Health Choice

What Health Choice does

Health Choice Utah, Inc. is a Utah-based Medicaid managed care organization (MCO) that delivers capitated healthcare coverage to Medicaid-eligible residents across all 29 counties of the state. Founded in 2016 and operating from Murray, Utah, the company is a subsidiary of University of Utah Health Plans, providing it with affiliation to the broader University of Utah Health system and an academic medical center. The plan enrolls low-income individuals and families, pregnant women, children, and adults with disabilities, and provides a comprehensive benefits package including medical, pharmacy, behavioral health, dental, maternal/newborn, and preventive services. Member-facing infrastructure includes 24/7 nurse advice, a mental health crisis line, multilingual customer service in 17 languages, and a HealthTrio Connect member portal.

Health Choice Utah's core technology is a care management platform that conducts health risk assessments (medical, psychosocial, cognitive, and functional), identifies candidates for case and disease management programs, and coordinates care across interdisciplinary teams. Product modules include the Care Transition Program (hospital discharge coordination), Disease Management programs (asthma, diabetes, hepatitis C, complex case management), a Prior Authorization system, a Maternal and Newborn Health program (Stork Program), and Health Risk Assessment tools. On the provider side, the company operates EDI-based claims submission through the Utah Health Information Network (UHIN) under trading partner ID HT006998-001, and uses CAQH and Certify OS for NCQA-compliant credentialing. HEDIS performance measurement is used for quality reporting. The company is compliant with HIPAA, NCQA credentialing standards, CDC immunization schedules, and the CMS Interoperability and Prior Authorization final rule.

The business model is a single-payer, single-state Medicaid managed care contract: Health Choice Utah receives fixed per-member-per-month (PMPM) capitation premiums from the State of Utah in exchange for providing the full Medicaid benefit package to enrolled members. Member out-of-pocket costs are minimal and set by Medicaid guidelines rather than market-based pricing. Distribution is conducted through the State Medicaid enrollment process, provider referrals, community outreach, and the member portal. The plan is one of four Utah Medicaid managed care plans (alongside Healthy U, Molina Healthcare, and Select Health), operating in a procurement-driven, rate-regulated market.

Name

Health Choice

Legal name

Health Choice Utah, Inc.

Website

https://healthchoiceutah.com

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

101–250 employees

Short description

Health Choice Utah is a Medicaid managed care plan, affiliated with University of Utah Health Plans, providing capitated healthcare coverage — including medical, pharmacy, behavioral, and maternal health — to Medicaid-eligible residents across all 29 Utah counties.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Health Care and Social Assistance (62), Services for the Elderly and Persons with Disabilities (624120)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB)

akta.pro secondary industry

Aged, Blind & Disabled (ABD) Managed Care Plans (HLAEAEAC)

Keywords

• Medicaid managed care
• Government health plans
• Managed care organization
• Medicaid care management
• Behavioral health services

Headquarters

HQ city

Murray

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Supply Chain, Infrastructure

Revenue model

1. Medicaid Capitation Premiums: Health Choice Utah operates as a Medicaid managed care plan receiving capitated premium payments from the State of Utah in exchange for providing comprehensive healthcare coverage to enrolled Medicaid members. Revenue is generated through fixed per-member-per-month (PMPM) payments from government Medicaid contracts.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels4 records

Core offering

Health Choice Utah is a Medicaid managed care plan providing comprehensive healthcare coverage to Medicaid-eligible residents across all 29 counties in Utah. Members receive medical, pharmacy, behavioral health, and dental benefits along with integrated programs including case management, disease management, maternal/newborn health (Stork Program), and a Care Transition Program for hospital discharge coordination. Coverage is delivered via contracted provider networks, member portals, multilingual support, and 24/7 nurse advice services.

