UnitedHealthcare Community & State

What UnitedHealthcare Community & State does

UnitedHealthcare Community & State is a line of business within UnitedHealth Group (NYSE: UNH) that provides managed care services to Medicaid populations across 32 states and Washington D.C., serving approximately 7 million members through a network of over 1,400 hospitals and 193,000 providers. The organization offers a broad portfolio including Medicaid managed care, TANF, CHIP, Long-Term Care/ABD, dual-eligible Special Needs Plans, Administrative Services Organization (ASO), and Management Services Organization (MSO) arrangements, alongside specialized programs such as the Enabling Technology benefit for LTSS recipients, the PRIME value-based care initiative in Colorado, My Maternity Journey, and the Community Grants Program. Technology stack includes a Medicaid managed care platform with care coordination and population health analytics, integrations with Scene Health for video Directly Observed Therapy, FindHelp for closed-loop social referrals, Brainshark for grant training, and voice-enabled smart home devices for LTSS members. Revenue is generated primarily through capitation payments (per-member per-month) from state Medicaid agencies under competitively procured multi-year contracts, with value-based care overlays (such as PRIME's shared-savings structure) layering economic alignment with provider partners.

Name

UnitedHealthcare Community & State

Legal name

UnitedHealthcare Services, Inc.

Website

https://uhccommunityandstate.com

Company type

Public

Founded year

1974

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

UnitedHealthcare Community & State is a UnitedHealth Group division providing Medicaid managed care to nearly 7 million members across 32 states and Washington D.C. via capitation contracts with state agencies and a 1,400+ hospital, 193,000+ provider network.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Social Assistance (624), Individual and Family Services (6241)

SIC

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

akta.pro primary industry

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

akta.pro secondary industries

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH), Care Management & Care Coordination (Home & Community-Based) (HLAFAEAL), Skilled Home Health (Medicare-Certified) Agencies (HLAFAEAA)

Keywords

• Medicaid managed care
• Government health programs
• Health insurance services
• Long-term services supports
• Value-based care

Headquarters

HQ city

Minnetonka

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

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

Revenue model

1. Medicaid Capitation Payments: The company generates revenue primarily through capitation payments from state Medicaid programs. As a managed care organization, they receive fixed per-member per-month payments to manage the health care needs of Medicaid enrollees, assuming financial risk for delivering comprehensive health services including medical, behavioral, and long-term care.
2. Government Contracts - State Medicaid Programs: Operating as a line of business within UnitedHealth Group, the company enters into contractual relationships with 32 state Medicaid agencies and Washington D.C. to provide managed care services to eligible populations including children, pregnant women, elderly, and individuals with disabilities.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels7 records

Core offering

UnitedHealthcare Community & State is a Medicaid managed care organization that contracts with 32 state Medicaid agencies and Washington D.C. to deliver health coverage and care coordination to nearly 7 million low-income and disadvantaged Americans. It operates Medicaid, CHIP, TANF, Long-Term Care/ABD, Special Needs Plans, and Administrative Services Organization programs, supported by a network of 1,400+ hospitals and 193,000+ providers, and wraps in social-determinants programs such as nutrition support, housing assistance, enabling technology, and community grants.

Product overview

UnitedHealthcare Community & State operates as a Medicaid managed care organization offering a comprehensive portfolio of health coverage products and programs. The core offerings include Medicaid, TANF, CHIP, Long-Term Care/Aged Blind & Disabled (ABD), Medicare (with focus on dual eligibles), Special Needs Plans (SNP), Management Services Organization (MSO), Administrative Services Organization (ASO), and Childless Adults programs. The portfolio extends to specialized programs including My Maternity Journey (maternal health), the Enabling Technology Benefit (tech-based LTSS support), PRIME (Colorado value-based care initiative), and the Community Grants Program. The company organizes insights through content hubs covering Behavioral Health, Complex Care, Foster Care, FQHC partnerships, and Maternal Health, complemented by the Medicaid Made Clear educational resource. UnitedHealthcare Community & State serves nearly 7 million members across 32 states and Washington D.C., with a network of over 1,400 hospitals and 193,000 providers.

