Benefits at a Glance

Utah Molina Medicaid

For a full list of benefits information, please read your Member Handbook or call Member Services at (888) 483-0760.

Covered Services are marked with "X."

Services that need approval in advance are marked "+."

Services You May Need Traditional Utah Medicaid Non-Traditional Utah Medicaid
Abortion X + X +
Autism services X + Not covered
Diabetes education X X
Medical supplies/equipment X X
Durable Medical Equipment (DME) X + Exclusions apply
End state renal disease - dialysis X X
Home health services X + X + (Speech and language services are excluded)
Hospice services (up to 30 days) X + X +
Skilled nursing facility, intermediate care facility, long­term acute care (up to 30 days) X + X +
Family planning X X (some exclusions apply)
Lab/X-ray X X
Inpatient hospital services X X
Outpatient hospital services X X
Emergency department services X X
Physician services X X
Podiatry services X X
Preventative services (mammograms, Pap smears, prostate exams) X X
Physical therapy (PT)/occupational therapy (OT) X X (limit of 10 combines visits per calendar year)
PT/OT in home services EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC) and pregnant women only Not Covered
Prenatal services (care coordination, prenatal and postnatal home visits, group education, nutritional assessment, counseling) X Not Covered
Private duty nursing X + Not Covered
Speech and hearing Services EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC) EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC)
Hearing aids and batteries EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC) EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC)
Speech augmentative communication devices (SACDs) X + X +
Sterilizations X + X +
Substance use treatment X X
Organ transplant X X
Vision (VSP)
Routine eye exam X X
Eyeglasses (frames and lenses) EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC) and pregnant women only EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC)
Contact lenses EPSDT or Early Periodic Screening, Diagnosis and Treatment (previously called CHEC) and pregnant women only + Not covered

Carved Out Services (not covered by Molina Medicaid)
Dental Contact State Medicaid Contact State Medicaid
Targeted case management T1017, T1023 Contact State Medicaid Contact State Medicaid
Ambulance transportation Contact State Medicaid Contact State Medicaid
Nursing facility, Long Term Care (longer than 30 days) Contact State Medicaid Contact State Medicaid
Specialized mental health services Prepaid Mental Health Plan Contact State Medicaid
Transportation Contact State Medicaid Contact State Medicaid
Chiropractic services Contact State Medicaid Contact State Medicaid
Apnea monitors Contact State Medicaid Contact State Medicaid