Product overview

Health Choice Utah is a Medicaid managed care plan operated by University of Utah Health Plans that provides healthcare coverage to members throughout all Utah counties. The offering consists of a core Medicaid managed care plan with integrated modules including Health Risk Assessment tools (adult and pediatric), Case Management programs, Disease Management programs (Asthma, Diabetes, Hepatitis C, Complex Case), a Care Transition Program, Prior Authorization system, Maternal & Newborn Health services with the Stork Program, and EDI claims submission capabilities. The plan connects members to providers through online portals and integrates with UHIN for electronic claims processing and CAQH for provider credentialing.

Differentiator

Problem solved

Functional benefit

Products and services

• Health Choice Utah Medicaid Managed Care Plan Core Medicaid managed care health plan offering comprehensive healthcare coverage — including doctor visits, hospital services, prescription drugs, mental health services, dental care, and preventive care — to Medicaid-eligible residents across all 29 counties in Utah, funded through capitated per-member-per-month payments from the State of Utah.
• Health Risk Assessment (HRA) Standalone health questionnaire service for adult and pediatric Medicaid members that assesses overall physical and mental well-being and helps coordinate ongoing healthcare needs.
• Case Management Program Nurse-led care management service that helps members and their families obtain needed healthcare and coordinates with primary care physicians to manage care and maintain health.
• Maternal & Newborn Health Program (Stork Program) Dedicated support program for pregnant and postpartum members featuring maternity nurse guidance, a well-baby booklet, pregnancy visit schedules, and connections to WIC and community resources.
• Care Transition Program Interdisciplinary program that initiates a care transition plan when members move between care settings (e.g., hospital admission/discharge), including discharge planning, medication reconciliation, behavioral health coordination, home services assistance, and follow-up appointment scheduling.
• Disease Management Programs Disease-specific management programs for members with chronic illnesses including asthma, diabetes, and hepatitis C, plus complex case management with individualized care plans.

Quantifiable outcome

• HEDIS performance measurement and reporting for preventive health services including well-care visits, dental visits, breast cancer screenings, and other quality measures.

Named customers1 record

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature5 records

Partnerships

14 partnerships are on record, tiered core, major and supporting.

• Findhelp.orgcoreStrategic or Co-development PartnerFindhelp.org is a community resource platform that helps members find free or reduced-cost services including food, housing, financial assistance, and healthcare. Health Choice Utah integrates this resource to connect members with community support services.
• House Call DoctorscoreStrategic or Co-development PartnerHouse Call Doctors provides in-home health assessments for eligible Health Choice Utah members. This partnership enables comprehensive health evaluations in members' homes as part of care management.
• Fia CarecoreStrategic or Co-development PartnerFia Care provides in-home health assessment services for eligible Health Choice Utah members, supporting the company's home-based care evaluation program.
• Community Nursing ServicescoreStrategic or Co-development PartnerCommunity Nursing Services partners with Health Choice Utah to deliver in-home nursing services and health assessments for members who qualify for home-based care.
• Utah Health Information Network (UHIN)coreTechnology or IntegrationUHIN is a non-profit coalition of payers and providers in Utah that standardizes electronic health information transactions. Health Choice Utah uses UHIN for all HIPAA-compliant EDI transactions including claims submission, remittance advice, and provider enrollment. Trading partner number: HT006998-001.
• Certify OScoreTechnology or IntegrationCertify OS conducts all primary source verifications for Health Choice Utah's credentialing process, enabling efficient provider credentialing in compliance with NCQA standards.
• CAQH (Council for Affordable Quality Healthcare)coreTechnology or IntegrationCAQH provides the universal provider credentialing application platform. Health Choice Utah requires all practitioners to complete CAQH profiles and uses CAQH exclusively for credentialing applications.
• Clearance Houses (Multiple)coreTechnology or IntegrationHealth Choice Utah accepts claims through multiple clearinghouses that connect to UHIN. Providers can submit electronic claims through their preferred clearinghouse for processing.
• Intermountain HealthcaremajorChannel Partner/ Reseller/ DistributorIntermountain Healthcare is a major health system partner providing hospital and physician services throughout Utah. Amy Prince serves as primary contact for Intermountain Healthcare relationships.
• University of Utah Hospitals and ClinicsmajorChannel Partner/ Reseller/ DistributorUniversity of Utah Hospitals and Clinics serves as the academic medical center partner, providing specialized and tertiary care services. Lisa DeKarver serves as primary contact for this relationship.
• Holy Cross HospitalsmajorChannel Partner/ Reseller/ DistributorHoly Cross Hospitals (Jordan Valley, Jordan Valley West, Salt Lake, Mountain Point, Davis) provide hospital services in the greater Salt Lake area. Kayanne Malin serves as primary contact.
• HCA MountainStar HospitalsmajorChannel Partner/ Reseller/ DistributorHCA MountainStar Hospitals provide hospital services in Utah. Kayanne Malin serves as primary contact for HCA MountainStar relationships.
• Utah Transit Authority (UTA)supportingStrategic or Co-development PartnerUTA provides bus passes and transportation services for eligible Health Choice Utah members who cannot arrange their own transportation to medical appointments. Services include UTA FlexTrans and PickMeUp Medical Transport for members with medical reasons preventing bus use.
• Utah Area Behavioral Health CentersmajorChannel Partner/ Reseller/ DistributorNetwork of behavioral health centers including Bear River Mental Health, Davis Behavioral Health, OptumHealth Mental Health, Wasatch Mental Health, Weber Human Services, and others serving different Utah counties for mental health and substance use disorder services.

