots covering drug management and women's health, building on an already controversial state AI initiative. The pilots could eventually allow AI tools to generate care plans and medication recommendations without human review. Details on timing, scope, and which populations or providers are included were not specified in the source reporting. The expansion raises questions about oversight and patient safety given the pilots' trajectory toward reduced clinical oversight.
Utah has authorized a pilot letting Nolla Health's AI tool issue initial prescriptions for acne treatment without a physician visit, which the company says is the first U.S. clearance for AI to write new (not just renewal) prescriptions. Developed with the Utah Office of Artificial Intelligence Policy and the state's Medical Licensing Board, the program launched October 5 through the Nolla Derm app for Utah residents 18 and older at $4.99/month. Patients complete an intake questionnaire and face scan, and the AI selects from a limited list of physician-approved topical treatments, escalating uncertain cases to a licensed physician. Physician oversight of AI prescriptions decreases in stages, from reviewing every case for the first 100 patients to sampling weekly after 500 patients, building on Utah's earlier AI prescription-renewal pilots with Doctronic and Legion Health.
The Disability Law Center released a report Monday accusing Utah's Department of Health and Human Services of inadequate oversight of Safe and Sound Services, a licensed provider whose transport driver has been charged with murder after three clients with disabilities died in his vehicle in February 2026. The center says DHHS allowed a high-risk provider to serve individuals with complex needs despite prior complaints of physical assaults, failure to provide medical care, dangerously low staffing ratios, and facilities lacking heat or running water. Utah DHHS responded that it has hired a contractor to assess risk mitigation, added four oversight staff, and is exploring stricter provider qualification standards. The provider's license has been revoked.
Utah state, county, and city officials are implementing 25 recommendations to divert nonviolent individuals with mental illness and substance use disorders from jails into behavioral health treatment, modeled on Miami-Dade County's approach. The plan, developed by the Leifman Group in partnership with Salt Lake County in late 2025, involves new workgroups with law enforcement, courts, behavioral health providers, and other stakeholders. Governor Spencer Cox has endorsed the effort. The initiative seeks to modernize behavioral health services for populations currently cycling through criminal justice systems.
Utah Medicaid advocates are raising concerns that a new federal Medicaid rule will further reduce coverage in the state, compounding recent Congressional cuts to the program. The advocates cite cases of beneficiaries who could lose coverage, including substitute teachers facing gaps during summer months, a single mother who nearly lost her vision, and children affected by family custody situations. The timing and specific provisions of the federal rule are not detailed in the available excerpt, but advocates warn the combined effect of federal and Congressional actions threatens coverage continuity for vulnerable populations.
16 active waivers tracked for Utah. Available with Pro.
See them with ProNo active solicitations currently tracked for Utah.
32 managed care contracts tracked for Utah. Available with Pro.
See them with Pro16 bills tracked for Utah. Available with Pro.
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