Member Handbook

Your Member Handbook

Your Member handbook tells you about:

Your health plan.
Your benefits and what is covered.
How to get the services you need
How to contact us.
Your rights and responsibilities as a member.

Get a copy of your handbook below or call Member Services at (888) 483-0760 (TTY/TDD: 711) for a paper copy by mail.

Download Member Handbook, English

Download Member Handbook, Spanish

If you have any problem reading or understanding this or any Molina Healthcare information, call Member Services at (888) 483-0760. We can explain in English or in your primary language. You may request printed versions of these materials and they will be sent to you free of charge and within five business days. We may have it printed in other languages. You may ask for it in braille, large print, or audio. If you are hearing impaired, dial 711 for the Utah Relay Service.

CMS-0057 Prior Authorization Annual Reporting

This report shows how prior authorization requests are handled, such as how many were approved or denied and how quickly decisions were made. To find out if a specific service needs prior authorization, members and providers should check the plan’s Prior Authorization Guide or use the Prior Authorization Lookup Tool.

Prior Authorization Guide 2025

Prior Authorization Lookup Tool

UTAH INTEGRATED CARE PLAN - NON-TRADITIONAL Medicaid Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	100%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	0%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	100%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	0%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	10
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	9
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	2
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	2

UTAH HEALTHY KIDS PLAN B Medicaid Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	82%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	18%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	67%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	100%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	100%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	0%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	27
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	19

UTAH INTEGRATED CARE PLAN - TRADITIONAL Medicaid Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	81%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	19%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	68%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	58%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	64%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	50%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	88%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	12%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	21
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	20

UTAH URBAN MEDICAID TRADITIONAL - NO COPAY - NO COINS Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	76%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	24%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	77%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	76%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	54%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	100%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	90%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	10%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	7
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	21
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	20

UTAH URBAN MEDICAID TRADITIONAL - W/ COPAY - NO COINS Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	80%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	20%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	83%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	0%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	100%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	89%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	11%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	18
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	19

UTAH HEALTHY KIDS PLAN C Medicaid Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	72%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	28%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	93%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	100%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	94%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	6%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	7
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	7
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	19
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	20

Z UTAH URBAN MEDICAID NON-TRADITIONAL - NO COPAY - NO COINS Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	50%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	50%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	NA
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	9
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	7
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	NA
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	NA

UTAH HEALTHY KIDS PLAN C - N Medicaid Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	75%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	25%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	NA
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	4
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	3
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	NA
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	NA

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