Scale indicators1 record

Recent moves6 records

Expansion highlights4 records

Direct peers

• Healthy U: University of Utah Health Plans' Medicaid managed care plan competing head-to-head with Health Choice Utah in Utah. Same parent system, same product, same Medicaid enrollee population — the closest comparable peer.
• Select Health Community Care: Intermountain Healthcare's Medicaid managed care plan operating in Utah. Direct competitor for Medicaid members across overlapping counties, with comparable integrated provider network model.
• Molina Healthcare: National Medicaid managed care company with a Utah plan that directly competes with Health Choice Utah. Operates with similar government-program-only focus and a comparable care management approach, but with substantially greater scale.

Broad incumbents

• Centene Corporation: The largest U.S. Medicaid managed care operator with a national footprint. Competes with Health Choice Utah in Medicaid procurement, leverages vastly greater scale, capital, and government-relations depth across multiple state contracts.
• UnitedHealth Group: Diversified national health insurer with a sizable Medicaid managed care presence through UnitedHealthcare Community & State. Operates a much broader portfolio across commercial, Medicare, and Medicaid, putting Health Choice Utah at a competitive scale disadvantage.
• Elevance Health: Major diversified health insurer (formerly Anthem) with a sizable Medicaid business across multiple states. Competes for state Medicaid contracts with significantly greater capitalization and geographic diversification than Health Choice Utah.
• Humana: National health insurer with a Medicaid managed care presence. Operates a broader portfolio centered on Medicare and group plans, but participates in selected state Medicaid procurements that can compete directly with Health Choice Utah's footprint.
• CVS Health (Aetna): Vertically integrated health insurer with Medicaid managed care through Aetna. Brings pharmacy benefit management (Caremark) and retail health assets that create pricing and care-coordination advantages versus regional plans like Health Choice Utah.

Others

• University of Utah Health Plans: Parent organization of Health Choice Utah. Comparable in that it administers health plans under the University of Utah Health umbrella, but functions as the strategic/operating parent rather than a direct competitor.
• Intermountain Healthcare: Major Utah provider system and partner of Health Choice Utah, while also the parent of competing Medicaid plan Select Health Community Care. Demonstrates the provider-insurer convergence that defines the Utah Medicaid competitive landscape.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/healthchoiceut
• Facebookfacebook.com/HealthChoiceUtah
• LinkedInlinkedin.com/company/healthchoiceutah

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Health Choice