Differentiator

Problem solved

Functional benefit

Brands

• PRIME: Payment Reform Initiative for Medicaid Enrollees - a fully capitated managed care innovation program in Colorado focused on whole-person health through value-based care
• Community Grants Program
• CAPP+ Home Repairs Program
• Enabling Technology

Products and services

• Medicaid Core Medicaid health coverage program serving low-income Americans, primarily children, women of child-bearing age, adults in families with dependent children, individuals with disabilities, and the elderly.
• TANF (Temporary Assistance to Needy Families) Programs for families and children focusing on high-prevalence chronic illnesses such as hypertension, cardiovascular disease, asthma, sickle cell disease, diabetes, HIV/AIDS, and high-risk pregnancies.
• CHIP (Children's Health Insurance Program) Coverage for children not covered by commercial insurance and not eligible for Medicaid.
• Long-Term Care / Aged, Blind & Disabled (ABD) Medicaid programs for the long-term care population including nursing home costs and other long-term care programs.
• Special Needs Plans (SNP) Services for individuals with multiple chronic conditions, limited incomes, and those living in nursing facilities; Dual SNPs serve those enrolled in both Medicare and Medicaid.
• Management Services Organization (MSO) Disease management and other health care services for individuals with chronic conditions.
• Administrative Services Organization (ASO) Coordination of services for high-risk populations, helping states manage costs without assuming medical and financial risk.
• Medicare (Dual-Eligible Focus) Coverage focused on dual-eligible individuals who qualify for both Medicaid on the basis of income and Medicare on the basis of age or disability.
• Childless Adults & Programs for the Uninsured Programs developed by states with state or federal funds for adults and families not covered by commercial insurance and not eligible for Medicaid or Medicare.
• PRIME (Payment Reform Initiative for Medicaid Enrollees) Fully capitated managed care innovation program for Health First Colorado members in nine counties, operating under per-member-per-month capitation with value-based care incentives that returned 90% of shared savings ($5 million) directly to providers in the first year.
• Enabling Technology Benefit Tech-based solutions for LTSS members including smart home assistants (Alexa, Google Assistant), video doorbells, smart locks, smart lighting, and remote supports through passive sensors to enhance safety, independence, and connectivity.
• My Maternity Journey Maternal health program helping moms, babies, and states thrive through prenatal and postpartum care support.
• Community Grants Program Grant funding program providing support and resources to design impactful community programs, including free online grant writing training courses (Grant Writing 101 and 201).

Quantifiable outcome

• Breast cancer screening rates increased from 36% to 51% among target population in Cowlitz County through collaborative program
• +5 more outcomes

Named customers4 records

Segments6 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

AI capability9 records

Feature3 records

Partnerships

28 partnerships are on record, tiered core and supporting.

