Category Archives: Utah

Market Overview PDF

Download NowUtah_060524.pdf

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UT Medicaid Fee for Service vs. Managed Care Penetration, 2014-23

Total Medicaid enrollment in Utah was more than 369,000 in 2023. In January 2022, more than 389,000 Medicaid beneficiaries were enrolled in a managed care plan. The remainder were in fee-for-service Medicaid. Total Medicaid expenditures in Utah were $4.5 billion in 2023, with about 55.4% through managed care and the rest through fee-for-service.

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UT SNP Membership at 28,049, Mar-24 Data

Utah had 28,049 Special Needs Plan members as of March 2024.

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University of UT Health Plans Introduces New CHIP Plan Offering

The University of Utah Health Plans announced on May 9, 2024, that it is launching Healthy U CHIP, a new Children’s Health Insurance Program plan which will be available starting July 1 in Utah. Utah does not have a competitive Medicaid managed care procurement process. Read More

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UT PHE Medicaid Redeterminations Monthly Reports to CMS, Mar-24

1. Utah Public Health Emergency (PHE) Medicaid Redeterminations Monthly Report to CMS, March 2024
2. Utah PHE Medicaid Redeterminations Monthly Report to CMS, February 2024
3. Utah PHE Medicaid Redeterminations Monthly Report to CMS, January 2024
4. Utah PHE Medicaid Redeterminations Monthly Report to CMS, December 2023
5. Utah PHE Medicaid Redeterminations Monthly Report to CMS, November 2023
6. Utah PHE Medicaid Redeterminations Monthly Report to CMS, October 2023
7. Utah PHE Medicaid Redeterminations Monthly Report to CMS, September 2023
8. Utah PHE Medicaid Redeterminations Monthly Report to CMS, August 2023
9. Utah PHE Medicaid Redeterminations Monthly Report to CMS, July 2023
10. Utah PHE Medicaid Redeterminations Monthly Report to CMS, June 2023
11. Utah PHE Medicaid Redeterminations Monthly Report to CMS, May 2023
12. Utah PHE Medicaid Redeterminations Monthly Report to CMS, April 2023
13. Utah PHE Medicaid Redeterminations Baseline Report to CMS, March 2023

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UT Medicaid ACO Contracts, 2017-24

1. UT ACO Contracts SFY 2024
2-5. UT ACO Contracts, SFY 2023
6-9. UT ACO Contracts, January 1, 2018 – December 31, 2022
10-17. UT ACO Contracts, January 1, 2017 – December 31, 2017

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UT Medicaid External Quality Review Reports, 2018-23

1. UT Medicaid Managed Care Annual External Quality Review Report of Results, Published March 2023
2. UT Medicaid Managed Care Annual External Quality Review Report of Results, Published June 2022
3. UT Medicaid Managed Care Annual External Quality Review Report of Results, Published April 2021
4. UT Medicaid Managed Care Annual External Quality Review Report of Results, Published April 2020
5. UT Medicaid Managed Care Annual External Quality Review Report of Results, Published April 2019
6. UT Medicaid Managed Care Annual External Quality Review Report of Results, Published April 2018

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UT Medicaid MAC Pharmacy Pricing RFP, Mar-24

1. Utah Medicaid MAC Pharmacy Pricing Request for Proposals (RFP), Issued March 18, 2024
2. Attachments

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UT Receives Approval for Genetic Testing, Housing-Related Program, and Other Changes to State’s 1115 Demonstration Program

The Centers for Medicare & Medicaid Services announced on March 8, 2024, that it has approved Utah’s Medicaid Reform 1115 Demonstration amendments, effective through June 30, 2027. Under the waiver amendment, the state may provide coverage for in vitro fertilization and genetic testing services for eligible individuals ages 18 through 35 and for fertility preservation treatment for eligible individuals diagnosed with cancer. The state also received approval to increase the premium subsidy amount for the Children’s Health Insurance Program. Lastly, the amendment adds four risk factors to the state’s Housing Related Services and Supports demonstration program to align program eligibility with eligibility for the Targeted Adult Group. Read More

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UT Medicaid Reform 1115 Demonstration Waiver Documents, 2016-24

1. Utah 1115 Medicaid Reform (formerly Primary Care Network) Waiver Amendment Request Approval, February 29, 2024
2. Utah 1115 Medicaid Reform Waiver Amendment Request – Chronic Conditions, July 27, 2023
3. Utah 1115 Medicaid Reform Waiver Amendment Request – Dental, July 27, 2023
4. Utah 1115 Medicaid Reform Waiver Amendment Request – Family Planning, July 27, 2023
5. Utah 1115 Medicaid Reform Waiver Postpartum Extension Request, May 16, 2023
6. Utah 1115 Medicaid Reform Waiver Utah’s Premium Partnership for Health Insurance Program Premium Increase Amendment Request, April 10, 2023
7. Utah 1115 Primary Care Network (PCN) Waiver Medical Respite Services Amendment Request, December 30, 2021
8. Utah 1115 PCN Waiver Fertility Preservation Services Amendment Request, December 30, 2021
9. Utah 1115 PCN Waiver Extension Request, June 30, 2021
10. Utah 1115 PCN Waiver Letter from HHS Rescinding Approval, August 10, 2021
11. Utah 1115 PCN Waiver Premium Subsidy Adjustment Request, submitted February 19, 2021
12. Utah 1115 PCN Waiver Medicaid Coverage for Justice-Involved Populations Amendment, submitted June 29, 2020
13. Utah 1115 PCN Waiver Fallback Plan Amendment, released for public comment September 27, 2019
14. Utah 1115 PCN Waiver Enrollment of the Expansion in Managed Care Amendment Request, submitted August 29, 2019
15. Utah 1115 PCN Waiver Dental Benefits for Medicaid Eligible Individuals Age 65 and Older Draft for Public Comment, released May 6, 2019
16. Utah 1115 PCN Waiver Partial Expansion Approval, received March 29, 2019
17. Utah 1115 PCN Waiver Phase-Out Plan for Waiver Populations Transitioning to Adult Expansion Medicaid Draft for Public Comment, released January 24, 2019
18. Utah 1115 PCN Waiver Medicaid Expansion Alternative Benefit Plan for Public Comment, released January 24, 2019
19. Utah 1115 PCN Waiver Approval, October 2017
20. Utah 1115 PCN Waiver Amendment Request to CMS, August 15, 2017
21. Utah Department of Health 1115 Demonstration Waiver Renewal Application for January 1, 2017 through December 31, 2019.
22. Utah 1115 PCN Waiver Amendment Request to CMS, June 21, 2018
23. Utah 1115 PCN Waiver Amendment Request to CMS, June 29, 2018
24. Utah 1115 PCN Waiver Amendment Request Summary Handout, 2018
25. Utah 1115 PCN Waiver Adult Social Detoxification Covered Service Amendment Request, submitted February 6, 2019

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