Rehabs in Utah That Take PCN

Yes. Individuals who were on the Primary Care Network now have Adult Expansion Medicaid, which covers substance use disorder treatment across the full ASAM continuum, including outpatient, intensive outpatient, residential, withdrawal management, and opioid treatment programs under Utah's 1115 SUD demonstration.

This is a broader benefit than PCN ever provided.

Apply online through the Utah Department of Workforce Services at jobs.utah.gov/mycase, which handles eligibility for Medicaid rather than the Medicaid agency itself. No paper application is needed if you apply online.

For help, call 1-866-435-7414 toll-free or (801) 526-0950 in Salt Lake County, or visit a DWS employment center in person.

Yes. A smaller Bridge Plan began enrolling adults up to 100% of the federal poverty level on April 1, 2019, the same date PCN members transitioned to Adult Expansion. CMS then approved full Medicaid expansion to 138% of the federal poverty level on December 23, 2019.

Utah residents aged 19 to 64 who are citizens or legal residents qualify based on income.

Former PCN members now choose among four Accountable Care Organizations for physical health: Health Choice Utah, Healthy U, Molina Healthcare, and SelectHealth Community Care. A plan is mandatory in 13 counties, including Salt Lake and Utah County, and optional elsewhere.

Behavioral health runs through a separate county-based Prepaid Mental Health Plan or, in five counties, an integrated UMIC plan.

Yes. Residential and ambulatory withdrawal management are both covered levels of care for Adult Expansion members, the group that absorbed former PCN enrollees. Hospital medical detox is handled by the physical health plan, integrated plan, or Fee for Service Network rather than the behavioral health plan.

Prior authorization may be required depending on the setting.

Yes. Residential substance use treatment is covered in programs with 16 or fewer beds and in larger licensed residential programs under Utah's 1115 waiver. Prior authorization from the member's Prepaid Mental Health Plan or integrated plan is required before admission.

This replaced the narrower primary-care-only benefit PCN used to offer.

Outpatient mental health and substance use treatment carries no copay for Utah Medicaid members, including those who moved over from PCN. Other adult copays include $4 per doctor visit, $4 per prescription up to $20 a month, and $75 per inpatient hospital stay.

Targeted Adult Medicaid members, pregnant members, and those under 18 pay no copays at all.

Yes. Intensive outpatient programs and day treatment or partial hospitalization are both covered levels of care under Utah Medicaid's substance use disorder benefit, which now applies to everyone who moved from PCN into Adult Expansion Medicaid in 2019.

Coverage follows ASAM placement criteria rather than a fixed visit limit.

Yes, buprenorphine products are part of Utah Medicaid's covered opioid treatment benefit and appear on the state Preferred Drug List, which is updated monthly. A prior authorization form applies to some oral buprenorphine products, and ACO members follow their own plan's drug list.

Former PCN enrollees now get this coverage through Adult Expansion Medicaid.