Utah Medicaid and CHIP 2025 Annual Report

Welcome to the Utah Medicaid and CHIP Annual Report Dashboard!

This dashboard includes data on the Medicaid and CHIP populations in Utah, including enrollment levels, delivery of care, and funding/expenditure information. Data included in this dashboard is updated periodically and can change based on retroactive adjustments to enrollment or expenditures.

Information contained in this dashboard includes:

• Historical information about CHIP and Medicaid.
• Monthly enrollment levels for Medicaid and CHIP in Utah.
• Demographic enrollment data:
  • Percentage of county population enrolled
  • Race
  • Ethnicity
  • Gender
  • Category of assistance
  • Age
• Managed care plan enrollment data:
  • Percentage of the population enrolled in each type of plan
  • Monthly enrollment numbers by type of plan and specific plan
• Funding and expenditure data:
  • The five most recent completed state fiscal years funding levels
  • The most recent state fiscal years and total expenditures by type of expenditure and entity
• Provider information:
  • The number of providers enrolled in the past five state fiscal years (by type)
  • Expenditures by provider type from the past five state fiscal years
• Utilization data:
  • Number of services rendered through fee for service or managed care delivery, by type of service, for the past five state fiscal years
  • Expenditures through fee for service delivery, by type of service, for the past five state fiscal years

Utah Medicaid 101

Medicaid was established in 1965 by Title XIX of the Social Security Act. Utah implemented its Medicaid program in 1966, which at the time, focused on acute and long term care. Today, Utah Medicaid provides coverage for physical health, behavioral health, and dental services, as well as long term services and supports.

Medicaid operates as a partnership program between the federal and state governments. Currently, the federal government shares financial responsibility by matching state costs with federal dollars. Utah's Federal Medicaid Assistance Percentages (FMAP) in 2025 was 65.8% federal and 34.2% state funding.

While certain federal requirements outline whom and what must be covered in each program, states generally have flexibility to tailor and expand their Medicaid program to meet the needs of their population and state budgets.

Who is Eligible?

All individuals who meet the minimum federal Medicaid eligibility requirements are guaranteed coverage. States can expand upon the minimum federal requirements, add optional or special populations to their Medicaid programs or increase the income eligibility limits. For example, all states have expanded Medicaid coverage to children beyond the minimum required under federal law, but not all states have opted to expand Medicaid to adults without dependent children.

Although many people believe Medicaid provides health care services for all low-income people, in Utah, the program actually only covers individuals that fit in one of the designated qualifying groups. There are more than 30 Medicaid aid categories, each with varying eligibility requirements and varying benefits.

What is Covered?

Individuals eligible for Medicaid are guaranteed a basic set of benefits covering specific services and settings. States can add to or vary these benefits in terms of the duration, type, amount and scope of services covered. For example, all states have opted to cover prescription drugs, but not every state covers dental services, vision care or comprehensive behavioral health services.

The Medicaid benefits that an individual may receive depend on several different factors, which include:

• Age
• Pregnancy
• Category of Assistance

Differences in benefits include:

• Individuals who are not pregnant, do not have a dependent child or are not a child may have co-payments or cost-sharing requirements
• Children are generally entitled to greater benefits as long as they are medically necessary

How are Medicaid Services Delivered?

States, in general, set the standards or policies for how they deliver services to Medicaid enrollees within the federal framework and requirements. They also choose how to purchase services and distribute payments to providers. The most common methods of payment in Medicaid programs include:

• Fee for service, where the state directly pays providers a flat fee for each service delivered.
• Managed care, where the state contracts with health, dental or behavioral health plans and pays them a monthly per member capitation payment to provide all covered services. Learn more about Utah's managed care plans here (opens in a new tab).

Regardless of the structure, states must ensure sufficient statewide access of services to enrollees.

How Do States Uniquely Tailor the Program to Address Priorities?

States can address their priorities by seeking waivers from federal law or choosing certain variations in the Medicaid program. Some examples include:

• States can use Medicaid to cover services provided in home and community based settings instead of nursing homes.
• States can choose to require some form of cost sharing for certain populations or services.
• States can choose to use Medicaid dollars during public health emergencies to help pay for unexpected health care costs associated with response efforts, such as paying for insect repellent during the Zika outbreak.

The Utah Department of Health and Human Services is designated as Utah's Single State Agency responsible for making state applications to the federal government for all Medicaid funding and Medicaid-related program initiatives.

How Do Residents Apply for Coverage?

Historically, eligibility workers were stationed around the state and applicants would fill out paper applications and mail it in or return it in person. People can still fill out a paper application; however, today they can apply online at medicaid.utah.gov (opens in a new tab). The Department of Workforce Services performs the eligibility determinations for all of Utah's medical assistance programs.

---

Geographic Distribution

Managed Care Enrollment