Medicaid program name: Utah Medicaid

Medicaid ACO program name: Utah Medicaid ACOs

Status: Active

Most Utah Medicaid beneficiaries who are not elderly or disabled are enrolled in state-defined Medicaid ACOs. Utah adopted this program in 2011 before the MSSP began and the current Utah Medicaid ACO approach is different than Medicare models. Utah Medicaid ACOs are described as an expanded approach to Medicaid managed care and the program is tied to a statute that required the state agency to move to risk-based MCOs. While the model did not initially include downside risk, in 2013, Utah moved to capitated care contracts tied to quality and access criteria. Certain ACOs have engaged in shared savings arrangements with some of their contracted providers. Importantly, Utah’s Medicaid ACO model is payer-led, rather than provider-led, and allows the ACOs to build networks and structure contracts with downstream providers. Given this key difference, there has been some movement away from calling this an “ACO” program toward referring to it as a general Medicaid value-based payment model. As of 2021, Medicaid members in 13 of Utah’s 29 counties are required to enroll in an ACO plan while members in the other counties may choose between an ACO and fee for service Medicaid. Utah currently contracts with four ACO plans: Healthy U, SelectHealth Community Care, Molina Healthcare of Utah, and Health Choice Utah. While ACOs were initially only required to maintain quality standards, in 2018, the state shifted its focus from maintaining quality to improving quality, asking plans to progressively achieve scores at or above the national average. Utah’s Medicaid ACO program has saved the state an average of $15 million annually.

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