• A.T. Still University-Arizona School of Dentistry & Oral Health (ATSU-ASDOH)coreStrategic or Co-development Partner · 1 January 2026Collaboration to establish fellowship program for five Arizona dentists to address dental health workforce shortage (Arizona meets only 34% of dental health need). Two-year, part-time fellowship combines online learning, research, and hands-on clinical experience in specialized settings.
• Roadrunner Food Bank of New MexicocoreStrategic or Co-development Partner · 1 November 2025Launched 'Keeping healthy while waiting for assistance' program providing home-delivered healthy grocery boxes to eligible Medicaid members. Program includes low sodium, low sugar, gluten-free, or general wellness box options, with over 100 members supported and approximately $39,000 in healthy groceries delivered.
• Hawaii Med-QUEST DivisioncoreStrategic or Co-development Partner · 1 November 2025Collaboration to implement Kau 'Ai Pono: Season of Eating Well nutrition support pilot providing food boxes, vouchers or gift cards valued at approximately $50 per week to eligible Medicaid members experiencing food insecurity.
• Cowlitz Family Health CentercoreStrategic or Co-development Partner · 1 January 2022Collaboration with local FQHC to improve breast cancer screening rates for rural residents. Partnership identified barriers including low provider availability, transportation issues, and limited weekday appointment availability. Breast cancer screening rates increased from 36% to 51% among target population.
• PeaceHealth St. John Medical CentercoreStrategic or Co-development Partner · 1 January 2022Partnership with screening provider to deliver mammography services in rural Cowlitz County, Washington. Joint workflow decreased timeframe between screening appointments and follow-up diagnostic mammograms from one month to two business days.
• Columbia Basin Health Association (CBHA)coreStrategic or Co-development Partner · 1 January 2022Partnership with FQHC serving rural Central Washington to develop hybrid telehealth model for behavioral health care in schools. CBHA's chatbot enables students to book appointments and connects them with 24/7 crisis support. Part of Community Health Entrepreneur Challenge providing two years of support.
• Catalytic Health Partners (CHP)coreStrategic or Co-development Partner · 1 January 2021Partnership to deliver integrated services in members' homes through value-based care arrangement. Five-person care teams include nurse practitioner, care coordinator, behavioral health therapist, community health worker, and clinical liaison. Program achieved NPS of 86 and supported 1,000+ members with demonstrated cost reduction.
• Rocky Mountain Health PlanscoreStrategic or Co-development Partner · 1 January 2012Collaboration through PRIME (Payment Reform Initiative for Medicaid Enrollees) - a fully capitated managed care innovation program supporting Health First Colorado members in nine counties. PRIME operates under per-member per-month capitation with shared savings for providers.
• Scene HealthcoreStrategic or Co-development PartnerPartnership to provide asthma-specific tools and resources including Scene Health's video Directly Observed Therapy (vDOT) program. The program engages pediatric asthma patients with daily check-ins, video submission of medication administration, and asynchronous coaching from pharmacists to improve medication adherence rates.
• Advocates for Community Health (ACH)coreStrategic or Co-development PartnerUnitedHealthcare collaboration with ACH to empower FQHCs to drive local change. Includes Community Health Entrepreneur Challenge program providing financial and technical support to bring innovative approaches to address community challenges.
• Children's Hospital of Philadelphia (CHOP)coreStrategic or Co-development Partner$1.7 million investment in CHOP to expand community-based programs addressing medical and social health factors. Supports CHOP's Center for Health Equity, Office of Community Impact, and Center for Violence Prevention including Community Asthma Prevention Program, CAPP+ Home Repairs, Mobile Food Market, and Firearm Safety Initiative.
• Mom's MealscoreStrategic or Co-development PartnerCollaboration to deliver dietitian-designed meals to pregnant members with diabetes experiencing food insecurity under NJ FamilyCare Medically Indicated Meals Pilot. Meals crafted by registered dietitians to meet nutritional needs balancing pregnancy and diabetes.
• Ripe for RevivalcoreStrategic or Co-development Partner$100,000 investment in nonprofit organization to bring fresh produce, meat and dairy to residents across eastern and central North Carolina through mobile food markets. Markets deliver food at approximately 30% below traditional retail, serving more than 30 community sites each week.
• Appalachian Mountain HealthcoreStrategic or Co-development Partner$750,000 investment to expand mobile medical program through FQHC operating six brick-and-mortar clinics and mobile unit. New mobile unit will feature two exam rooms, providing primary care, behavioral health, lab testing, wound care, dental services, and clinical pharmacy consultations.
• Saving AmycoreStrategic or Co-development Partner$500,000 investment in Phoenix-based nonprofit to support homeless families through three-year wraparound model. Programs include Rise Up, Rolling Forward (transportation), Empowerment Through Therapy, THRIVE life skills, and Kids Go. 100% success rate where all families maintain housing.
• FindHelpsupportingTechnology or IntegrationClosed-loop referral technology platform used to make referrals to Roadrunner Food Bank. Enables secure information sharing and coordinated follow-up, allowing Roadrunner to understand member needs before contact.
• Community Partnership of the Ozarks (CPO)coreStrategic or Co-development PartnerInvestment to strengthen financial resilience and prevent homelessness through Making Sense of Money (financial education) and Shelter Diversion programs. Serves adults, families, seniors, and veterans across Greene, Christian and Webster Counties in Missouri.
• AccessPoint RIcoreStrategic or Co-development PartnerPartnership for CNA-to-MedTech Career Pathway Pilot with Rhode Island Office of Postsecondary Commissioner and RI Reconnect. Program will enroll 13-20 participants with tuition assistance, hybrid evening courses, and wraparound services including childcare and transportation stipends.
• Operation Stand Down Rhode IslandcoreStrategic or Co-development Partner$75,000 investment to support homeless and at-risk veterans with housing move-in assistance, employment training, legal navigation, and certification materials. Serves cohort of 20-30 veterans.
• Southern Rhode Island VolunteerscoreStrategic or Co-development PartnerInvestment to expand grocery delivery, rides to medical appointments, and companionship services for isolated older adults in Washington County, Rhode Island.
• Ocean State Center for Independent LivingcoreStrategic or Co-development PartnerInvestment to provide home accessibility improvements for 20-25 Rhode Islanders with disabilities including ramps, grab bars, and widened doorways to reduce fall risk and allow individuals to remain in their communities.
• Valle del Sol Community HealthcoreStrategic or Co-development Partner$3 million grant from United Health Foundation for mobile units delivering integrated care to high-need communities in Phoenix, Arizona.
• Brighter Way InstitutecoreStrategic or Co-development Partner$800,000 investment to build and deploy mobile dental clinic serving low-income areas including people experiencing homelessness, veterans, and families.
• March of DimescoreStrategic or Co-development Partner$800,000 investment to launch Phoenix's first March of Dimes Mom & Baby Mobile Health Center.
• Arizona Community Health Workers AssociationsupportingStrategic or Co-development PartnerDonation to increase the number of Community Health Workers serving Medicaid members across Arizona.
• Central New Mexico Community CollegecoreStrategic or Co-development Partner$100,000+ investment in health care education scholarships for students pursuing clinical careers. 30 scholarships provided each year to remove financial barriers and strengthen New Mexico's health care workforce.
• Eastern New Mexico UniversitycoreStrategic or Co-development PartnerPartnership for healthcare education scholarship program providing 30 scholarships annually to help build New Mexico's health care workforce.
• Navajo Technical UniversitycoreStrategic or Co-development PartnerPartnership for healthcare education scholarship program providing 30 scholarships annually to help build New Mexico's health care workforce.

