Many Medicaid recipients are required to enroll with a Managed Care Organization (MCO). An MCO that covers physical health care is called an Accountable Care Organization (ACO); one that covers behavioral health is a Prepaid Mental Health Plan (PMHP), and one that covers dental services is called a dental plan (only for those eligible for full dental coverage). Medicaid members enrolled in MCOs are entitled to the same Medicaid benefits as fee-for-service members. However, MCOs may offer more benefits and may have different prior authorization requirements than the Medicaid scope of benefits. A Medicaid member enrolled in an MCO must receive services through that plan with some exceptions called “carve-out services.”
Medicaid contracts with four ACOs to provide healthcare: HealthChoice of Utah, Healthy U, Molina Healthcare and SelectHealth Community Care.
Learn more about MCOs and ACOs by reviewing the Utah Medicaid Provider Manual, Section I: General Information:
https://medicaid.utah.gov/publications
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