Scale indicators9 records

Recent moves6 records

Expansion highlights8 records

Direct peers

• CVS Health / Aetna: Operates Medicaid managed care plans through Aetna, competing for state contracts in multiple overlapping states. Similar dual-eligible and whole-person care positioning, with retail health and pharmacy integration as a differentiator.
• Centene Corporation: Largest pure-play Medicaid managed care company in the US. Directly comparable as a Medicaid MCO competitor bidding on the same state contracts across multiple overlapping states; both operate integrated whole-person Medicaid models.
• Humana: Major health insurer with significant Medicaid presence (notably in Florida and Kentucky via CenterWell). Directly competes for state Medicaid contracts and shares a focus on integrated care for complex and dual-eligible populations.
• Molina Healthcare: Pure-play government-sponsored health plan focused almost entirely on Medicaid, Marketplace, and dual-eligible members. Directly comparable in state Medicaid markets, with similar member populations and value-based care approaches.
• Elevance Health (Anthem): Major diversified health insurer with a large Medicaid MCO business (formerly Amerigroup). Directly competes in state Medicaid procurements and operates integrated care programs across many of the same states as UnitedHealthcare Community & State.
• Health Net (Centene subsidiary): Medicaid and government-program health plan operating in multiple western and southwestern states. Directly competes for the same state Medicaid contracts (e.g., California, Arizona) as UnitedHealthcare Community & State.

Broad incumbents

• Kaiser Permanente: Integrated health system and insurer with Medicaid contracts in select states (e.g., California, Colorado). Comparable as a Medicaid contractor in some markets, though narrower geographic footprint and integrated-provider model differ from UnitedHealthcare Community & State's network-based approach.
• UnitedHealth Group (parent): Parent conglomerate providing capital, technology, and infrastructure to UnitedHealthcare Community & State. Listed for context as the broader organization of which the subject is a division.

Regional players

• Inland Empire Health Plan (IEHP): Large not-for-profit Medicaid plan in California with comparable dual-eligible and LTSS programs. Comparable in operating model and complex-population focus, though regional rather than multi-state.

Emerging players

• CareSource: Nonprofit Medicaid managed care plan with growing footprint across multiple states. Comparable member population and whole-person care focus; emerging competitive threat in state rebid processes.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat7 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/UnitedHealthcare
• LinkedInlinkedin.com/company/uhccs
• Xx.com/UHCCS

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 records

Subsidiaries5 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 UnitedHealthcare Community & State